65 results on '"Pecoits-Filho, Roberto"'
Search Results
2. List of Contributors
- Author
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Abramovitz, Blaise, primary, Adu, Dwomoa, additional, Afshinnia, Farsad, additional, Agarwal, Anupam, additional, Andrews, Sarah C., additional, Appel, Gerald, additional, Bailey, James L., additional, Bakris, George L., additional, Bauer, Carolyn A., additional, Baxi, Pravir V., additional, Berns, Jeffrey S., additional, Birks, Peter, additional, Bomback, Andrew, additional, Bose, Anirban, additional, Brosius, Frank C., additional, Brown, Lee K., additional, Bushinsky, David A., additional, Busse, Laurence W., additional, Campbell, Ruth C., additional, Canney, Mark, additional, Cathro, Helen, additional, Chávez-Iñiguez, Jonathan, additional, Chawla, Lakhmir S., additional, Chen, Sheldon, additional, Chertow, Glenn M., additional, Chew, Emily Y., additional, Chonchol, Michel, additional, Clegg, Deborah J., additional, Clive, David M., additional, Clive, Pia H., additional, Cohen, Scott D., additