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Renouf D, Wong MMY. From Prophecy to Plate: How to Actualize a Planetary Menu for Kidney Disease Nutrition. Can J Kidney Health Dis 2024; 11:20543581241244965. [PMID: 38712334 PMCID: PMC11072064 DOI: 10.1177/20543581241244965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 03/12/2024] [Indexed: 05/08/2024] Open
Affiliation(s)
- Dani Renouf
- Providence Health Care, Vancouver, BC, Canada
- BC Renal, Vancouver, Canada
| | - Michelle M. Y. Wong
- BC Renal, Vancouver, Canada
- Division of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, Canada
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2
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Mielke N, Barghouth MH, Fietz AK, Villain C, Bothe T, Ebert N, Schaeffner E. Effect modification of polypharmacy on incident frailty by chronic kidney disease in older adults. BMC Geriatr 2024; 24:335. [PMID: 38609867 PMCID: PMC11015642 DOI: 10.1186/s12877-024-04887-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/12/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Frailty and polypharmacy are common conditions in older adults, especially in those with chronic kidney disease (CKD). Therefore, we analyzed the association of polypharmacy and incident frailty and the effect modification by CKD in very old adults. METHODS In non-frail individuals within the Berlin Initiative (cohort) Study, polypharmacy (≥ 5 medications) was assessed according to multiple definitions based on the number of regular and on demand prescription and over the counter drugs, as well as vitamins and supplements. CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73m2 and/or an albumin-creatinine ratio ≥ 30 mg/g. Incident frailty was assessed at follow-up using Fried criteria. Logistic regression was applied to assess (1) the association of different polypharmacy definitions with incident frailty and (2) effect modification by CKD. RESULTS In this cohort study, out of 757 non-frail participants (mean age 82.9 years, 52% female, 74% CKD), 298 (39%) participants reported polypharmacy. Over the observation period of 2.1 years, 105 became frail. Individuals with polypharmacy had 1.96 adjusted odds (95% confidence interval (CI): 1.20-3.19) of becoming frail compared to participants without polypharmacy. The effect of polypharmacy on incident frailty was modified by CKD on the additive scale (relative excess risk due to interaction: 1.56; 95% CI 0.01-3.12). CONCLUSIONS This study demonstrates an association of polypharmacy and incident frailty and suggests strong evidence for an effect modification of CKD on polypharmacy and incident frailty. Revision of prescriptions could be a target strategy to prevent frailty occurrence, especially in older adults with CKD.
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Affiliation(s)
- Nina Mielke
- Institute of Public Health, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Muhammad Helmi Barghouth
- Institute of Public Health, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Anne-Katrin Fietz
- Institute of Public Health, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Cédric Villain
- Institute of Public Health, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Service de Gériatrie, Normandie Univ UNICAEN, INSERM U1075 COMETE, CHU de Caen, Caen, France
| | - Tim Bothe
- Institute of Public Health, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Natalie Ebert
- Institute of Public Health, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Elke Schaeffner
- Institute of Public Health, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Manis MM, Skelley JW, Read JB, Maxson R, O'Hagan E, Wallace JL, Siew ED, Barreto EF, Silver SA, Kane-Gill SL, Neyra JA. Role of a Pharmacist in Postdischarge Care for Patients With Kidney Disease: A Scoping Review. Ann Pharmacother 2024:10600280241240409. [PMID: 38563565 DOI: 10.1177/10600280241240409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE The objective was to explore and describe the role of pharmacists in providing postdischarge care to patients with kidney disease. DATA SOURCES PubMed, Embase (Elsevier), CINAHL (Ebscohost), Web of Science Core Collection, and Scopus were searched on January 30, 2023. Publication date limits were not included. Search terms were identified based on 3 concepts: kidney disease, pharmacy services, and patient discharge. Experimental, quasi-experimental, observational, and qualitative studies, or study protocols, describing the pharmacist's role in providing postdischarge care for patients with kidney disease, excluding kidney transplant recipients, were eligible. STUDY SELECTION AND DATA EXTRACTION Six unique interventions were described in 10 studies meeting inclusion criteria. DATA SYNTHESIS Four interventions targeted patients with acute kidney injury (AKI) during hospitalization and 2 evaluated patients with pre-existing chronic kidney disease. Pharmacists were a multidisciplinary care team (MDCT) member in 5 interventions and were the sole provider in 1. Roles commonly identified include medication review, medication reconciliation, medication action plan formation, kidney function assessment, drug dose adjustments, and disease education. Some studies showed improvements in diagnostic coding, laboratory monitoring, medication therapy problem (MTP) resolution, and patient education; prevention of hospital readmission was inconsistent. Limitations include lack of standardized reporting of kidney disease, transitions of care processes, and differences in outcomes evaluated. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE This review identifies potential roles of a pharmacist as part of a postdischarge MDCT for patients with varying degrees of kidney disease. CONCLUSIONS The pharmacist's role in providing postdischarge care to patients with kidney disease is inconsistent. Multidisciplinary care teams including a pharmacist provided consistent identification and resolution of MTPs, improved patient education, and increased self-awareness of diagnosis.
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Affiliation(s)
- Melanie M Manis
- Department of Pharmacy Practice, McWhorter School of Pharmacy, Samford University, Birmingham, AL, USA
- Division of Nephrology, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jessica W Skelley
- Department of Pharmacy Practice, McWhorter School of Pharmacy, Samford University, Birmingham, AL, USA
| | - J Braden Read
- Department of Pharmacy Practice, McWhorter School of Pharmacy, Samford University, Birmingham, AL, USA
| | - Rebecca Maxson
- Department of Pharmacy Practice, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
| | - Emma O'Hagan
- Department of Libraries, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jessica L Wallace
- Department of Pharmacy Practice, College of Pharmacy, Lipscomb University, Nashville, TN, USA
- Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Edward D Siew
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
- Tennessee Valley Health Systems (TVHS), Nashville Veterans Affairs Medical Center, Nashville, TN, USA
| | | | - Samuel A Silver
- Division of Nephrology, Kingston Health Sciences Center, Queen's University, Kingston, ON, Canada
| | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Javier A Neyra
- Division of Nephrology, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
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Ikenouchi K, Takahashi D, Mandai S, Watada M, Koyama S, Hoshino M, Takahashi N, Shoda W, Kuyama T, Mori Y, Ando F, Susa K, Mori T, Iimori S, Naito S, Sohara E, Fushimi K, Uchida S. Impact of COVID-19 versus other pneumonia on in-hospital mortality and functional decline among Japanese dialysis patients: a retrospective cohort study. Sci Rep 2024; 14:5177. [PMID: 38431709 PMCID: PMC10908858 DOI: 10.1038/s41598-024-55697-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/27/2024] [Indexed: 03/05/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) affects both life and health. However, the differentiation from other types of pneumonia and effect of kidney disease remains uncertain. This retrospective observational study investigated the risk of in-hospital death and functional decline in ≥ 20% of Barthel Index scores after COVID-19 compared to other forms of pneumonia among Japanese adults, both with and without end-stage kidney disease (ESKD). The study enrolled 123,378 patients aged 18 years and older from a national inpatient administrative claims database in Japan that covers the first three waves of the COVID-19 pandemic in 2020. After a 1:1:1:1 propensity score matching into non-COVID-19/non-dialysis, COVID-19/non-dialysis, non-COVID-19/dialysis, and COVID-19/dialysis groups, 2136 adults were included in the analyses. The multivariable logistic regression analyses revealed greater odds ratios (ORs) of death [5.92 (95% CI 3.62-9.96)] and functional decline [1.93 (95% CI 1.26-2.99)] only in the COVID-19/dialysis group versus the non-COVID-19/non-dialysis group. The COVID-19/dialysis group had a higher risk of death directly due to pneumonia (OR 6.02, 95% CI 3.50-10.8) or death due to other diseases (OR 3.00, 95% CI 1.11-8.48; versus the non-COVID-19/non-dialysis group). COVID-19 displayed a greater impact on physical function than other types of pneumonia particularly in ESKD.
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Affiliation(s)
- Ken Ikenouchi
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8519, Japan
- Department of Nephrology, Musashino Red Cross Hospital, 1-26-1, Kyonann-cho, Musashino-shi, Tokyo, 180-8610, Japan
| | - Daiei Takahashi
- Department of Nephrology, Musashino Red Cross Hospital, 1-26-1, Kyonann-cho, Musashino-shi, Tokyo, 180-8610, Japan
| | - Shintaro Mandai
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8519, Japan.
| | - Mizuki Watada
- Department of Nephrology, Musashino Red Cross Hospital, 1-26-1, Kyonann-cho, Musashino-shi, Tokyo, 180-8610, Japan
| | - Sayumi Koyama
- Department of Nephrology, Musashino Red Cross Hospital, 1-26-1, Kyonann-cho, Musashino-shi, Tokyo, 180-8610, Japan
| | - Motoki Hoshino
- Department of Nephrology, Musashino Red Cross Hospital, 1-26-1, Kyonann-cho, Musashino-shi, Tokyo, 180-8610, Japan
| | - Naohiro Takahashi
- Department of Nephrology, Musashino Red Cross Hospital, 1-26-1, Kyonann-cho, Musashino-shi, Tokyo, 180-8610, Japan
| | - Wakana Shoda
- Department of Nephrology, Musashino Red Cross Hospital, 1-26-1, Kyonann-cho, Musashino-shi, Tokyo, 180-8610, Japan
| | - Tamaki Kuyama
- Department of Nephrology, Musashino Red Cross Hospital, 1-26-1, Kyonann-cho, Musashino-shi, Tokyo, 180-8610, Japan
| | - Yutaro Mori
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8519, Japan
| | - Fumiaki Ando
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8519, Japan
| | - Koichiro Susa
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8519, Japan
| | - Takayasu Mori
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8519, Japan
| | - Soichiro Iimori
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8519, Japan
| | - Shotaro Naito
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8519, Japan
| | - Eisei Sohara
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8519, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8519, Japan
| | - Shinichi Uchida
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8519, Japan.
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Okubo R, Kondo M, Imasawa T, Saito C, Kai H, Tsunoda R, Hoshino J, Watanabe T, Narita I, Matsuo S, Makino H, Hishida A, Yamagata K. Health-related Quality of Life in 10 years Long-term Survivors of Chronic Kidney Disease: A From-J Study. J Ren Nutr 2024; 34:161-169. [PMID: 37832838 DOI: 10.1053/j.jrn.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/06/2023] [Accepted: 10/01/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVE The Chronic Kidney Disease (CKD) practice facilitation program in the Frontier of Renal Outcome Modifications in Japan study reduced cardiovascular disease (CVD) events in patients with CKD. 10-year long-term survivors with CKD lived with serious complications, including end-stage kidney disease and CVD. This study aimed to measure health-related quality of life in 10-year long-term CKD survivors and examine the predictors and determinants of clinical indices for measured quality of life (QOL) scores. METHODS The EQ-5D-5L, a generic preference-based instrument, was administered to 1,473 CKD survivors enrolled in the Frontier of Renal Outcome Modifications in JapanFrontier of Renal Outcome Modifications in JapanFrontier of Renal Outcome Modifications in Japan study. The 10th-year data collection was performed by either primary care physicians or participants who filled out questionnaires from October 2018 to March 31, 2019. RESULTS The response rate was 38.2% (423/1,473). The mean QOL score was 0.893 (95% confidence interval (CI), 0.880-0.906), and the median QOL score was 1.000 (interquartile range (IQR), 0.826-1.000). The mean QOL score in participants with renal replacement therapy was 0.824 (95% CI, 0.767-0.881), and the median was 0.828 (IQR, 0.755-1.000). The mean QOL score in participants with CVD was 0.877 (95% CI, 0.811-0.943), and the median was 1.000 (IQR, 0.723-1.000). The mean QOL score in participants with 50% decline in estimated glomerular filtration was 0.893 (95% CI, 0.860-0.926), and the median was 0.889 (IQR, 0.825-1.000). The decrease in QOL scores with baseline CKD stages was significant according to the Jonckheere-Terpstra test for trend (P = .002). Baseline age, systolic blood pressure, and history of hyperuricemia were significant predictors of 10th-year QOL scores. CONCLUSION We suggest that CKD complications negatively affect the QOL scores in 10-year long-term survivors with CKD. CKD guideline-based practices, prevention of end-stage kidney disease/CVD and management of hypertension, diabetes and hyperuricemia, might contribute to future health-related quality of life in patients with CKD.
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Affiliation(s)
- Reiko Okubo
- Department of Health Care Policy and Health Economics, Institute of Medicine, University of Tsukuba, Ibaraki, Japan; Department of Clinical Laboratory Medicine, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan; Department of Nephrology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masahide Kondo
- Department of Health Care Policy and Health Economics, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Toshiyuki Imasawa
- Department of Nephrology, National Hospital Organization Chibahigashi National Hospital, Chuo-ku Chiba City, Chiba, Japan
| | - Chie Saito
- Department of Nephrology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hirayasu Kai
- Department of Nephrology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Ryoya Tsunoda
- Department of Nephrology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Junichi Hoshino
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Science, Niigata, Niigata, Japan
| | | | | | | | - Kunihiro Yamagata
- Department of Nephrology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
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Erdemli Z, Gul M, Kayhan E, Gokturk N, Bag HG, Erdemli ME. High-fat and carbohydrate diet caused chronic kidney damage by disrupting kidney function, caspase-3, oxidative stress and inflammation. Prostaglandins Other Lipid Mediat 2024; 172:106822. [PMID: 38395139 DOI: 10.1016/j.prostaglandins.2024.106822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/10/2024] [Accepted: 02/19/2024] [Indexed: 02/25/2024]
Abstract
The study aimed to compare the effects of a diet rich in fat, carbohydrates and protein on rat kidneys. The study was conducted on 40 Wistar albino rats bred at İnönü University Faculty of Medicine after the approval of the ethics committee. Rats were randomly divided into 4 groups: Control group, and the groups where the animals were fed with high carbohydrate, fat and protein rich feed. After the applications, the rat kidney tissues were removed by laparoscopy under anesthesia and blood samples were collected. 13 weeks long fat-rich and carbohydrate feed application had negative effects on oxidant-antioxidant balance, oxidative stress index, inflammation markers, kidney functions tests, histopathology and immunohistochemistry caspase-3 findings in rat kidney tissues, especially in the carbohydrate group when compared to the controls. Protein-rich feed, there were no significant difference in biochemical and histopathology compared to the control group. Fat and carbohydrate rich feed led to an increase in oxidative stress in rat kidney tissues. Oxidative stress led to nephrotoxicity, which in turn led to chronic kidney tissue damages. A more balanced and protein-rich diet instead of excessive sugar and fatty food intake could be suggested to prevent chronic kidney damage.
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Affiliation(s)
- Zeynep Erdemli
- Department of Medical Biochemistry, Medical Faculty, Inonu University, Malatya, Turkey
| | - Mehmet Gul
- Department of Histology and Embryology, Medical Faculty, Inonu University, Malatya, Turkey
| | - Elif Kayhan
- Department of Histology and Embryology, Medical Faculty, Turgut Ozal University, Malatya, Turkey
| | - Nurcan Gokturk
- Department of Medical Biochemistry, Medical Faculty, Inonu University, Malatya, Turkey
| | - Harika Gozukara Bag
- Department of Biostatistics, Medical Faculty, Inonu University, Malatya, Turkey
| | - Mehmet Erman Erdemli
- Department of Medical Biochemistry, Medical Faculty, Inonu University, Malatya, Turkey.
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Bothe T, Fietz AK, Schaeffner E, Douros A, Pöhlmann A, Mielke N, Villain C, Barghouth MH, Wenning V, Ebert N. Diagnostic Validity of Chronic Kidney Disease in Health Claims Data Over Time: Results from a Cohort of Community-Dwelling Older Adults in Germany. Clin Epidemiol 2024; 16:143-154. [PMID: 38410416 PMCID: PMC10895982 DOI: 10.2147/clep.s438096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/15/2023] [Indexed: 02/28/2024] Open
Abstract
Purpose The validity of ICD-10 diagnostic codes for chronic kidney disease (CKD) in health claims data has not been sufficiently studied in the general population and over time. Patients and Methods We used data from the Berlin Initiative Study (BIS), a prospective longitudinal cohort of community-dwelling individuals aged ≥70 years in Berlin, Germany. With estimated glomerular filtration rate (eGFR) as reference, we assessed the diagnostic validity (sensitivity, specificity, positive [PPV], and negative predictive values [NPV]) of different claims-based ICD-10 codes for CKD stages G3-5 (eGFR <60mL/min/1.73m²: ICD-10 N18.x-N19), G3 (eGFR 30-<60mL/min/1.73m²: N18.3), and G4-5 (eGFR <30mL/min/1.73m²: N18.4-5). We analysed trends over five study visits (2009-2019). Results We included data of 2068 participants at baseline (2009-2011) and 870 at follow-up 4 (2018-2019), of whom 784 (38.9%) and 440 (50.6%) had CKD G3-5, respectively. At baseline, sensitivity for CKD in claims data ranged from 0.25 (95%-confidence interval [CI] 0.22-0.28) to 0.51 (95%-CI 0.48-0.55) for G3-5, depending on the included ICD-10 codes, 0.20 (95%-CI 0.18-0.24) for G3, and 0.36 (95%-CI 0.25-0.49) for G4-5. Over the course of 10 years, sensitivity increased by 0.17 to 0.29 in all groups. Specificity, PPVs, and NPVs remained mostly stable over time and ranged from 0.82-0.99, 0.47-0.89, and 0.66-0.98 across all study visits, respectively. Conclusion German claims data showed overall agreeable performance in identifying older adults with CKD, while differentiation between stages was limited. Our results suggest increasing sensitivity over time possibly attributable to improved CKD diagnosis and awareness.
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Affiliation(s)
- Tim Bothe
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anne-Katrin Fietz
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Elke Schaeffner
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Antonios Douros
- Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Anna Pöhlmann
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nina Mielke
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Cédric Villain
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Normandie Univ UNICAEN, INSERM U1075 COMETE, service de Gériatrie, CHU de Caen, Caen, France
| | | | | | - Natalie Ebert
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Shi Y, Pu S, Peng H, Luo Y. Development and validation of the patient-reported outcome scale for chronic kidney disease. Int Urol Nephrol 2024; 56:653-665. [PMID: 37452989 PMCID: PMC10808283 DOI: 10.1007/s11255-023-03702-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The patient-reported outcomes (PROs) measuring patient's experience and perception of disease are important components of approach to care. However, no tools are available to assess the PROs of chronic kidney disease (CKD). This study aims to develop and verify a PROs scale to evaluate clinical outcomes in CKD patients. METHODS The theoretical structure model and original item pool were formed through a literature review, patient interviews and references to relevant scales. The Delphi method, classical test theory methods and item response theory method were used to select items and adjust dimensions to form the final scale. Altogether 360 CKD patients were recruited through convenience sampling. CKD-PROs could be evaluated from four aspects, namely reliability, content validity, construct validity, responsibility, and feasibility. RESULTS The CKD-PROs scale covers 4 domains, including the physiological, psychological, social, and therapeutic domain, and 12 dimensions, 54 items. The Cronbach's α is 0.939, the split reliability coefficient is 0.945, and the correlation of the scores each item and domain's coefficients range from 0.413 to 0.669. The results of structure validity, content validity and reactivity showed that the multidimensional measurement of the scale met professional expectations. The recovery rate and effective rate of the scale were over 99%. CONCLUSION The CKD-PROs scale has great reliability, validity, reactivity, acceptability and is capable of being used as one of the evaluation tools for the clinical outcomes of CKD patients.
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Affiliation(s)
- Yu Shi
- School of Nursing, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, People's Republic of China
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Shi Pu
- School of Nursing, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, People's Republic of China
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Hongmei Peng
- School of Nursing, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, People's Republic of China
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Yu Luo
- School of Nursing, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, People's Republic of China.
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Schwarz A, Hernandez L, Arefin S, Sartirana E, Witasp A, Wernerson A, Stenvinkel P, Kublickiene K. Sweet, bloody consumption - what we eat and how it affects vascular ageing, the BBB and kidney health in CKD. Gut Microbes 2024; 16:2341449. [PMID: 38686499 PMCID: PMC11062370 DOI: 10.1080/19490976.2024.2341449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 04/04/2024] [Indexed: 05/02/2024] Open
Abstract
In today's industrialized society food consumption has changed immensely toward heightened red meat intake and use of artificial sweeteners instead of grains and vegetables or sugar, respectively. These dietary changes affect public health in general through an increased incidence of metabolic diseases like diabetes and obesity, with a further elevated risk for cardiorenal complications. Research shows that high red meat intake and artificial sweeteners ingestion can alter the microbial composition and further intestinal wall barrier permeability allowing increased transmission of uremic toxins like p-cresyl sulfate, indoxyl sulfate, trimethylamine n-oxide and phenylacetylglutamine into the blood stream causing an array of pathophysiological effects especially as a strain on the kidneys, since they are responsible for clearing out the toxins. In this review, we address how the burden of the Western diet affects the gut microbiome in altering the microbial composition and increasing the gut permeability for uremic toxins and the detrimental effects thereof on early vascular aging, the kidney per se and the blood-brain barrier, in addition to the potential implications for dietary changes/interventions to preserve the health issues related to chronic diseases in future.
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Affiliation(s)
- Angelina Schwarz
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Leah Hernandez
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Samsul Arefin
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Elisa Sartirana
- Department of Translational Medicine, Nephrology and Kidney Transplantation Unit, University of Piemonte Orientale, Novara, Italy
| | - Anna Witasp
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Annika Wernerson
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Peter Stenvinkel
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Renal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Karolina Kublickiene
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
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10
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Zhang S, Zhang GB, Huang P, Ren Y, Lin B, Shao YF, Ye XL. Drug-related problems in hospitalized patients with chronic kidney diseases and clinical pharmacist interventions. BMC Geriatr 2023; 23:849. [PMID: 38093184 PMCID: PMC10717358 DOI: 10.1186/s12877-023-04557-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) are at high risk of drug-related problems (DRPs) because of extensive comorbidities and pharmacokinetic changes. This study aimed to identify DRPs and possible contributing factors in hospitalized patients with CKD, and evaluate the efficacy of the clinical pharmacist services in detection and intervention of DRPs in a large general hospital in Zhejiang Province, eastern China. METHODS With the approval of the Ethics Committee, patients with CKD admitted to the nephrology ward from January to December 2020 were enrolled in this prospective study. The clinical pharmacist identified and intervened the DRPs during hospitalization. The DRPs were classified using the Pharmaceutical Care Network Europe (PCNE) DRP classification system, and all data were statistically analyzed using Statistical Package for Social Science (SPSS) version 26.0. RESULTS A total of 914 patients with CKD were included, with 463 DRPs observed among 420 (45.95%) participants; the average DRP per patient was 0.51 (standard deviation [SD], 0.60) before pharmacist intervention. Treatment safety accounted for the highest proportion of problems (43.84%), followed by treatment efficacy, accounting for 43.20%. Drug selection was the most common cause of DRPs (60.26%), and antibiotics and cardiovascular agents were the most common drugs associated with DRPs (32.84% and 28.66%, respectively). A total of 85.53% of pharmaceutical intervention recommendations were followed, and 84.23% of DRPs were completely resolved after intervention by the clinical pharmacist. The proportion of patients who experienced DRPs decreased to 7.77%, with an average of 0.08 (SD 0.28) DRPs during hospitalization after pharmacist's intervention. Significant contributing factors for DRPs were CKD stage 4, number of comorbid diseases, number of prescribed medications, and hospitalization days in both the univariate and multivariate logistic regression models. CONCLUSION DRPs are common among hospitalized patients with CKD in China. CKD stage 4, the number of comorbidities, use of multiple prescription drugs, and extended length of hospital stay are contributing factors for DRPs. Even only one clinical nephrology pharmacist in the nephrology ward, clinical pharmacist can play an important role in facilitating the identification of DRPs in patients with CKD and assisting physicians resolve DRPs in this single center study in China.
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Affiliation(s)
- Su Zhang
- Center for Clinical Pharmacy, Cancer Center, Department of Pharmacy, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Guo-Bing Zhang
- Center for Clinical Pharmacy, Cancer Center, Department of Pharmacy, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Ping Huang
- Center for Clinical Pharmacy, Cancer Center, Department of Pharmacy, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yan Ren
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Bo Lin
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yan-Fei Shao
- Center for Clinical Pharmacy, Cancer Center, Department of Pharmacy, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xiao-Lan Ye
- Center for Clinical Pharmacy, Cancer Center, Department of Pharmacy, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
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11
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Frandsen CE, Dieperink H, Trettin B, Agerskov H. A life-changing process when living with chronic kidney disease: A qualitative study. J Ren Care 2023. [PMID: 37792275 DOI: 10.1111/jorc.12481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/17/2023] [Accepted: 09/19/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Patients with chronic kidney disease and their family members experience a number of lifestyle changes caused by the illness. The value of advance care planning includes understanding health status and options for future care, communication between close family members, and identification of wishes and preferences for care and treatment in relation to family and everyday life. OBJECTIVE Explore how patients with chronic kidney disease and their families experience everyday life and how they experience having to make choices about treatment. DESIGN An explorative study using a qualitative method with a phenomenological-hermeneutic approach. PARTICIPANTS Twelve patients with chronic kidney disease without kidney replacement therapy who were considering their treatment options and eight family members. APPROACH Individual semistructured interviews with a narrative approach were conducted between August 2021 and March 2022. The data were analysed using Ricoeur's interpretation theory on three levels: naïve reading, structural analysis and critical interpretation and discussion. FINDINGS One main theme was generated: Family dynamics in a life-changing process. From this, three subthemes were derived: Living in an ordinary life placed in a waiting position, The dilemma of readiness to share and Feelings of being left alone. CONCLUSION There are changes in family roles and in identity and a desire to maintain the known and ordinary life. Living with chronic kidney disease as a part of daily life is managed differently in the family, which can lead to feelings such as sadness, frustration and loss of shared life and resilience.
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Affiliation(s)
- Christina E Frandsen
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Family Focused Healthcare Research Center (FaCe), University of Southern Denmark, Odense, Denmark
- OPEN, Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Hans Dieperink
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bettina Trettin
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - Hanne Agerskov
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Family Focused Healthcare Research Center (FaCe), University of Southern Denmark, Odense, Denmark
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12
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Cardol CK, Meuleman Y, van Middendorp H, van der Boog PJ, Hilbrands LB, Navis G, Sijpkens YW, Sont JK, Evers AW, van Dijk S. Psychological Distress and Self-Management in CKD: A Cross-Sectional Study. Kidney Med 2023; 5:100712. [PMID: 37753249 PMCID: PMC10518713 DOI: 10.1016/j.xkme.2023.100712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023] Open
Abstract
Rationale & Objective Patients with chronic kidney disease (CKD) not receiving dialysis, including kidney transplant recipients, often experience difficulties regarding self-management. An important barrier for adherence to self-management recommendations may be the presence of psychological distress, consisting of depressive and anxiety symptoms. We investigated relationships between psychological distress and adherence to self-management recommendations. Study Design Cross-sectional online questionnaire data as part of the E-GOAL study. Setting & Participants Patients with CKD (estimated glomerular filtration rate, 20-89 mL/min/1.73 m2) were recruited from April 2018 to October 2020 at 4 hospitals in The Netherlands and completed online screening questionnaires. Exposures Psychological distress, depressive symptoms, and anxiety symptoms. Outcomes Dietary adherence, physical activity, medication adherence, smoking, body mass index, and a CKD self-management index (ie, the sum of 5 binary indicators of nonadherence to the recommended self-management factors). Analytical Approach Adjusted multivariable regression and ordinal logistic regression analyses. Results In our sample (N = 460), 27.2% of patients reported psychological distress, and 69.8% were nonadherent to 1 or more recommendations. Higher psychological distress was significantly associated with poorer dietary adherence (βadj, -0.13; 95% CI, -0.23 to -0.04), less physical activity (βadj, -0.13; 95% CI, -0.22 to -0.03), and lower medication adherence (βadj, -0.15; 95% CI, -0.24 to -0.05), but not with smoking and body mass index. Findings were similar for depressive symptoms, whereas anxiety was only associated with poorer dietary and medication adherence. Every 1-point higher psychological distress was also associated with a higher likelihood of being nonadherent to an accumulating number of different recommendations (adjusted OR, 1.04; 95% CI, 1.02-1.07). Limitations Cross-sectional design, possible residual confounding, and self-report. Conclusions Many people with CKD experience psychological distress, of whom most have difficulties self-managing their CKD. Given the relationship between psychological distress and adherence to CKD self-management recommendations, behavioral interventions are needed to identify and treat psychological distress as a potential barrier to CKD self-management. Plain-Language Summary This online questionnaire study investigated relationships between psychological distress and self-management among 460 people with chronic kidney disease. Over a quarter of them reported mild-to-severe psychological distress. Alarmingly, 4 out of 5 patients with psychological distress were also nonadherent to 1 or more self-management recommendations, and higher levels of psychological distress were associated with poorer dietary and medication adherence and lower physical activity. Moreover, patients who suffered from moderate-to-severe distress were relatively more often nonadherent to 3 or more recommendations compared with patients with no or mild distress symptoms. So, it seems that psychological distress can be a barrier for self-management. To support patients in managing chronic kidney disease, researchers and health professionals should not overlook patients' mental health.
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Affiliation(s)
- Cinderella K. Cardol
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Luuk B. Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gerjan Navis
- Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| | - Yvo W.J. Sijpkens
- Department of Internal Medicine, Haaglanden Medical Center Bronovo, The Hague, The Netherlands
| | - Jacob K. Sont
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrea W.M. Evers
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Medical Delta, Leiden University, TU Delft, and Erasmus University Rotterdam, The Netherlands
| | - Sandra van Dijk
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Medical Delta, Leiden University, TU Delft, and Erasmus University Rotterdam, The Netherlands
| | - E-GOAL Study Group
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
- Department of Internal Medicine, Haaglanden Medical Center Bronovo, The Hague, The Netherlands
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
- Medical Delta, Leiden University, TU Delft, and Erasmus University Rotterdam, The Netherlands
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13
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Lin MY, Chiu YW, Lin YH, Kang Y, Wu PH, Chen JH, Luh H, Hwang SJ. Kidney Health and Care: Current Status, Challenges, and Developments. J Pers Med 2023; 13:jpm13050702. [PMID: 37240872 DOI: 10.3390/jpm13050702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
The concept of chronic kidney disease (CKD) originated in the 2000s, and an estimated 850 million patients are currently suffering from health threats from different degrees of CKD. However, it is unclear whether the existing CKD care systems are optimal for improving patient prognosis and outcomes, so this review summarizes the burden, existing care models, effectiveness, challenges, and developments of CKD care. Even under the general care principles, there are still significant gaps in our understanding of the causes of CKD, prevention or care resources, and care burdens between countries worldwide. Receiving care from multidisciplinary teams rather than only a nephrologist shows potential profits in comprehensive and preferable outcomes. In addition, we propose a novel CKD care structure that combines modern technologies, biosensors, longitudinal data visualization, machine learning algorithms, and mobile care. The novel care structure could simultaneously change the care process, significantly reduce human contact, and make the vulnerable population less likely to be exposed to infectious diseases such as COVID-19. The information offered should be beneficial, allowing us to rethink future CKD care models and applications to reach the goals of health equality and sustainability.
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Affiliation(s)
- Ming-Yen Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yi-Wen Chiu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yu-Hsuan Lin
- Taiwan Instrument Research Institute, National Applied Research Laboratories, Hsinchu 300, Taiwan
| | - Yihuang Kang
- Department of Information and Management, National Sun Yat-Sen University, Kaohsiung 804, Taiwan
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Ping-Hsun Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Jeng-Huei Chen
- Department of Mathematical Sciences, National Chengchi University, Taipei 116, Taiwan
| | - Hsing Luh
- Department of Mathematical Sciences, National Chengchi University, Taipei 116, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan Town, Miaoli County 350, Taiwan
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14
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Yu F, He G, Hao WK, Hu W. The Long-Term Survival Outcome in Older Patients with Different Pathological Types of Chronic Kidney Disease. Kidney Blood Press Res 2023; 48:338-346. [PMID: 37040725 PMCID: PMC10308525 DOI: 10.1159/000530507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/24/2023] [Indexed: 04/13/2023] Open
Abstract
INTRODUCTION Chronic kidney diseases (CKDs) are prevalent in older people, and renal pathological manifestations are important for diagnosis, treatment, and prognosis. However, the long-term survival outcome and risk factors for older CKD patients with different pathological types are not fully understood and need to be further investigated. METHODS Medical data were recorded and all-cause mortality was followed up in patients who underwent renal biopsy diagnosed in Guangdong Provincial People's Hospital from 2005 to 2015. Kaplan-Meier analysis was used to identify the incidence of survival outcomes. Multivariate Cox regression models and nomograms were applied to analyze pathological types and other factors for overall survival outcomes. RESULTS 368 cases were included and the median follow-up was 85 (46.5, 111) months. Overall mortality was 35.6%. The highest mortality was in the mesangioproliferative glomerulonephritis (MPGN) group (88.9%), followed by amyloidosis (AMY) group (84.6%), and the lowest mortality was in the minimal change disease (MCD) group (21.9%). Moreover, multivariate Cox regression model showed that survival times of MPGN {hazard ratio (HR) = 8.215 (95% confidence interval [CI]: 2.735-24.674), p < 0.001} and AMY (HR = 6.130 [95% CI: 2.219-16.94], p < 0.001) were significantly shorter than MCD. In addition, age, lower baseline estimated glomerular filtration rate (eGFR), history of chronic obstructive pulmonary disease (COPD) and cerebrovascular accidents (CVA)/transient ischemic attack (TIA), MPGN, and AMY were independent risk factors for the mortality of older patients with CKD. CONCLUSION The long-term survival outcome of older CKD patients showed differences among different pathological types, and MPGN, AMY, age, baseline eGFR, CVA/TIA, and COPD were independent predictors for mortality.
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Affiliation(s)
- Feng Yu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Ganyuan He
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Wen-Ke Hao
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Wenxue Hu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China
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15
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Alsalemi N, Lafrance JP, Sadowski CA. Older age, kidney concordant diseases and the dilemma of adherence to guidelines: A narrative review. Res Social Adm Pharm 2023; 19:1018-1024. [PMID: 37055315 DOI: 10.1016/j.sapharm.2023.04.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/15/2023] [Accepted: 04/04/2023] [Indexed: 04/15/2023]
Abstract
Evidence-based medicine is pivotal to contemporary clinical practice, and the excellence of a healthcare institution is measured by the adherence of its clinical staff to the clinical practice guidelines (CPGs) among other standards and policies. Following the recommendations of CPGs in older adults poses different challenges to prescribers. In this narrative review we explore research studies that assessed clinicians' adherence to CPGs when prescribing to older adults with chronic kidney disease and its concordant disorders, and to discuss the potential barriers and facilitators to better adherence to CPGs. Our review of the literature found that the adherence level to CPGs differed according to country, disease condition and healthcare setting. Clinicians' attitudes toward older adults and the CPGs, the unfamiliarity with the CPGs, and the lack of time, were commonly cited barriers. Interventions suggested to improve adherence to CPGs include direct mentoring, educational activities, and the integration of CPGs recommendations within hospital protocols and policies.
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Affiliation(s)
- Noor Alsalemi
- Département de pharmacologie et physiologie, Université de Montréal, Montréal, QC, Canada; Centre de Recherche de l'Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada
| | - Jean-Philippe Lafrance
- Département de pharmacologie et physiologie, Université de Montréal, Montréal, QC, Canada; Centre de Recherche de l'Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada; Service de néphrologie, CIUSSS de l'Est-de-l'Île-de-Montréal, Montréal, QC, Canada
| | - Cheryl A Sadowski
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada.
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Liu CK, Miao S, Giffuni J, Katzel LI, Fielding RA, Seliger SL, Weiner DE. Geriatric Syndromes and Health-Related Quality of Life in Older Adults with Chronic Kidney Disease. Kidney360 2023; 4:e457-e465. [PMID: 36790849 PMCID: PMC10278840 DOI: 10.34067/kid.0000000000000078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/23/2023] [Indexed: 02/16/2023]
Abstract
Key Points In older adults with CKD, geriatric syndromes are common and are associated with reduced quality of life. Addressing geriatric syndromes could potentially improve quality of life for older adults with CKD. Background Geriatric syndromes, which are multifactorial conditions common in older adults, predict health-related quality of life (HRQOL). Although CKD is associated with lower HRQOL, whether geriatric syndromes contribute to HRQOL in CKD is unknown. Our objective was to compare associations of geriatric syndromes and medical conditions with HRQOL in older adults with CKD. Methods This was a secondary analysis of a parallel-group randomized controlled clinical trial evaluating a 12-month exercise intervention in persons 55 years or older with CKD stage 3b–4. Participants were assessed for baseline geriatric syndromes (cognitive impairment, poor appetite, dizziness, fatigue, and chronic pain) and medical conditions (diabetes, hypertension, coronary artery disease, cancer, or chronic obstructive pulmonary disease). Participants' HRQOL was assessed with the Short Form Health Survey-36 (SF-36), EuroQol 5-Dimensions 5-Level, and the EuroQol Visual Analogue Scale. We examined the cross-sectional and longitudinal associations of geriatric syndromes and medical conditions with HRQOL using multiple linear regression. Results Among 99 participants, the mean age was 68.0 years, 25% were female, and 62% were Black. Participants had a baseline mean of 2.0 geriatric syndromes and 2.1 medical conditions; 49% had ≥ two geriatric syndromes and ≥ two medical conditions concurrently. Sixty-seven (68%) participants underwent 12-month assessments. In models using geriatric syndromes and medical conditions as concurrent exposures, the number of geriatric syndromes was cross-sectionally associated with SF-36 scores for general health (β =−0.385) and role limitations because of physical health (β =−0.374) and physical functioning (β =−0.300, all P <0.05). The number of medical conditions was only associated with SF-36 score for role limitations because of physical health (β =−0.205). Conclusions In older adults with CKD stage 3b–4, geriatric syndromes are common and are associated with lower HRQOL. Addressing geriatric conditions is a potential approach to improve HRQOL for older adults with CKD. Clinical Trial registry name and registration number: NCT01462097 ; Registration Date–October 26, 2011.
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Affiliation(s)
- Christine K. Liu
- Section of Geriatric Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
- Geriatric Research and Education Clinical Center, Veteran Affairs Palo Alto Health Care System, Palo Alto, California
- Nutrition Exercise Physiology and Sarcopenia Team, Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Shiyuan Miao
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Jamie Giffuni
- Geriatric Research Education and Clinical Center, Veterans Affairs Maryland Healthcare System, Baltimore, Maryland
| | - Leslie I. Katzel
- Geriatric Research Education and Clinical Center, Veterans Affairs Maryland Healthcare System, Baltimore, Maryland
- Division of Gerontology, Geriatrics, and Palliative Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Roger A. Fielding
- Nutrition Exercise Physiology and Sarcopenia Team, Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Stephen L. Seliger
- Geriatric Research Education and Clinical Center, Veterans Affairs Maryland Healthcare System, Baltimore, Maryland
- Division of Nephrology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Daniel E. Weiner
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
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17
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Mansour O, Paik JM, Wyss R, Mastrorilli JM, Bessette LG, Lu Z, Tsacogianis T, Lin KJ. A Novel Chronic Kidney Disease Phenotyping Algorithm Using Combined Electronic Health Record and Claims Data. Clin Epidemiol 2023; 15:299-307. [PMID: 36919110 PMCID: PMC10008306 DOI: 10.2147/clep.s397020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/16/2023] [Indexed: 03/10/2023] Open
Abstract
Purpose Because chronic kidney disease (CKD) is often under-coded as a diagnosis in claims data, we aimed to develop claims-based prediction models for CKD phenotypes determined by laboratory results in electronic health records (EHRs). Patients and Methods We linked EHR from two networks (used as training and validation cohorts, respectively) with Medicare claims data. The study cohort included individuals ≥65 years with a valid serum creatinine result in the EHR from 2007 to 2017, excluding those with end-stage kidney disease or on dialysis. We used LASSO regression to select among 134 predictors for predicting continuous estimated glomerular filtration rate (eGFR). We assessed the model performance when predicting eGFR categories of <60, <45, <30 mL/min/1.73m2 in terms of area under the receiver operating curves (AUC). Results The model training cohort included 117,476 patients (mean age 74.8 years, female 58.2%) and the validation cohort included 56,744 patients (mean age 73.8 years, female 59.6%). In the validation cohort, the AUC of the primary model (with 113 predictors and an adjusted R2 of 0.35) for predicting eGFR <60, eGFR<45, and eGFR <30 mL/min/1.73m2 categories was 0.81, 0.88, and 0.92, respectively, and the corresponding positive predictive values for these 3 phenotypes were 0.80 (95% confidence interval: 0.79, 0.81), 0.79 (0.75, 0.84), and 0.38 (0.30, 0.45), respectively. Conclusion We developed a claims-based model to determine clinical phenotypes of CKD stages defined by eGFR values. Researchers without access to laboratory results can use the model-predicted phenotypes as a proxy clinical endpoint or confounder and to enhance subgroup effect assessment.
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Affiliation(s)
- Omar Mansour
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Julie M Paik
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
| | - Richard Wyss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Julianna M Mastrorilli
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Lily Gui Bessette
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Zhigang Lu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Theodore Tsacogianis
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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18
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Hawthorne G, Lightfoot CJ, Smith AC, Khunti K, Wilkinson TJ. Multimorbidity prevalence and patterns in chronic kidney disease: findings from an observational multicentre UK cohort study. Int Urol Nephrol 2023. [PMID: 36806100 DOI: 10.1007/s11255-023-03516-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 02/12/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE Multimorbidity [defined as two or more long-term conditions (LTCs)] contributes to increased treatment and medication burden, poor health-related quality of life, and worse outcomes. Management strategies need to be patient centred and tailored depending on existing comorbidities; however, little is known about the prevalence and patterns of comorbidities in people with chronic kidney disease (CKD). We investigated the prevalence of multimorbidity and comorbidity patterns across all CKD stages. METHODS Multimorbidity was assessed, using a composite of self-report and clinical data, across four CKD groups stratified by eGFR [stage 1-2, stage 3a&b, stage 4-5, and kidney transplant (KTx)]. Principal component analysis using varimax rotation was used to identify comorbidity clusters across each group. RESULTS Of the 978 participants (mean 66.3 ± 14 years, 60% male), 96.0% had multimorbidity. In addition to CKD, the mean number of comorbidities was 3.0 ± 1.7. Complex multimorbidity (i.e. ≥ 4 multiple LTCs) was identified in 560 (57.3%) participants. When stratified by CKD stage, the two most prevalent comorbidities across all stages were hypertension (> 55%) and musculoskeletal disorders (> 40%). The next most prevalent comorbidity for CKD stages 1-2 was lung conditions and for CKD stages 3 and 4-5 it was heart problems. CKD stages 1-2 showed different comorbidity patterns and clustering compared to other CKD stages. CONCLUSION Most people across the spectrum of CKD have multimorbidity. Different patterns of multimorbidity exist at different stages of CKD, and as such, clinicians should consider patient comorbidities to integrate care and provide effective treatment strategies.
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Spanakis M, Ioannou P, Tzalis S, Chouzouri F, Patelarou E, Kofteridis DP, Antoniou KM, Schiza SE, Patelarou A, Tzanakis N. Evaluation of Drug Interactions in Hospitalized Patients with Respiratory Disorders in Greece. Adv Respir Med 2023; 91:74-92. [PMID: 36825942 PMCID: PMC9952796 DOI: 10.3390/arm91010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/23/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023]
Abstract
Background: Patients with respiratory disorders often have additional diseases and are usually treated with more than one medication to manage their respiratory conditions as well as additional comorbidities. Thus, they are frequently exposed to polypharmacy (≥5 drugs), which raises the risk for drug-drug interactions (DDIs) and adverse drug reactions (ADRs). In this work, we present the results regarding the prevalence of DDIs in hospitalized patients with respiratory disorders in Greece. Methods: A 6-month descriptive single-center retrospective observational study enrolled 102 patients with acute or chronic respiratory disorders. Clinical characteristics and medication regimens were recorded upon admission, hospitalization, and discharge. The prevalence of DDIs and their clinical significance was recorded and analyzed. Results: Unspecified acute lower respiratory tract infection (25%), exacerbations of chronic obstructive pulmonary disease (12%) and pneumonia (8%) were the most frequent reasons for admission. Cardiovascular disorders (46%), co-existing respiratory disorders (32%), and diabetes (25%) were the most prevalent comorbidities. Polypharmacy was noted in 61% of patients upon admission, 98% during hospitalization, and 63% upon discharge. Associated DDIs were estimated to be 55% upon admission, 96% throughout hospitalization, and 63% on discharge. Pharmacodynamic (PD) DDIs were the most prevalent cases (81%) and referred mostly to potential risk for QT-prolongation (31.4% of PD-DDIs) or modulation of coagulation process as expressed through the international normalized ratio (INR) (29.0% of DDIs). Pharmacokinetic (PK) DDIs (19% of DDIs) were due to inhibition of Cytochrome P450 mediated metabolism that could lead to elevated systemic drug concentrations. Clinically significant DDIs characterized as "serious-use alternative" related to 7% of cases while 59% of DDIs referred to combinations that could be characterized as "use with caution-monitor". Clinically significant DDIs mostly referred to medication regimens upon admission and discharge and were associated with outpatient prescriptions. Conclusions: Hospitalized patients with respiratory disorders often experience multimorbidity and polypharmacy that raise the risk of DDIs. Clinicians should be conscious especially if any occurring arrhythmias, INR modulations, and prolonged or increased drug action is associated with DDIs.
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Affiliation(s)
- Marios Spanakis
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71004 Heraklion, Crete, Greece
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research & Technology-Hellas (FORTH), GR-70013 Heraklion, Crete, Greece
- Correspondence:
| | - Petros Ioannou
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece
| | - Sotiris Tzalis
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece
| | - Flora Chouzouri
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece
| | - Evridiki Patelarou
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71004 Heraklion, Crete, Greece
| | - Diamantis P. Kofteridis
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece
| | - Katerina M. Antoniou
- Department of Respiratory Medicine, University Hospital of Heraklion, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
| | - Sophia E. Schiza
- Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
| | - Athina Patelarou
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71004 Heraklion, Crete, Greece
| | - Nikos Tzanakis
- Department of Respiratory Medicine, University Hospital of Heraklion, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
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20
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Álvarez-García G, Nogueira Pérez Á, Prieto Alaguero MP, Pérez Garrote C, Díaz Testillano A, Moral Caballero MÁ, Ruperto M, González Blázquez C, Barril G. Comorbidity and nutritional status in adult with advanced chronic kidney disease influence the decision-making choice of renal replacement therapy modality: A retrospective 5-year study. Front Nutr 2023; 10:1105573. [PMID: 36875858 PMCID: PMC9979974 DOI: 10.3389/fnut.2023.1105573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/09/2023] [Indexed: 02/18/2023] Open
Abstract
Background Nutritional and inflammation status are significant predictors of morbidity and mortality risk in advanced chronic kidney disease (ACKD). To date, there are a limited number of clinical studies on the influence of nutritional status in ACKD stages 4-5 on the choice of renal replacement therapy (RRT) modality. Aim This study aimed to examine relationships between comorbidity and nutritional and inflammatory status and the decision-making on the choice of RRT modalities in adults with ACKD. Methods A retrospective cross-sectional study was conducted on 211 patients with ACKD with stages 4-5 from 2016 to 2021. Comorbidity was assessed using the Charlson comorbidity index (CCI) according to severity (CCI: ≤ 3 and >3 points). Clinical and nutritional assessment was carried out by prognosis nutritional index (PNI), laboratory parameters [serum s-albumin, s-prealbumin, and C-reactive protein (s-CRP)], and anthropometric measurements. The initial decision-making of the different RRT modalities [(in-center, home-based hemodialysis (HD), and peritoneal dialysis (PD)] as well as the informed therapeutic options (conservative treatment of CKD or pre-dialysis living donor transplantation) were recorded. The sample was classified according to gender, time on follow-up in the ACKD unit (≤ 6 and >6 months), and the initial decision-making of RRT (in-center and home-RRT). Univariate and multivariate regression analyses were carried out for evaluating the independent predictors of home-based RRT. Results Of the 211 patients with ACKD, 47.4% (n = 100) were in stage 5 CKD, mainly elderly men (65.4%). DM was the main etiology of CKD (22.7%) together with hypertension (96.6%) as a CV risk factor. Higher CCI scores were significantly found in men, and severe comorbidity with a CCI score > 3 points was 99.1%. The mean time of follow-up time in the ACKD unit was 9.6 ± 12.8 months. A significantly higher CCI was found in those patients with a follow-up time > 6 months, as well as higher mean values of eGFR, s-albumin, s-prealbumin, s-transferrin, and hemoglobin, and lower s-CRP than those with a follow-up <6 months (all, at least p < 0.05). The mean PNI score was 38.9 ± 5.5 points, and a PNI score ≤ 39 points was found in 36.5%. S-albumin level > 3.8 g/dl was found in 71.1% (n = 150), and values of s-CRP ≤ 1 mg/dl were 82.9% (n = 175). PEW prevalence was 15.2%. The initial choice of RRT modality was higher in in-center HD (n = 119 patients; 56.4%) than in home-based RRT (n = 81; 40.5%). Patients who chose home-based RRT had significantly lower CCI scores and higher mean values of s-albumin, s-prealbumin, s-transferrin, hemoglobin, and eGFR and lower s-CRP than those who chose in-center RRT (p < 0.001). Logistic regression demonstrated that s-albumin (OR: 0.147) and a follow-up time in the ACKD unit >6 months (OR: 0.440) were significantly associated with the likelihood of decision-making to choose a home-based RRT modality (all, at least p < 0.05). Conclusion Regular monitoring and follow-up of sociodemographic factors, comorbidity, and nutritional and inflammatory status in a multidisciplinary ACKD unit significantly influenced decision-making on the choice of RRT modality and outcome in patients with non-dialysis ACKD.
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Affiliation(s)
| | | | | | | | | | | | - Mar Ruperto
- Department of Pharmaceutical and Health Sciences, School of Pharmacy, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | | | - Guillermina Barril
- Department of Nephrology, Hospital Universitario de la Princesa, Madrid, Spain
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21
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Nygård HT, Nguyen L, Berg RC. Effect of remote patient monitoring for patients with chronic kidney disease who perform dialysis at home: a systematic review. BMJ Open 2022; 12:e061772. [PMID: 36600376 PMCID: PMC9730362 DOI: 10.1136/bmjopen-2022-061772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The purpose of the systematic review was to assess the effectiveness of remote patient monitoring (RPM) follow-up compared with standard care, for patients with chronic kidney disease (CKD) who perform dialysis at home. METHODS We conducted a systematic review in accordance with international guidelines. We performed systematic searches for publications from 2015 to 2021 in five databases (eg, Medline, Cinahl, Embase) and a search for grey literature in reference lists. Included effect measures were quality of life, hospitalisation, technical failure as the cause for transfer to a different dialysis modality, infections and time patients use for travel. Screening of literature, data extraction, risk-of-bias assessment and certainty of evidence assessment (using the Grading of Recommendations Assessment, Development and Evaluation approach) were done by two researchers. We conducted meta-analyses when possible. RESULTS Seven studies met the inclusion criteria, of which two were randomised controlled trials and five were retrospective cohort studies with control groups. The studies included 9975 participants from 5 countries, who were a good representation of dialysis patients in high-income and upper-middle-income countries. The patients were on peritoneal dialysis (six studies) or home haemodialysis (one study). There was very low certainty of evidence for the outcomes, except for hospitalisations: there was low certainty evidence from three cohort studies for fewer hospitalisation days in the RPM group. No studies included data for time patients used for travel. CONCLUSION We found low to very low certainty evidence that indicate there may be positive effects of RPM follow-up, in comparison to standard care only, for adult patients with CKD who perform dialysis at home. Offering RPM follow-up for home dialysis patients as an alternative or supplement to standard care appears to be safe and provide health benefits such as fewer hospitalisation days. Future implementation should be coupled with robust, high-quality evaluations. PROSPERO REGISTRATION NUMBER CRD42021281779.
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Affiliation(s)
- Henriette Tyse Nygård
- Department of Community Medicine, University of Tromsø, Tromsø, Norway
- Divison for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Lien Nguyen
- Divison for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Rigmor C Berg
- Department of Community Medicine, University of Tromsø, Tromsø, Norway
- Divison for Health Services, Norwegian Institute of Public Health, Oslo, Norway
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22
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Diamantidis CJ, Cook DJ, Dunning S, Redelosa CK, Bartolome MFD, Romero RAA, Vassalotti JA. Missing Care: the Initial Impact of the COVID-19 Pandemic on CKD Care Delivery. J Gen Intern Med 2022; 37:4241-4247. [PMID: 36163529 PMCID: PMC9512959 DOI: 10.1007/s11606-022-07805-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 09/08/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a common condition with adverse health outcomes addressable by early disease management. The impact of the COVID-19 pandemic on care utilization for the CKD population is unknown. OBJECTIVE To examine pandemic CKD care and identify factors associated with a high care deficit. DESIGN Retrospective observational study PARTICIPANTS: 248,898 insured individuals (95% Medicare Advantage, 5% commercial) with stage G3-G4 CKD in 2018 MAIN MEASURES: Predicted (based on the pre-pandemic period of January 1, 2019-February 28, 2020) to observed per-member monthly face-to-face and telehealth encounters, laboratory testing, and proportion of days covered (PDC) for medications, evaluated during the early (March 1, 2020-June 30, 2020), pre-vaccine (July 1, 2020-December 31, 2020), and late (January 2021-August 2021) periods and overall. KEY RESULTS In-person encounters fell by 24.1% during the pandemic overall; this was mitigated by a 14.2% increase in telehealth encounters, resulting in a cumulative observed utilization deficit of 10% relative to predicted. These reductions were greatest in the early pandemic period, with a 19.8% cumulative deficit. PDC progressively decreased during the pandemic (range 9-20% overall reduction), with the greatest reductions in hypertension and diabetes medicines. CKD laboratory monitoring was also reduced (range 11.8-43.3%). Individuals of younger age (OR 1.63, 95% CI 1.16, 2.28), with commercial insurance (1.43, 95% CI 1.25, 1.63), residing in the Southern US (OR 1.17, 95% CI 1.14, 1.21), and with stage G4 CKD (OR 1.21, 95% CI 1.17, 1.26) had greater odds of a higher care deficit overall. CONCLUSIONS The early COVID-19 pandemic resulted in a marked decline of healthcare services for individuals with CKD, with an incomplete recovery during the later pandemic. Increased telehealth use partially compensated for this deficit. The downstream impact of CKD care reduction on health outcomes requires further study, as does evaluation of effective care delivery models for this population.
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Affiliation(s)
| | | | | | | | | | | | - Joseph A Vassalotti
- National Kidney Foundation, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
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23
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Cogley C, Carswell C, Bramham K, Chilcot J. Chronic Kidney Disease and Severe Mental Illness: Addressing Disparities in Access to Health Care and Health Outcomes. Clin J Am Soc Nephrol 2022; 17:1413-1417. [PMID: 35361628 PMCID: PMC9625106 DOI: 10.2215/cjn.15691221] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Individuals with severe mental illness, including conditions such as schizophrenia and bipolar disorder, are at a higher risk of developing CKD. Higher incidences of CKD in this population can be partially explained by known risk factors, such as the use of lithium treatment and higher rates of cardiovascular disease. However, this does not fully explain the higher proportion of CKD in individuals with severe mental illness, and further research investigating the factors influencing disease onset and progression is needed. Similarly, although it is well documented that mental health difficulties, such as depression and anxiety, are highly prevalent among individuals with CKD, there is a lack of published data regarding the rates of severe mental illness in individuals with CKD. Furthermore, for individuals with CKD, having severe mental illness is associated with poor health outcomes, including higher mortality rates and higher rates of hospitalizations. Evidence also suggests that individuals with severe mental illness receive suboptimal kidney care, have fewer appointments with nephrologists, and are less likely to receive a kidney transplant. Limited research suggests that care might be improved through educating kidney health care staff regarding the needs of patients with severe mental illness and by facilitating closer collaboration with psychiatry. Further research investigating the rates of severe mental illness in patients with CKD, as well as the barriers and facilitators to effective care for this population, is clearly required to inform the provision of appropriate supports and to improve health outcomes for individuals with CKD and co-occurring severe mental illness.
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Affiliation(s)
- Clodagh Cogley
- Department of Psychology, University College Dublin, Dublin, Ireland
| | - Claire Carswell
- Department of Health Sciences, University of York, Heslington, York, United Kingdom
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
| | - Kate Bramham
- Department of Women and Children’s Health, King’s College London, London, United Kingdom
| | - Joseph Chilcot
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
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24
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Durgaprasad BK, Malla RR, Lahari BD, Vijayalakshmi P, Guntoory I, Kalyan KV. Role of predictable biomarkers in early detection of cardiovascular events in Chronic Kidney Disease III and IV. Current Issues in Pharmacy and Medical Sciences 2022; 35:99-105. [DOI: 10.2478/cipms-2022-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
This comes about because of a lack of predicted biomarkers in the risk analysis of CVD events in chronic kidney disease (CKD) patients. The present study aimed to determine the clinical utility of independent, predictable biomarkers such as serum creatinine, estimated Glomerular Filtration Rate (eGFR), high sensitive C-Reactive protein (hsCRP), fibrinogen and lipid profile as early predictors of CVD in CKD at stage III/IV.
Methods. This is a case-control study that includes a sample size of 100 patients of cases and 100 patients of controls who were recruited from November 2020 to April 2021, from the Nephrology department of the Visakhapatnam tertiary care teaching hospital, and present with chronic kidney disease – stage III/IV. The subjects’ general conditions (age, gender, height, weight, systolic blood pressure, diastolic blood pressure, and smoking history); underlying diseases (coronary heart disease and diabetes mellitus) were recorded. Fasting venous blood samples were collected under aseptic conditions from the study group after taking informed consent. The measurement of serum creatinine was performed by modification of kinetic Jaffe reaction. The Cockcroft-Gault equation was used to calculate eGFR in both cases and controls. CRP testing was done with a Cobas C311 analyzer, using immunoturbidimetric assay. The Fibroquant kit from Tulip was employed to measure fibrinogen levels in blood samples, and enzymatic methods were applied for lipid profile analysis.
Results. In this study, higher mean values of hsCRP (34.28 mg/dl), increased serum creatinine levels (2.876 mg/dl), reduced eGFR (28.37 mls/min), high levels of serum fibrinogen (291.6 mg/dl), and cholesterol (214.5 mg/dl), HDL (28.34 mg/dl), TG (162.1 mg/dl), VLDL (32.41 mg/dl) and LDL (153.77 mg/dl) were found to be independent predictors of assessment of CV events in patients with CKD stages III and IV as determined by Chi-square test.
Conclusion. A prompt and accurate assessment of cardiovascular risk in CKD patients would enable more aggressive and focused treatment of the individuals who are most in need of preventive interventions to decrease incident rates.
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25
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Ghimire A, Ye F, Hemmelgarn B, Zaidi D, Jindal KK, Tonelli MA, Cooper M, James MT, Khan M, Tinwala MM, Sultana N, Ronksley PE, Muneer S, Klarenbach S, Okpechi IG, Bello AK. Trends in nephrology referral patterns for patients with chronic kidney disease: Retrospective cohort study. PLoS One 2022; 17:e0272689. [PMID: 35951609 PMCID: PMC9371302 DOI: 10.1371/journal.pone.0272689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Information on early, guideline discordant referrals in nephrology is limited. Our objective was to investigate trends in referral patterns to nephrology for patients with chronic kidney disease (CKD). Methods Retrospective cohort study of adults with ≥1 visits to a nephrologist from primary care with ≥1 serum creatinine and/or urine protein measurement <180 days before index nephrology visit, from 2006 and 2019 in Alberta, Canada. Guideline discordant referrals were those that did not meet ≥1 of: Estimated glomerular filtration rate (eGFR) ˂ 30 mL/min/1.73m2, persistent albuminuria (ACR ≥ 300 mg/g, PCR ≥ 500 mg/g, or Udip ≥ 2+), or progressive and persistent decline in eGFR until index nephrology visit (≥ 5 mL/min/1.73m2). Results Of 69,372 patients with CKD, 28,518 (41%) were referred in a guideline concordant manner. The overall rate of first outpatient visits to nephrology increased from 2006 to 2019, although guideline discordant referrals showed a greater increase (trend 21.9 per million population/year, 95% confidence interval 4.3, 39.4) versus guideline concordant referrals (trend 12.4 per million population/year, 95% confidence interval 5.7, 19.0). The guideline concordant cohort were more likely to be on renin-angiotensin system blockers or beta blockers (hazard ratio 1.14, 95% confidence interval 1.12, 1.16), and had a higher risk of CKD progression (hazard ratio 1.09, 95% confidence interval 1.06, 1.13), kidney failure (hazard ratio 7.65, 95% confidence interval 6.83, 8.56), cardiovascular event (hazard ratio 1.40, 95% confidence interval 1.35,1.45) and mortality (hazard ratio 1.58, 95% confidence interval 1.52, 1.63). Conclusions A significant proportion nephrology referrals from primary care were not consistent with current guideline-recommended criteria for referral. Further work is needed to identify quality improvement initiatives aimed at enhancing referral patterns of patients with CKD.
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Affiliation(s)
- Anukul Ghimire
- Division of Nephrology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Feng Ye
- Division of Nephrology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Brenda Hemmelgarn
- Division of Nephrology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Deenaz Zaidi
- Division of Nephrology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kailash K. Jindal
- Division of Nephrology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Marcello A. Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthew Cooper
- Division of Nephrology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew T. James
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maryam Khan
- Division of Nephrology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Mohammed M. Tinwala
- Division of Nephrology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Naima Sultana
- Division of Nephrology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Paul E. Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shezel Muneer
- Division of Nephrology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Scott Klarenbach
- Division of Nephrology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ikechi G. Okpechi
- Division of Nephrology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Aminu K. Bello
- Division of Nephrology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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26
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Zhu N, Lisinski A, Lagerberg T, Johnell K, Xu H, Carrero JJ, Chang Z. Kidney function and prescribed dose in middle‐aged and older patients starting selective serotonin reuptake inhibitors. Pharmacoepidemiol Drug Saf 2022; 31:1091-1101. [PMID: 36076345 PMCID: PMC9545078 DOI: 10.1002/pds.5515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/01/2022] [Accepted: 07/31/2022] [Indexed: 11/14/2022]
Abstract
Purpose To avoid adverse drug reactions, dose reductions are recommended when prescribing selective serotonin reuptake inhibitors (SSRIs) to patients with impaired kidney function. The extent of this practice in routine clinical care is however unknown. We aimed to evaluate the starting and maintenance SSRI doses prescribed to patients stratified by levels of kidney function in real‐world practice. Methods Using data from the Stockholm CREAtinine Measurements (SCREAM) project, we identified 101 409 new users of antidepressants (including 52 286 SSRI users) in the region of Stockholm during 2006–2019, who were ≥50 years of age and had a recent creatinine test taken in order to estimate glomerular filtration rate (eGFR). SSRI dose reduction was defined as a prescribed SSRI dose of ≤0.5 defined daily doses, according to current recommendations. We examined the associations between eGFR and reductions in initial dose and maintenance dose of SSRIs using logistic regression models. Results Overall, reductions in initial and maintenance dose were observed among 54.1% and 34.1% of new SSRI users. Nevertheless, about 40% of individuals with an eGFR <30 ml/min/1.73 m2 were prescribed an SSRI without dose reduction. After adjusting for age and other covariates, lower eGFR was associated with moderately higher odds of dose reduction, for both initial and maintenance dose. Compared to individuals with an eGFR of 90–104 ml/min/1.73 m2, the adjusted odds ratios for those with an eGFR <30 ml/min/1.73 m2 were 1.18 (95% CI: 1.03, 1.36) for initial dose reduction, and 1.49 (1.29, 1.72) for maintenance dose reduction. Stratified analyses showed stronger associations between lower eGFR and SSRI dose reduction among individuals aged 50–64 years and in those receiving prescriptions from psychiatric care. Conclusions Lower kidney function was moderately associated with a reduced SSRI dose, independently of age. Prescribing SSRIs to middle‐aged and older patients should not only consider patients' age but also their kidney function.
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Affiliation(s)
- Nanbo Zhu
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden
| | - Alexander Lisinski
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Tyra Lagerberg
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden
| | - Hong Xu
- Division of Clinical Geriatrics, Department of Neurobiology Care Sciences and Society, Karolinska Institutet Stockholm Sweden
| | - Juan Jesús Carrero
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden
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Ido K, Miyazaki M, Nakayama M. Hemodialysis Record Sharing: Solution for Work Burden Reduction and Disaster Preparedness. JMIR Form Res 2022; 6:e32925. [PMID: 35867394 PMCID: PMC9356332 DOI: 10.2196/32925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 12/02/2022] Open
Abstract
Background After the Great East Japan Earthquake in 2011, backup systems for clinical information were launched in Japan. The system in Miyagi Prefecture called the Miyagi Medical and Welfare Information Network (MMWIN) is used as a health information exchange network to share clinical information among various medical facilities for patients who have opted in. Hospitals and clinics specializing in chronic renal failure require patients’ data and records during hemodialysis to facilitate communication in daily clinical activity and preparedness for disasters. Objective This study aimed to facilitate the sharing of clinical data of patients undergoing hemodialysis among different hemodialysis facilities. Methods We introduced a document-sharing system to make hemodialysis reports available on the MMWIN. We also recruited hospitals and clinics to share the hemodialysis reports of their patients and promoted the development of a network between emergency and dialysis clinics. Results In addition to basic patient information as well as information on diagnosis, prescription, laboratory data, hospitalization, allergy, and image data from different facilities, specific information about hemodialysis is available, as well as a backup of indispensable information in preparation for disasters. As of June 1, 2021, 12 clinics and 10 hospitals of 68 dialysis facilities in Miyagi participated in the MMWIN. The number of patients who underwent hemodialysis in Miyagi increased by more than 40%. Conclusions Our backup system successfully developed a network of hemodialysis facilities. We have accumulated data that are beneficial to prevent the fragmentation of patient information and would be helpful in transferring patients efficiently during unpredictable disasters.
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Affiliation(s)
- Keisuke Ido
- Medical Information Center, Tohoku University Hospital, Sendai, Japan
| | - Mariko Miyazaki
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, Sendai, Japan
| | - Masaharu Nakayama
- Department of Medical Informatics, Tohoku University Graduate School of Medicine, Sendai, Japan
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Rathi N, Yasuda Y, Attawettayanon W, Palacios DA, Ye Y, Li J, Weight C, Eltemamy M, Benidir T, Abouassaly R, Campbell SC. Optimizing prediction of new-baseline glomerular filtration rate after radical nephrectomy: are algorithms really necessary? Int Urol Nephrol 2022; 54:2537-2545. [DOI: 10.1007/s11255-022-03298-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022]
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Donald M, Beanlands H, Straus S, Smekal M, Gil S, Elliott MJ, Harwood L, Waldvogel B, Delgado M, Sparkes D, Tong A, Grill A, Novak M, James MT, Brimble KS, Tu K, Hemmelgarn BR. An eHealth self-management intervention for adults with chronic kidney disease, My Kidneys My Health: a mixed-methods study. CMAJ Open 2022; 10:E746-E754. [PMID: 35973709 PMCID: PMC9388218 DOI: 10.9778/cmajo.20210332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is limited research of electronic tools for self-management for patients with chronic kidney disease (CKD). We sought to evaluate participant engagement, perceived self-efficacy and website usage in a preliminary evaluation of My Kidneys My Health, a patient-facing eHealth tool in Canada. METHODS We conducted an explanatory sequential mixed-methods study of adults with CKD who were not on kidney replacement therapy and who had access to My Kidneys My Health for 8 weeks. Outcomes included acceptance (measured by the Technology Acceptance Model), self-efficacy (measured by the Chronic Disease Self-Efficacy Scale [CDSES]) and website usage patterns (captured using Google Analytics). We analyzed participant interviews using qualitative content analysis. RESULTS Twenty-nine participants with CKD completed baseline questionnaires, of whom 22 completed end-of-study questionnaires; data saturation was achieved with 15 telephone interviews. Acceptance was high, with more than 70% of participants agreeing or strongly agreeing that the website was easy to use and useful. Of the 22 who completed end-of-study questionnaires, 18 (82%) indicated they would recommend its use to others and 16 (73%) stated they would use the website in the future. Average scores for website satisfaction and look and feel were 7.7 (standard deviation [SD] 2.0) and 8.2 (SD 2.0) out of 10, respectively. The CDSES indicated that participants gained an increase in CKD information. Interviewed participants reported that the website offered valuable information and interactive tools for patients with early or newly diagnosed CKD, or for those experiencing changes in health status. Popular website pages and interactive features included Food and Diet, What is CKD, My Question List and the Depression Screener. INTERPRETATION Participants indicated that the My Kidneys My Health website provided accessible content and tools that may improve self-efficacy and support in CKD self-management. Further evaluation of the website's effectiveness in supporting self-management among a larger, more heterogenous population is warranted.
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Affiliation(s)
- Maoliosa Donald
- Department of Medicine (Donald, Smekal, Gil, Elliott, James, Hemmelgarn), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; London Health Sciences Centre (Harwood), London, Ont.; Can-SOLVE CKD Patient Partner (Waldvogel, Delgado, Sparkes), Vancouver, BC; Sydney School of Public Health (Tong), The University of Sydney, Sydney, New South Wales, Australia; Department of Family & Community Medicine (Grill, Tu) University of Toronto, Ont.; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta.
| | - Heather Beanlands
- Department of Medicine (Donald, Smekal, Gil, Elliott, James, Hemmelgarn), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; London Health Sciences Centre (Harwood), London, Ont.; Can-SOLVE CKD Patient Partner (Waldvogel, Delgado, Sparkes), Vancouver, BC; Sydney School of Public Health (Tong), The University of Sydney, Sydney, New South Wales, Australia; Department of Family & Community Medicine (Grill, Tu) University of Toronto, Ont.; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta
| | - Sharon Straus
- Department of Medicine (Donald, Smekal, Gil, Elliott, James, Hemmelgarn), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; London Health Sciences Centre (Harwood), London, Ont.; Can-SOLVE CKD Patient Partner (Waldvogel, Delgado, Sparkes), Vancouver, BC; Sydney School of Public Health (Tong), The University of Sydney, Sydney, New South Wales, Australia; Department of Family & Community Medicine (Grill, Tu) University of Toronto, Ont.; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta
| | - Michelle Smekal
- Department of Medicine (Donald, Smekal, Gil, Elliott, James, Hemmelgarn), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; London Health Sciences Centre (Harwood), London, Ont.; Can-SOLVE CKD Patient Partner (Waldvogel, Delgado, Sparkes), Vancouver, BC; Sydney School of Public Health (Tong), The University of Sydney, Sydney, New South Wales, Australia; Department of Family & Community Medicine (Grill, Tu) University of Toronto, Ont.; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta
| | - Sarah Gil
- Department of Medicine (Donald, Smekal, Gil, Elliott, James, Hemmelgarn), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; London Health Sciences Centre (Harwood), London, Ont.; Can-SOLVE CKD Patient Partner (Waldvogel, Delgado, Sparkes), Vancouver, BC; Sydney School of Public Health (Tong), The University of Sydney, Sydney, New South Wales, Australia; Department of Family & Community Medicine (Grill, Tu) University of Toronto, Ont.; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta
| | - Meghan J Elliott
- Department of Medicine (Donald, Smekal, Gil, Elliott, James, Hemmelgarn), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; London Health Sciences Centre (Harwood), London, Ont.; Can-SOLVE CKD Patient Partner (Waldvogel, Delgado, Sparkes), Vancouver, BC; Sydney School of Public Health (Tong), The University of Sydney, Sydney, New South Wales, Australia; Department of Family & Community Medicine (Grill, Tu) University of Toronto, Ont.; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta
| | - Lori Harwood
- Department of Medicine (Donald, Smekal, Gil, Elliott, James, Hemmelgarn), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; London Health Sciences Centre (Harwood), London, Ont.; Can-SOLVE CKD Patient Partner (Waldvogel, Delgado, Sparkes), Vancouver, BC; Sydney School of Public Health (Tong), The University of Sydney, Sydney, New South Wales, Australia; Department of Family & Community Medicine (Grill, Tu) University of Toronto, Ont.; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta
| | - Blair Waldvogel
- Department of Medicine (Donald, Smekal, Gil, Elliott, James, Hemmelgarn), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; London Health Sciences Centre (Harwood), London, Ont.; Can-SOLVE CKD Patient Partner (Waldvogel, Delgado, Sparkes), Vancouver, BC; Sydney School of Public Health (Tong), The University of Sydney, Sydney, New South Wales, Australia; Department of Family & Community Medicine (Grill, Tu) University of Toronto, Ont.; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta
| | - Maria Delgado
- Department of Medicine (Donald, Smekal, Gil, Elliott, James, Hemmelgarn), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; London Health Sciences Centre (Harwood), London, Ont.; Can-SOLVE CKD Patient Partner (Waldvogel, Delgado, Sparkes), Vancouver, BC; Sydney School of Public Health (Tong), The University of Sydney, Sydney, New South Wales, Australia; Department of Family & Community Medicine (Grill, Tu) University of Toronto, Ont.; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta
| | - Dwight Sparkes
- Department of Medicine (Donald, Smekal, Gil, Elliott, James, Hemmelgarn), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; London Health Sciences Centre (Harwood), London, Ont.; Can-SOLVE CKD Patient Partner (Waldvogel, Delgado, Sparkes), Vancouver, BC; Sydney School of Public Health (Tong), The University of Sydney, Sydney, New South Wales, Australia; Department of Family & Community Medicine (Grill, Tu) University of Toronto, Ont.; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta
| | - Allison Tong
- Department of Medicine (Donald, Smekal, Gil, Elliott, James, Hemmelgarn), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; London Health Sciences Centre (Harwood), London, Ont.; Can-SOLVE CKD Patient Partner (Waldvogel, Delgado, Sparkes), Vancouver, BC; Sydney School of Public Health (Tong), The University of Sydney, Sydney, New South Wales, Australia; Department of Family & Community Medicine (Grill, Tu) University of Toronto, Ont.; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta
| | - Allan Grill
- Department of Medicine (Donald, Smekal, Gil, Elliott, James, Hemmelgarn), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; London Health Sciences Centre (Harwood), London, Ont.; Can-SOLVE CKD Patient Partner (Waldvogel, Delgado, Sparkes), Vancouver, BC; Sydney School of Public Health (Tong), The University of Sydney, Sydney, New South Wales, Australia; Department of Family & Community Medicine (Grill, Tu) University of Toronto, Ont.; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta
| | - Marta Novak
- Department of Medicine (Donald, Smekal, Gil, Elliott, James, Hemmelgarn), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; London Health Sciences Centre (Harwood), London, Ont.; Can-SOLVE CKD Patient Partner (Waldvogel, Delgado, Sparkes), Vancouver, BC; Sydney School of Public Health (Tong), The University of Sydney, Sydney, New South Wales, Australia; Department of Family & Community Medicine (Grill, Tu) University of Toronto, Ont.; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta
| | - Matthew T James
- Department of Medicine (Donald, Smekal, Gil, Elliott, James, Hemmelgarn), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; London Health Sciences Centre (Harwood), London, Ont.; Can-SOLVE CKD Patient Partner (Waldvogel, Delgado, Sparkes), Vancouver, BC; Sydney School of Public Health (Tong), The University of Sydney, Sydney, New South Wales, Australia; Department of Family & Community Medicine (Grill, Tu) University of Toronto, Ont.; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta
| | - K Scott Brimble
- Department of Medicine (Donald, Smekal, Gil, Elliott, James, Hemmelgarn), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; London Health Sciences Centre (Harwood), London, Ont.; Can-SOLVE CKD Patient Partner (Waldvogel, Delgado, Sparkes), Vancouver, BC; Sydney School of Public Health (Tong), The University of Sydney, Sydney, New South Wales, Australia; Department of Family & Community Medicine (Grill, Tu) University of Toronto, Ont.; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta
| | - Karen Tu
- Department of Medicine (Donald, Smekal, Gil, Elliott, James, Hemmelgarn), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; London Health Sciences Centre (Harwood), London, Ont.; Can-SOLVE CKD Patient Partner (Waldvogel, Delgado, Sparkes), Vancouver, BC; Sydney School of Public Health (Tong), The University of Sydney, Sydney, New South Wales, Australia; Department of Family & Community Medicine (Grill, Tu) University of Toronto, Ont.; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta
| | - Brenda R Hemmelgarn
- Department of Medicine (Donald, Smekal, Gil, Elliott, James, Hemmelgarn), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Daphne Cockwell School of Nursing (Beanlands), Ryerson University; Department of Medicine (Straus), University of Toronto; Li Ka Shing Knowledge Institute (Straus), St. Michael's Hospital, Toronto, Ont.; London Health Sciences Centre (Harwood), London, Ont.; Can-SOLVE CKD Patient Partner (Waldvogel, Delgado, Sparkes), Vancouver, BC; Sydney School of Public Health (Tong), The University of Sydney, Sydney, New South Wales, Australia; Department of Family & Community Medicine (Grill, Tu) University of Toronto, Ont.; Centre for Mental Health (Novak), University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ont.; Department of Medicine (Brimble), McMaster University, Hamilton, Ont.; Faculty of Medicine and Dentistry (Hemmelgarn), University of Alberta, Edmonton, Alta
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Latif AA, Lee KW, Phang K, Rashid AA, Chan NN, Peh SC, Thilaganathan T, Ooi PB. Patient-related factors associated with medication adherence behavior in patients with end-stage renal disease: A systematic review. Tzu Chi Med J 2022; 34:473-484. [PMID: 36578649 PMCID: PMC9791854 DOI: 10.4103/tcmj.tcmj_212_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/02/2021] [Accepted: 03/11/2022] [Indexed: 12/31/2022] Open
Abstract
Objectives This systematic review aims to identify influencing factors of medication adherence behavior in patients with end-stage renal disease (ESRD), with a special interest in patient-related factors based on the World Health Organization adherence model. Materials and Methods Primary electronic databases comprising PubMed, Scopus, Web of Science, Embase and Cochrane Library, as well as ProQuest (Health and Medical), ProQuest (Psychology), and EBSCOHost (APA PsychARTICLES) were used to search for literature on patient-related factors in medication adherence, from inception till August 31, 2021. Results 479 articles were identified and six articles meeting eligibility criteria were reviewed and remained in this systematic review. The present review found that despite different tools being used to measure ESRD's perception of medication's necessity and beliefs, there was a profound association between perception and beliefs with medication adherence behavior. There is a positive relationship between knowledge, belief, educational level, ethnicity, female, and medication adherence behavior. Mixed finding was reported between perception, age, and medication adherence behavior. However, there were no studies on patients' attitudes and medication adherence behavior as suggested in the WHO adherence model. Conclusion Only a limited number of patient-related factors were available for evaluation in the current systematic review. Additional research is needed to advance the understanding of medication adherence behavior affected by patient-related factors on the medication and illness. However, the findings must be taken with caution because of the limited studies included in this review.
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Affiliation(s)
- Anis A'lliya Latif
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Selangor, Malaysia
| | - Kai Wei Lee
- Department of Pre-Clinical Sciences, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Malaysia
| | - Kelly Phang
- Faculty of Psychology and Social Sciences, University of Cyberjaya, Selangor, Malaysia
| | - Aneesa Abdul Rashid
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Nee Nee Chan
- Department of Education, Faculty of Social Sciences and Liberal Arts, UCSI University, Kuala Lumpur, Malaysia
| | - Suat Cheng Peh
- Jeffrey Sachs Center, School of Interdisciplinary Studies, Sunway University, Selangor, Malaysia
| | | | - Pei Boon Ooi
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Selangor, Malaysia,Department of General Studies, School of Interdisciplinary Studies, Sunway University, Selangor, Malaysia,Address for correspondence: Dr. Pei Boon Ooi, Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, 5, Jalan Universiti, Bandar Sunway, 47500 Selangor, Malaysia. E-mail:
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Yapa HE, Purtell L, Chambers S, Bonner A. Factors influencing health-related quality of life in people with chronic kidney disease: A structural equation modelling approach. J Clin Nurs 2022. [PMID: 35739638 DOI: 10.1111/jocn.16422] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/03/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To test whether the revised Wilson and Cleary model could identify which factors contribute to health-related quality of life in chronic kidney disease. BACKGROUND Chronic kidney disease affects a person's health-related quality of life detrimentally although nursing practice informed by theory is only beginning to emerge. DESIGN A cross-sectional study reported using the STROBE guidelines. METHODS About 886 participants with chronic kidney disease (varying grades) completed validated measures of symptoms (renal version of the Integrated Palliative care Outcome Scale), and general health perceptions and health-related quality of life (European Quality of Life five-dimension three-level). Socio-demographic and renal characteristics were also collected. Data were analysed using descriptive statistics and structural equation modelling. RESULTS Biological function (decreased kidney function and haemoglobin and greater number of comorbidities), directly contributed to increased symptom burden. Symptoms demonstrated strong negative relationships with both general health perceptions and health-related quality of life. General health perceptions had a direct positive relationship with health-related quality of life. As age increased, health-related quality of life decreased. The only environmental characteristic of significance was the distance between home and hospital although it was not directly associated with health-related quality of life. Overall, the model explained approximately half of the deterioration in health-related quality of life. CONCLUSIONS The model demonstrated how various factors influence alteration of health-related quality of life in people with chronic kidney disease. Early identification of these factors could assist nurses to introduce effective management strategies into patient care plans proactively. RELEVANCE TO CLINICAL PRACTICE Comprehensive symptom assessment needs to occur not only in kidney failure but in earlier chronic kidney disease grades to enable timely interventions targeted at improving people's wellbeing. PATIENT OR PUBLIC CONTRIBUTION Validated interviewer administered questionnaires were completed by participants with chronic kidney disease in this study.
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Affiliation(s)
- Harith Eranga Yapa
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Nursing, Faculty of Health Sciences, Open University of Sri Lanka, Nawala, Nugegoda, Sri Lanka
| | - Louise Purtell
- Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.,Research Development Unit, Caboolture Hospital, Brisbane, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Shirley Chambers
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ann Bonner
- Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
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Rydén A, Nolan S, Maher J, Meyers O, Kündig A, Bjursell M. Understanding the patient experience of chronic kidney disease stages 2-3b: a qualitative interview study with Kidney Disease Quality of Life (KDQOL-36) debrief. BMC Nephrol 2022; 23:201. [PMID: 35641914 PMCID: PMC9155979 DOI: 10.1186/s12882-022-02826-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Qualitative patient interviews and patient-reported outcome instruments are important tools to understand the patient experience of disease. The aim of this study was to use patient interviews to identify concepts relevant and important to patients living with chronic kidney disease (CKD) stages 2–3b, develop a comprehensive conceptual model of the patient experience and debrief the Kidney Disease Quality of Life 36-item instrument (KDQOL-36) for patients with CKD stages 2–3b. Methods Concept elicitation interviews were conducted with patients with CKD stages 2–3b to identify signs/symptoms and impacts most relevant and important to patients (i.e., ‘salient’ concepts) and develop a conceptual model for the disease. Based on the salient concepts identified in the interviews, new items were proposed to supplement the KDQOL-36. Cognitive debriefing was performed to evaluate the KDQOL-36 and the additional items. Results A total of 31 patients were interviewed in this study (22 for concept elicitation and 15 for cognitive debriefing). The interviews identified 56 concepts (33 signs/symptoms and 23 impacts), 17 of which had not been identified in a previous literature review. Four signs/symptoms (‘fatigue/lack of energy/tiredness’, ‘sleep problems’, ‘increased urination [including nocturia]’ and ‘swelling in legs/ankles/feet’) and two impacts (‘anxiety/worry’ and ‘general negative emotional/mental impact’) were identified as salient. Of the salient signs/symptoms, three were not covered by the KDQOL-36 (sleep problems, increased urination and swelling in legs/ankles/feet) and were represented during cognitive debriefing interviews through four additional items (trouble falling asleep, trouble staying asleep, increased urination [including nocturia] and swelling in legs/ankles/feet) generated in the style of the KDQOL-36. All patients found the KDQOL-36 plus the four additional items relevant, and the majority found them clear. Conclusions By identifying previously unknown concepts and augmenting the understanding of which are most important to patients, a comprehensive conceptual model was developed for patients who have CKD stages 2–3b. This study also demonstrates the suitability of the KDQOL-36 for patients who have CKD stages 2–3b and provides suggestions for how the instrument could be further developed to more comprehensively capture patient experience. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02826-3.
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Affiliation(s)
- Anna Rydén
- Patient Centered Science, Cardiovascular, Renal and Metabolism (CVRM), Biopharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.
| | - Stephen Nolan
- Global Medical Affairs, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | | | | | - Anna Kündig
- Patient Centered Science, Cardiovascular, Renal and Metabolism (CVRM), Biopharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Magnus Bjursell
- Late-Stage Development, Cardiovascular, Renal, and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.,Present address: Global Medical Affairs, Cardiovascular, Renal, and Metabolism (CVRM), BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
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Wilk AS, Hu JC, Chehal P, Yarbrough CR, Ji X, Cummings JR. National Estimates of Mental Health Needs among Adults with Self-Reported Chronic Kidney Disease in the United States. Kidney Int Rep 2022; 7:1630-1642. [PMID: 35812303 PMCID: PMC9263246 DOI: 10.1016/j.ekir.2022.04.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 03/08/2022] [Accepted: 04/25/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Among adults with chronic kidney disease (CKD), comorbid mental illness is associated with poorer health outcomes and can impede access to transplantation. We provide the first US nationally representative estimates of the prevalence of mental illness and mental health (MH) treatment receipt among adults with self-reported CKD. Methods Using 2015 to 2019 National Survey on Drug Use and Health (NSDUH) data, we conducted an observational study of 152,069 adults (age ≥22 years) reporting CKD (n = 2544), with no reported chronic conditions (n = 117,235), or reporting hypertension (HTN) or diabetes mellitus (DM) but not CKD (HTN/DM, n = 32,290). We compared prevalence of (past-year) any mental illness, serious mental illness (SMI), MH treatment, and unmet MH care needs across the groups using logistic regression models. Results Approximately 26.6% of US adults reporting CKD also had mental illness, including 7.1% with SMI. When adjusting for individual characteristics, adults reporting CKD were 15.4 percentage points (PPs) and 7.3 PPs more likely than adults reporting no chronic conditions or HTN/DM to have any mental illness (P < 0.001) and 5.6 PPs (P < 0.001) and 2.2 PPs (P = 0.01) more likely to have SMI, respectively. Adults reporting CKD were also more likely to receive any MH treatment (21% vs. 12%, 18%, respectively) and to have unmet MH care needs (6% vs. 3%, 5%, respectively). Conclusion Mental illness is common among US adults reporting CKD. Enhanced management of MH needs could improve treatment outcomes and quality-of-life downstream.
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Affiliation(s)
- Adam S. Wilk
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Correspondence: Adam S. Wilk, Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, Georgia 30322, USA.
| | - Ju-Chen Hu
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Puneet Chehal
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Courtney R. Yarbrough
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Xu Ji
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Janet R. Cummings
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Xiong J, Peng H, Yu Z, Chen Y, Pu S, Li Y, Huang X, Tang X, He J, Shi Y, Zhao J. Daily walking dose and health-related quality of life in patients with chronic kidney disease. J Ren Nutr 2022; 32:710-717. [DOI: 10.1053/j.jrn.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/13/2021] [Accepted: 01/30/2022] [Indexed: 11/11/2022] Open
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Miao H, Liu L, Wang Y, Wang Y, He Q, Jafar TH, Tang S, Zeng Y, Ji JS. Chronic kidney disease biomarkers and mortality among older adults: A comparison study of survey samples in China and the United States. PLoS One 2022; 17:e0260074. [PMID: 35020733 PMCID: PMC8754291 DOI: 10.1371/journal.pone.0260074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 11/02/2021] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Among older adults in China and the US, we aimed to compare the biomarkers of chronic-kidney-diseases (CKD), factors associated with CKD, and the correlation between CKD and mortality. SETTING China and the US. STUDY DESIGN Cross-sectional and prospective cohorts. PARTICIPANTS We included 2019 participants aged 65 and above from the Chinese Longitudinal Healthy Longevity Study (CLHLS) in 2012, and 2177 from US National Health and Nutrition Examination Survey (NHANES) in 2011-2014. OUTCOMES Urinary albumin, urinary creatinine, albumin creatinine ratio (ACR), serum creatinine, blood urea nitrogen, plasma albumin, uric acid, and estimated glomerular filtration rate (eGFR). CKD (ACR ≥ 30 mg/g or eGFR< 60 ml/min/1.73m2) and mortality. ANALYTICAL APPROACH Logistic regression and Cox proportional hazard models. Covariates included age, sex, race, education, income, marital status, health condition, smoking and drinking status, physical activity and body mass index. RESULTS Chinese participants had lower levels of urinary albumin, ACR, and uric acid than the US (mean: 25.0 vs 76.4 mg/L, 41.7 vs 85.0 mg/g, 292.9 vs 341.3 μmol/L). In the fully-adjusted model, CKD was associated with the risk of mortality only in the US group (hazard ratio [HR], 95% CI: 2.179, 1.561-3.041 in NHANES, 1.091, 0.940-1.266 in CLHLS). Compared to eGFR≥90, eGFR ranged 30-44 ml/min/1.73m2 was only associated with mortality in the US population (HR, 95% CI: 2.249, 1.141-4.430), but not in the Chinese population (HR, 95% CI: 1.408, 0.884-2.241). CONCLUSIONS The elderly participants in the US sample had worse CKD-related biomarker levels than in China sample, and the association between CKD and mortality was also stronger among the US older adults. This may be due to the biological differences, or co-morbid conditions.
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Affiliation(s)
- Hui Miao
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Linxin Liu
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yeli Wang
- Health Services and Systems Research, Duke‐NUS Medical School, Singapore, Singapore
| | - Yucheng Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China
- School of Health Humanities, Peking University, Beijing, China
| | - Qile He
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tazeen Hasan Jafar
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Yi Zeng
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina, United States of America
- Center for Healthy Aging and Development Studies, and Raissun Institute for Advanced Studies, Peking University, Beijing, China
| | - John S. Ji
- Vanke School of Public Health, Tsinghua University, Beijing, China
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Wu YH, Hsu YJ, Tzeng WC. Physical Activity and Health-Related Quality of Life of Patients on Hemodialysis with Comorbidities: A Cross-Sectional Study. Int J Environ Res Public Health 2022; 19:ijerph19020811. [PMID: 35055633 PMCID: PMC8775483 DOI: 10.3390/ijerph19020811] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/08/2022] [Accepted: 01/09/2022] [Indexed: 01/27/2023]
Abstract
Patients on hemodialysis with multiple comorbidities have limited physical activity, resulting in poor health, low activity participation, and low quality of life. Accordingly, the nursing care provided to such patients should include regular physical activity training programs. Therefore, this cross-sectional descriptive study investigated whether patients on hemodialysis with and without comorbidities have different levels of physical activity and health-related quality of life (HRQoL); the correlations among the comorbidities, physical activity, and HRQoL of the two cohorts were also assessed. The 36-Item Short-Form Health Survey version 2 and International Physical Activity Questionnaire were employed to collect data from 120 patients on hemodialysis. An independent samples t-test and univariate and multivariate linear regression analyses were conducted. The overall HRQoL of patients with comorbidities was lower than that of patients without comorbidities (p = 0.008). Compared with patients who participated in low-intensity physical activity, the overall HRQoL of patients who participated in moderate-intensity physical activity was higher (p < 0.001). The overall HRQoL of patients with comorbidities who participated in low-intensity physical activity was lower than that of those who participated in moderate-intensity physical activity (p < 0.001). Moderate-intensity physical activity was correlated with higher HRQoL for patients with comorbidities. This finding supports the implementation of effective physical activity intervention measures. Furthermore, it supports the promotion of patient self-management and the implementation of regular exercise programs and lifestyle changes, and patients on hemodialysis can benefit from the future management of physical activities.
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Affiliation(s)
- Yu-Hui Wu
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 11490, Taiwan;
- Nursing Department, Tri-Service General Hospital, Taipei 11490, Taiwan
| | - Yu-Juei Hsu
- Nephrology Division, Tri-Service General Hospital, Taipei 11490, Taiwan;
- School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
| | - Wen-Chii Tzeng
- School of Nursing, National Defense Medical Center, Taipei 11490, Taiwan
- Correspondence:
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Feng X(S, Farej R, Dean BB, Xia F, Gaiser A, Kong SX, Elliott J, Lindemann S, Singh R. CKD Prevalence Among Patients With and Without Type 2 Diabetes: Regional Differences in the United States. Kidney Med 2022; 4:100385. [PMID: 35072048 PMCID: PMC8767132 DOI: 10.1016/j.xkme.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Rationale & Objective Regional variation in chronic kidney disease (CKD) prevalence in patients with or without type 2 diabetes mellitus (T2DM) has not been well characterized. Study Design Spatial and temporal comparative analysis. Setting & Participants MarketScan databases were used to identify patients with CKD overall and subgroups of patients with CKD with and without T2DM in the United States. Outcomes Spatial patterns in CKD prevalence based on year, regional clusters of CKD between years, and characteristics of patients in high-prevalence states. Analytical Approach Geomapping was used to visualize the state-level data of CKD prevalence generated from 2013 to 2018. We used univariate local indicators of spatial association (LISA) to evaluate geographic differences in prevalence, differential LISA for changes in CKD prevalence over time, and the χ2 test to identify patient characteristics in the top-20th percentile states for the prevalence of CKD. Results In univariate LISA, low-low clusters, in which a state has a low CKD prevalence and the surrounding states have a below-average CKD prevalence, were observed in the northwest region throughout the study period, regardless of the T2DM status, indicating a consistently low prevalence of CKD clustered in these areas. High-high clusters were observed, regardless of the T2DM status, in the southeast region in more recent years, suggesting an increased CKD prevalence in this region. Limitations Health care insurance enrollment might not have been representative of the United States; the estimates were based on claims data that likely underestimated the true prevalence. Conclusions Geographic disparities in CKD prevalence appear increasingly magnified, with an increase in the southeastern region of the United States. This increase is especially problematic because patients with CKD in high-prevalence states experience a greater likelihood of chronic conditions than those in the rest of the United States.
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Affiliation(s)
- Xue (Snow) Feng
- Bayer US LLC, Whippany, New Jersey
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | | | | | - Fang Xia
- Bayer US LLC, Whippany, New Jersey
| | | | | | | | | | - Rakesh Singh
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
- Address for Correspondence: Rakesh Singh, PhD, Bayer US LLC, 100 Bayer Blvd, Whippany, NJ 07981.
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Donald M, Beanlands H, Straus S, Harwood L, Herrington G, Waldvogel B, Delgado M, Sparkes D, Watson P, Elliott M, McBrien K, Bello A, Hemmelgarn B. A Research Protocol for Implementation and Evaluation of a Patient-Focused eHealth Intervention for Chronic Kidney Disease. Glob Implement Res Appl 2022; 2:85-94. [PMID: 35402999 PMCID: PMC8938369 DOI: 10.1007/s43477-022-00038-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/13/2022] [Indexed: 02/02/2023]
Abstract
Self-management in chronic kidney disease (CKD) can slow disease progression; however, there are few tools available to support patients with early CKD. My Kidneys My Health is a patient-focused electronic health (eHealth) self-management tool developed by patients and caregivers. This study will investigate the implementation of My Kidneys My Health across primary care and general nephrology clinics. The study aims to: (1) identify and address barriers and facilitators that may impact implementation and sustainability of the website into routine clinical care; (2) evaluate implementation quality to inform spread and scale-up. We will conduct a multi-stage approach using qualitative methods, guided by the Quality Implementation Framework and using a qualitative content analysis approach. First, we will identify perceived barriers and facilitators to implementation and considerations for sustainability through interviews with clinicians, based on the Readiness Thinking Tool and the Long Term Success Tool. Analysis will be guided by the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Appropriate implementation strategies will be identified using the Expert Recommendations for Implementing Change compilation, and implementation plans will be developed based on Proctor's recommendations and the Action, Actor, Context, Target, Time framework. Finally, we will explore implementation quality guided by the RE-AIM framework. There is limited literature describing systematic approaches to implementing and sustaining patient-focused self-management tools into clinical care, in addition to employing tailored implementation strategies to promote adoption and sustainability. We aim to generate insights on how My Kidneys My Health can be integrated into clinical care and how to sustain use of patient-centric eHealth tools in clinical settings on a larger scale. Supplementary Information The online version contains supplementary material available at 10.1007/s43477-022-00038-3.
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Affiliation(s)
- Maoliosa Donald
- Department of Medicine, University of Calgary, HSC G239, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Heather Beanlands
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON Canada
| | - Sharon Straus
- Department of Medicine, University of Toronto, Toronto, ON Canada
| | - Lori Harwood
- London Health Sciences Centre, London, ON Canada
| | | | | | | | | | - Paul Watson
- Can-SOLVE CKD Patient Partner, Vancouver, BC Canada
| | - Meghan Elliott
- Department of Medicine, University of Calgary, HSC G239, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Kerry McBrien
- Department of Family Medicine, University of Calgary, Calgary, AB Canada
| | - Aminu Bello
- Department of Medicine, University of Alberta, Edmonton, AB Canada
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Paik JM, Patorno E, Zhuo M, Bessette LG, York C, Gautam N, Kim DH, Kim SC. Accuracy of identifying diagnosis of moderate to severe chronic kidney disease in administrative claims data. Pharmacoepidemiol Drug Saf 2021; 31:467-475. [PMID: 34908211 DOI: 10.1002/pds.5398] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/18/2021] [Accepted: 12/12/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Prior validation studies of claims-based definitions of chronic kidney disease (CKD) using ICD-9 codes reported overall low sensitivity, high specificity, and variable but reasonable PPV. No studies to date have evaluated the accuracy of ICD-10 codes to identify a US patient population with CKD. METHODS We assessed the accuracy of claims-based algorithms to identify adults with CKD Stages 3-5 compared with laboratory values in a subset (~40%) of a US commercial insurance claims database (Optum's de-identified Clinformatics® Data Mart Database). We calculated the positive predictive value (PPV) of one or two ICD-9 (2012-2014) or ICD-10 (2016-2018) codes for CKD compared with a lab-based estimated glomerular filtration rate (eGFR) occurring within prespecified windows (±90 days, ±180 days, ±365 days) of the ICD-based CKD code(s). RESULTS The study population ranged between 104 774 and 161 305 patients (ICD-9 cohorts) and between 285 520 and 373 220 patients (ICD-10 cohorts). The mean age was 74.4 years (ICD-9) and 75.6 years (ICD-10) and the median eGFR was 48 ml/min/1.73 m2 . The algorithm of two CKD codes compared with a lab value ±90 days of the first code achieved the highest PPV (PPV 86.36% [ICD-9] and 86.07% [ICD-10]). Overall, ICD-10 based codes had comparable PPVs to ICD-9 based codes and all ICD-10 based algorithms had PPVs >80%. The algorithm of one CKD code compared with laboratory value ±180 days maintained the PPV above 80% but still retained a large number of patients (PPV 80.32% [ICD-9] and 81.56% [ICD-10]). CONCLUSION An ICD-10-based definition of CKD identified with sufficient accuracy a patient population with CKD Stages 3-5. Our findings suggest that claims databases could be used for future real-world research studies in patients with CKD Stages 3-5.
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Affiliation(s)
- Julie M Paik
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.,New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Min Zhuo
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Renal Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Lily G Bessette
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Cassandra York
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nileesa Gautam
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Dae Hyun Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Seoyoung C Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Lin YK, Zafirah Y, Ke MT, Andhikaputra G, Wang YC. The effects of extreme temperatures on emergency room visits-a population-based analysis by age, sex, and comorbidity. Int J Biometeorol 2021; 65:2087-2098. [PMID: 34173056 DOI: 10.1007/s00484-021-02166-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/02/2021] [Accepted: 06/16/2021] [Indexed: 06/13/2023]
Abstract
This study evaluated the effect of extreme temperatures on events requiring emergency room visits (ERVs) for hypertensive disease, ischemic heart disease (IHD), cerebrovascular disease, and chronic kidney disease (CKD) for population stratified by sex and age living in Taiwan's metropolitan city from 2000 to 2014. The distributed lag non-linear model was adopted to examine the association between ambient temperature and area-age-sex-disease-specific ERVs for a population aged 40 years and above. The reference temperature was defined by a percentile value to describe the temperature in each city. Area-age-sex-disease-specific relative risk (RR) and 95% confidence intervals (CI) were estimated in association with extreme high (99th percentile) and low (5th percentile) temperatures. Temperature-related ERV risks varied by area, age, sex, and disease. Patients with CKD tend to have comorbidities with hypertensive disease. All study populations with hypertensive disease have significant risk associations with extreme low temperatures with the highest RR of 2.64 (95% CI: 2.08, 3.36) appearing in New Taipei City. The risk of IHD was significantly associated with extreme high temperature for male subpopulation aged 40-64 years. A less significant association was observed between the risks of cerebrovascular disease with extreme temperature. The risk of CKD was most significantly associated with extreme high temperature especially for a subpopulation aged 40-64 years. All study subpopulations with hypertensive disease have significant risk associations with extreme low temperature. Male subpopulations were more vulnerable to extreme temperatures, especially for those aged 40-64 years.
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Affiliation(s)
- Yu-Kai Lin
- Department of Health and Welfare, University of Taipei, 101 Zhongcheng Road Sec. 2, Taipei, 111, Taiwan
| | - Yasmin Zafirah
- Department of Environmental Engineering, College of Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Zhongli, 320, Taiwan
| | - Meng-Ting Ke
- Department of Environmental Engineering, College of Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Zhongli, 320, Taiwan
| | - Gerry Andhikaputra
- Department of Environmental Engineering, College of Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Zhongli, 320, Taiwan
| | - Yu-Chun Wang
- Department of Environmental Engineering, College of Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Zhongli, 320, Taiwan.
- Research Center for Environmental Changes, Academia Sinica, 128 Academia Road, Section 2, Nankang, Taipei, 11529, Taiwan.
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Kimura H, Tanaka K, Saito H, Iwasaki T, Oda A, Watanabe S, Kanno M, Shimabukuro M, Asahi K, Watanabe T, Kazama JJ. Association of Polypharmacy with Kidney Disease Progression in Adults with CKD. Clin J Am Soc Nephrol 2021; 16:1797-1804. [PMID: 34782408 PMCID: PMC8729486 DOI: 10.2215/cjn.03940321] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 09/17/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Polypharmacy is common in patients with CKD and reportedly associated with adverse outcomes. However, its effect on kidney outcomes among patients with CKD has not been adequately elucidated. Hence, this investigation was aimed at exploring the association between polypharmacy and kidney failure requiring KRT. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS We retrospectively examined 1117 participants (median age, 66 years; 56% male; median eGFR, 48 ml/min per 1.73 m2) enrolled in the Fukushima CKD Cohort Study to investigate the association between the number of prescribed medications and adverse outcomes such as kidney failure, all-cause mortality, and cardiovascular events in Japanese patients with nondialysis-dependent CKD. Polypharmacy and hyperpolypharmacy were defined as the regular use of 5-9 and ≥10 medications per day, respectively. RESULTS The median number of medications was eight; the prevalence of polypharmacy and hyperpolypharmacy was each 38%. During the observation period (median, 4.8 years), 120 developed kidney failure, 153 developed cardiovascular events, and 109 died. Compared with the use of fewer than five medications, adjusted hazard ratios (95% confidence intervals) associated with polypharmacy and hyperpolypharmacy were 2.28 (1.00 to 5.21) and 2.83 (1.21 to 6.66) for kidney failure, 1.60 (0.85 to 3.04) and 3.02 (1.59 to 5.74) for cardiovascular events, and 1.25 (0.62 to 2.53) and 2.80 (1.41 to 5.54) for all-cause mortality. CONCLUSIONS The use of a high number of medications was associated with a high risk of kidney failure, cardiovascular events, and all-cause mortality in Japanese patients with nondialysis-dependent CKD under nephrology care.
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Affiliation(s)
- Hiroshi Kimura
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan
| | - Kenichi Tanaka
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan,Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Fukushima, Japan
| | - Hirotaka Saito
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan
| | - Tsuyoshi Iwasaki
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan
| | - Akira Oda
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan
| | - Shuhei Watanabe
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan
| | - Makoto Kanno
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan,Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Fukushima, Japan
| | - Michio Shimabukuro
- Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Fukushima, Japan,Department of Diabetes, Endocrinology and Metabolism, Fukushima Medical University, Fukushima, Japan
| | - Koichi Asahi
- Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Fukushima, Japan,Division of Nephrology and Hypertension, Iwate Medical University, Yahaba, Japan
| | - Tsuyoshi Watanabe
- Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Fukushima, Japan
| | - Junichiro James Kazama
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan,Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Fukushima, Japan
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Sullivan MK, Jani BD, McConnachie A, Hanlon P, McLoone P, Nicholl BI, Carrero JJ, Nitsch D, McAllister D, Mair FS, Mark PB. Hospitalisation events in people with chronic kidney disease as a component of multimorbidity: parallel cohort studies in research and routine care settings. BMC Med 2021; 19:278. [PMID: 34794437 DOI: 10.1186/s12916-021-02147-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/29/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) typically co-exists with multimorbidity (presence of 2 or more long-term conditions: LTCs). The associations between CKD, multimorbidity and hospitalisation rates are not known. The aim of this study was to examine hospitalisation rates in people with multimorbidity with and without CKD. Amongst people with CKD, the aim was to identify risk factors for hospitalisation. METHODS Two cohorts were studied in parallel: UK Biobank (a prospective research study: 2006-2020) and Secure Anonymised Information Linkage Databank (SAIL: a routine care database, Wales, UK: 2011-2018). Adults were included if their kidney function was measured at baseline. Nine categories of participants were used: zero LTCs; one, two, three and four or more LTCs excluding CKD; and one, two, three and four or more LTCs including CKD. Emergency hospitalisation events were obtained from linked hospital records. RESULTS Amongst 469,339 UK Biobank participants, those without CKD had a median of 1 LTC and those with CKD had a median of 3 LTCs. Amongst 1,620,490 SAIL participants, those without CKD had a median of 1 LTC and those with CKD had a median of 5 LTCs. Compared to those with zero LTCs, participants with four or more LTCs (excluding CKD) had high event rates (rate ratios UK Biobank 4.95 (95% confidence interval 4.82-5.08)/SAIL 3.77 (3.71-3.82)) with higher rates if CKD was one of the LTCs (rate ratios UK Biobank 7.83 (7.42-8.25)/SAIL 9.92 (9.75-10.09)). Amongst people with CKD, risk factors for hospitalisation were advanced CKD, age over 60, multiple cardiometabolic LTCs, combined physical and mental LTCs and complex patterns of multimorbidity (LTCs in three or more body systems). CONCLUSIONS People with multimorbidity have high rates of hospitalisation. Importantly, the rates are two to three times higher when CKD is one of the multimorbid conditions. Further research is needed into the mechanism underpinning this to inform strategies to prevent hospitalisation in this very high-risk group.
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Sullivan MK, Jani BD, Lees JS, Welsh CE, McConnachie A, Stanley B, Welsh P, Nicholl BI, Lyall DM, Carrero JJ, Nitsch D, Sattar N, Mair FS, Mark PB. Multimorbidity and the risk of major adverse kidney events: findings from the UK Biobank cohort. Clin Kidney J 2021; 14:2409-2419. [PMID: 34754437 PMCID: PMC8573008 DOI: 10.1093/ckj/sfab079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/22/2020] [Indexed: 01/28/2023] Open
Abstract
Background Multimorbidity [the presence of two or more long-term conditions (LTCs)] is associated with a heightened risk of mortality, but little is known about its relationship with the risk of kidney events. Methods Associations between multimorbidity and major adverse kidney events [MAKE: the need for long-term kidney replacement therapy, doubling of serum creatinine, fall of estimated glomerular filtration rate (eGFR) to <15 mL/min/1.73 m2 or 30% decline in eGFR] were studied in 68 505 participants from the UK Biobank cohort. Participants were enrolled in the study between 2006 and 2010. Associations between LTC counts and MAKE were tested using survival analyses accounting for the competing risk of death. Results Over a median follow-up period of 12.0 years, 2963 participants had MAKE. There were associations between LTC count categories and the risk of MAKE [one LTC adjusted subhazard ratio (sHR) = 1.29, 95% confidence interval (CI) 1.15–1.45; two LTCs sHR = 1.74 (95% CI 1.55–1.96); and three or more LTCs sHR = 2.41 (95% CI 2.14–2.71)]. This finding was more pronounced when only cardiometabolic LTCs were considered [one LTC sHR = 1.58 (95% CI 1.45–1.73); two LTCs sHR = 3.17 (95% CI 2.80–3.59); and three or more LTCs sHR = 5.24 (95% CI 4.34–6.33)]. Combinations of LTCs associated with MAKE were identified. Diabetes, hypertension and coronary heart disease featured most commonly in high-risk combinations. Conclusions Multimorbidity, and in particular cardiometabolic multimorbidity, is a risk factor for MAKE. Future research should study groups of patients who are at high risk of progressive kidney disease based on the number and type of LTCs.
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Affiliation(s)
- Michael K Sullivan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Bhautesh Dinesh Jani
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jennifer S Lees
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Claire E Welsh
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Bethany Stanley
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Barbara I Nicholl
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Donald M Lyall
- Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Swedenand
| | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Patrick B Mark
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Schick-Makaroff K, Wozniak LA, Short H, Davison SN, Klarenbach S, Buzinski R, Walsh M, Johnson JA. Burden of mental health symptoms and perceptions of their management in in-centre hemodialysis care: a mixed methods study. J Patient Rep Outcomes 2021; 5:111. [PMID: 34709470 PMCID: PMC8555046 DOI: 10.1186/s41687-021-00385-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/07/2021] [Indexed: 01/01/2023] Open
Abstract
Background We aimed to describe (1) depressive and anxiety symptom burdens reported by adults on in-centre hemodialysis in Northern Alberta, Canada and (2) patients’ and nurses’ perceptions of managing such symptoms using routine patient-reported outcome measures (PROMs). Methods A longitudinal mixed methods approach was employed. Cluster randomized controlled trial data exposed the prevalence of positive screens (scores ≥ 3) for depressive (PHQ-2) and anxiety (GAD-2) symptoms. A descriptive qualitative approach was used to understand patients’ and nurses’ perceptions of managing these symptoms using the ESAS-r: Renal and EQ-5D-5L. Using purposeful sampling, patients and nurses were invited for interviews. Field notes were documented from 6 dialysis unit observations. Patients’ responses to open-ended survey questions and nurses’ electronic chart notes related to mental health were compiled. Thematic and content analyses were used. Results Average age of patients (n = 408) was 64.0 years (SD 15.4), 57% were male, and 87% were not working; 29% screened positive for depressive symptoms, 21% for anxiety symptoms, and 16% for both. From patient (n = 10) and nurse (n = 8) interviews, unit observations, patient survey responses (n = 779) and nurses’ chart notes (n = 84), we discerned that PROMs (ESAS-r: Renal/EQ-5D-5L) had the potential to identify and prompt management of mental health concerns. However, opinions differed about whether mental health was within kidney care scope. Nonetheless, participants agreed there was a lack of mental health resources. Conclusions Prevalence of depressive and anxiety symptoms aligned with existing literature. Tensions regarding mental health management highlight the need for systemic decisions about how routine PROM use, including mental health assessment, may be optimized to meet patients’ needs. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-021-00385-z.
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Affiliation(s)
- Kara Schick-Makaroff
- 5-295 Edmonton Clinic Health Academy, Faculty of Nursing, University of Alberta, Edmonton, AB, T6G 1C9, Canada
| | - Lisa A Wozniak
- 2-040 Li Ka Shing Centre for Health Research Innovation, School of Public Health, University of Alberta, Edmonton, AB, T6G 2E1, Canada
| | - Hilary Short
- 2-040 Li Ka Shing Centre for Health Research Innovation, School of Public Health, University of Alberta, Edmonton, AB, T6G 2E1, Canada
| | - Sara N Davison
- 11-113L Clinical Sciences Building, Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, T6G 2G3, Canada
| | - Scott Klarenbach
- 11-107 Clinical Sciences Building, Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, T6G 2G3, Canada
| | | | - Michael Walsh
- Division of Nephrology, Department of Medicine, McMaster University, Marion Wing, Level 3, St. Joseph's Healthcare, 50 Charlton Ave. E., Hamilton, ON, L8N 4A6, Canada
| | - Jeffrey A Johnson
- 2-040 Li Ka Shing Centre for Health Research Innovation, School of Public Health, University of Alberta, Edmonton, AB, T6G 2E1, Canada.
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Nguyen VTH, Sriyuktasuth A, Phligbua W. Risk factors associated with uncontrolled blood pressure among patients with non-dialysis chronic kidney disease in Vietnam. Belitung Nurs J 2021; 7:370-379. [PMID: 37496500 PMCID: PMC10367987 DOI: 10.33546/bnj.1611] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/18/2021] [Accepted: 09/12/2021] [Indexed: 07/28/2023] Open
Abstract
Background Uncontrolled blood pressure rates are high in patients with non-dialysis chronic kidney disease, worsening the disease progression and leading to end-stage renal disease. However, studies on uncontrolled blood pressure in patients with non-dialysis chronic kidney disease and its associated factors in Vietnam are scarce.Objectives: This study aimed at identifying uncontrolled blood pressure rates and risk factors associated with uncontrolled blood pressure among Vietnamese patients with non-dialysis chronic kidney disease. Methods A cross-sectional, correlational study design was employed among 182 participants coming to follow up at two tertiary hospitals in Vietnam. The participants were selected by a convenience sampling technique. Data were collected using Participant Demographic Information Form, Clinical Characteristics Form, Alcohol Use Disorders Identification Test, Pittsburgh Sleep Quality Index, Charlson Comorbidity Index, and an automated office oscillometric upper arm device. Descriptive statistics, Chi-square, Fisher's Exact Test, and binary logistic regression were used to analyze the data. Results 63.2% of the participants could not control their BP less than 130/80 mmHg. Poor sleep quality (OR 2.076, 95%CI 1.059-4.073, p=.034) and severe comorbidities (OR 2.926, 95%CI 1.248-6.858, p=.013) were risk factors associated with uncontrolled blood pressure among Vietnamese patients with non-dialysis chronic kidney disease. Interestingly, the study found a high rate of awareness toward the importance of blood pressure control but a low rate of known blood pressure targets. Conclusion Uncontrolled blood pressure rates among Vietnamese patients with non-dialysis chronic kidney disease were high. Sleep quality and comorbidity severity were significantly associated with uncontrolled blood pressure in this population. To achieve blood pressure targets, nurses and other healthcare providers should pay more attention to the patients with poor sleep quality and severe comorbidities.
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Affiliation(s)
| | | | - Warunee Phligbua
- Department of Medical Nursing, Faculty of Nursing, Mahidol University, Thailand
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Chung CY, Wu PH, Chiu YW, Hwang SJ, Lin MY. Effect of Nephrology Care on Mortality in Incident Dialysis Patients: A Population-Based Cohort Study. J Pers Med 2021; 11:1071. [PMID: 34834424 DOI: 10.3390/jpm11111071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 12/02/2022] Open
Abstract
Long-term and continuous nephrology care effects on post-dialysis mortality remain unclear. This study aims to systematically explore the causal effect of nephrology care on mortality for patients with dialysis initiation. We conducted a retrospective cohort study to include incident patients with dialysis for ≥ 3 months in Taiwan from 2004 through 2011. The continuous nephrology care of incident patients in the three years before their dialysis was measured every six months. Continuous nephrology care was determined by 0–6, 0–12, …, 0–36 months and their counterparts; and none, intermittent, 0–6 months, …, and 0–36 months. Simple and weighted hazards ratio (HR) and 95% confidence interval (CI) for one-year mortality were estimated after propensity score (PS) matching. We included a total of 44,698 patients (mean age 63.3 ± 14.2, male 51.9%). Receiving ≥ 1 year predialysis nephrology care was associated with a 22% lower post-dialysis mortality hazard. No different effects were found (ranges of PS matching HR: 0.77–0.80) when comparing the defined duration of nephrology care with their counterparts. Stepped survival benefits were newly identified in the intermittent care, which had slightly lower HRs (weighted HR: 0.88, 95% CI: 0.79–0.97), followed by reviving care over six months to two years (ranges of weighted HR: 0.60–0.65), and reviving care over two years (ranges of weighted HR: 0.48–0.52). There was no existing critical period of nephrology care effect on post-dialysis, but there were extra survival benefits when extending nephrology care to >2 years, which suggests that continuous and long-term care during pre-dialysis/chronic kidney disease phase is required.
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Chang YS, Li YH, Lee IT. A synergistic effect of variability in estimated glomerular filtration rate with chronic kidney disease on all-cause mortality prediction in patients with type 2 diabetes: a retrospective cohort study. Cardiovasc Diabetol 2021; 20:209. [PMID: 34663321 PMCID: PMC8524871 DOI: 10.1186/s12933-021-01399-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/08/2021] [Indexed: 12/28/2022] Open
Abstract
Background The combination of diabetes mellitus (DM) and chronic kidney disease (CKD) is associated with a high risk of mortality. Annual assessment of the estimated glomerular filtration rate (eGFR) is recommended for patients with DM. We investigated the effect of variability in annual eGFR values on all-cause mortality in patients with type 2 DM. Methods In this retrospective cohort study, we enrolled patients with eGFR data between 01 Aug 2017 and 31 July 2018. We defined the index eGFR as the first available eGFR value within the enrollment year and collected additional annual eGFR data from the previous three years. A total of 3592 patients with type 2 DM were enrolled, including 959 patients with CKD (index eGFR < 60 mL/min/1.73 m2) and 2633 patients without CKD. We assessed eGFR variability by using the standard deviation (SD) of the three annual eGFR and index eGFR values. We divided patients into subgroups according to the median SD of their annual eGFR (7.62 mL/min/1.73 m2). The primary endpoint was all-cause mortality after the index eGFR was assessed. Results During a median follow-up of 19 months (interquartile range: 18‒20 months), 127 (3.5%) deaths occurred among all 3592 enrolled patients. The highest mortality risk was observed in the high SD with CKD group, with a hazard ratio (HR) of 2.382 [95% confidence interval (CI) 1.346‒4.215] in comparison to the low SD without CKD group after adjusting for the associated factors. In patients without CKD, a high SD was an independent risk factor for mortality (HR = 2.105, 95% CI 1.256‒3.528). According to the C-index, the mortality prediction ability was better for the index eGFR + SD model than for the index eGFR alone model (0.671 vs. 0.629, P < 0.001). Conclusion There was a synergistic effect of eGFR variability with single-measured eGFR for the prediction of mortality in patients with type 2 DM. The SD of the annual eGFR values was also an independent predictor of mortality in patients with an eGFR > 60 mL/min/1.73 m2. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01399-z.
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Affiliation(s)
- Yu-Shan Chang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Boulevard, Taichung, 40705, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung City, 40201, Taiwan
| | - Yu-Hsuan Li
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Boulevard, Taichung, 40705, Taiwan.,Department of Computer Science and Information Engineering, National Taiwan University, Taipei, 10617, Taiwan
| | - I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Boulevard, Taichung, 40705, Taiwan. .,School of Medicine, Chung Shan Medical University, Taichung City, 40201, Taiwan. .,School of Medicine, National Yang Ming Chiao Tung University, Taipei, 11221, Taiwan.
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Wang ZF, Cheng YC, Zhang NH, Luo R, Guo KL, Ge SW, Xu G. Effect of Marital Status on Depression and Mortality among Patients with Chronic Kidney Disease from National Health and Nutrition Examination Survey 2005-2014. Kidney Dis (Basel) 2021; 7:391-400. [PMID: 34604345 DOI: 10.1159/000515440] [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] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/22/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The relationship between marital status and CKD is rarely studied. We aimed to explore the effect of marital status on the depression and mortality of patients with CKD. METHODS The data sources came from the NHANES database during 2005-2014 and 3,865 participants were included in this study. We used logistic regression models to examine the relationship between marital status and depression of CKD patients. The Cox proportional hazard models were used to evaluate the association between marital status and mortality of CKD patients. RESULTS In terms of depression in CKD patients, unmarried patients had a worse situation than married patients. Meanwhile, after adjusting the covariables, unmarried patients had increased risk of depression (OR = 1.26, 95% CI: 1.01-1.57) compared with married CKD patients, especially in males (OR = 1.45, 95% CI: 1.02-2.06) and patients with more than college education level (OR = 12.4, 95% CI: 3.75-41.02). There was a significant relationship between marital status and mortality of general CKD patients (HR = 1.36, 95% CI: 1.17-1.58). Moreover, marriage showed a protective effect against death among male patients, patients with school graduate or less and more than college educational level, patients with high income, and patients in different estimated glomerular filtration rate groups. CONCLUSIONS The use of large numbers of participants has revealed the effect of marital status on CKD patients. Unmarried ones had a higher risk of depression than married ones among CKD patients. Meanwhile, the risk of death was higher in unmarried ones than married ones among CKD patients in this study.
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Affiliation(s)
- Zu-Feng Wang
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi-Chun Cheng
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nan-Hui Zhang
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ran Luo
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kang-Lin Guo
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shu-Wang Ge
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Xu
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Kotsis F, Schultheiss UT, Wuttke M, Schlosser P, Mielke J, Becker MS, Oefner PJ, Karoly ED, Mohney RP, Eckardt KU, Sekula P, Köttgen A. Self-Reported Medication Use and Urinary Drug Metabolites in the German Chronic Kidney Disease (GCKD) Study. J Am Soc Nephrol 2021; 32:2315-2329. [PMID: 34140400 PMCID: PMC8729827 DOI: 10.1681/asn.2021010063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/31/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Polypharmacy is common among patients with CKD, but little is known about the urinary excretion of many drugs and their metabolites among patients with CKD. METHODS To evaluate self-reported medication use in relation to urine drug metabolite levels in a large cohort of patients with CKD, the German Chronic Kidney Disease study, we ascertained self-reported use of 158 substances and 41 medication groups, and coded active ingredients according to the Anatomical Therapeutic Chemical Classification System. We used a nontargeted mass spectrometry-based approach to quantify metabolites in urine; calculated specificity, sensitivity, and accuracy of medication use and corresponding metabolite measurements; and used multivariable regression models to evaluate associations and prescription patterns. RESULTS Among 4885 participants, there were 108 medication-drug metabolite pairs on the basis of reported medication use and 78 drug metabolites. Accuracy was excellent for measurements of 36 individual substances in which the unchanged drug was measured in urine (median, 98.5%; range, 61.1%-100%). For 66 pairs of substances and their related drug metabolites, median measurement-based specificity and sensitivity were 99.2% (range, 84.0%-100%) and 71.7% (range, 1.2%-100%), respectively. Commonly prescribed medications for hypertension and cardiovascular risk reduction-including angiotensin II receptor blockers, calcium channel blockers, and metoprolol-showed high sensitivity and specificity. Although self-reported use of prescribed analgesics (acetaminophen, ibuprofen) was <3% each, drug metabolite levels indicated higher usage (acetaminophen, 10%-26%; ibuprofen, 10%-18%). CONCLUSIONS This comprehensive screen of associations between urine drug metabolite levels and self-reported medication use supports the use of pharmacometabolomics to assess medication adherence and prescription patterns in persons with CKD, and indicates under-reported use of medications available over the counter, such as analgesics.
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Affiliation(s)
- Fruzsina Kotsis
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center – University of Freiburg, Freiburg, Germany,Department of Medicine IV: Nephrology and Primary Care, Faculty of Medicine and Medical Center – University of Freiburg, Freiburg, Germany
| | - Ulla T. Schultheiss
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center – University of Freiburg, Freiburg, Germany,Department of Medicine IV: Nephrology and Primary Care, Faculty of Medicine and Medical Center – University of Freiburg, Freiburg, Germany
| | - Matthias Wuttke
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center – University of Freiburg, Freiburg, Germany,Department of Medicine IV: Nephrology and Primary Care, Faculty of Medicine and Medical Center – University of Freiburg, Freiburg, Germany
| | - Pascal Schlosser
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center – University of Freiburg, Freiburg, Germany
| | - Johanna Mielke
- Division of Pharmaceuticals, Open Innovation and Digital Technologies, Bayer AG, Wuppertal, Germany
| | - Michael S. Becker
- Division of Pharmaceuticals, Cardiovascular Research, Bayer AG, Wuppertal, Germany
| | - Peter J. Oefner
- Institute of Functional Genomics, University of Regensburg, Regensburg, Germany
| | | | | | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité – Berlin University of Medicine, Berlin, Germany,Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich–Alexander University Erlangen–Nürnberg, Erlangen, Germany
| | - Peggy Sekula
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center – University of Freiburg, Freiburg, Germany
| | - Anna Köttgen
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center – University of Freiburg, Freiburg, Germany
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Sowa PM, Venuthurupalli SK, Hoy WE, Zhang J, Cameron A, Healy HG, Connelly LB. Identification of factors associated with high-cost use of inpatient care in chronic kidney disease: a registry study. BMJ Open 2021; 11:e049755. [PMID: 34413105 PMCID: PMC8378349 DOI: 10.1136/bmjopen-2021-049755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To explore factors behind inpatient admissions by high-cost users (HCUs) in pre-end-stage chronic kidney disease (CKD). DESIGN Retrospective analysis of CKD.QLD Registry and hospital admissions of the Queensland Government Department of Health recorded between 1 July 2011 and 30 June 2016. SETTING Queensland public and private hospitals. PARTICIPANTS 5096 individuals with CKD who consented to the CKD.QLD Registry via 1 of 11 participating sites. MAIN OUTCOMES Associations of HCU status with patient characteristics, pathways and diagnoses behind hospital admissions at 12 months. RESULTS Age, advanced CKD, primary renal diagnosis, cardiovascular disease and hypertension were predictors of the high-cost outcome. HCUs were more likely than non-HCUs to be admitted by means of episode change (relative risk: 5.21; 95% CI 5.02 to 5.39), 30-day readmission (2.19; 2.13 to 2.25), scheduled readmission (1.29; 1.11 to 1.46) and emergency (1.07; 1.02 to 1.13), for diagnoses of the nervous (1.94; 1.74 to 2.15), circulatory (1.24; 1.14 to 1.34) and respiratory (1.2; 1.03 to 1.37) systems and other factors influencing health status (1.92; 1.74 to 2.09). CONCLUSIONS The high relevance of episode change and other factors influencing health status revealed that a substantial part of excess demand for inpatient care was associated with discordant conditions often linked to frailty, decline in psychological health and social vulnerability. This suggests that multidisciplinary models of care that aim to manage discordant comorbidities and address psychosocial determinants of health, such as renal supportive care, may play an important role in reducing inpatient admissions in this population.
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Affiliation(s)
- P Marcin Sowa
- NHMRC Chronic Kidney Disease Centre of Research Excellence, The University of Queensland, Herston, Queensland, Australia
- Centre for the Business and Economics of Health, The University of Queensland, St Lucia, Queensland, Australia
| | - Sree K Venuthurupalli
- NHMRC Chronic Kidney Disease Centre of Research Excellence, The University of Queensland, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Wendy E Hoy
- NHMRC Chronic Kidney Disease Centre of Research Excellence, The University of Queensland, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Jianzhen Zhang
- NHMRC Chronic Kidney Disease Centre of Research Excellence, The University of Queensland, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Anne Cameron
- NHMRC Chronic Kidney Disease Centre of Research Excellence, The University of Queensland, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Helen G Healy
- NHMRC Chronic Kidney Disease Centre of Research Excellence, The University of Queensland, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Luke B Connelly
- NHMRC Chronic Kidney Disease Centre of Research Excellence, The University of Queensland, Herston, Queensland, Australia
- Centre for the Business and Economics of Health, The University of Queensland, St Lucia, Queensland, Australia
- Department of Sociology and Business Law, The University of Bologna, Bologna, Italy
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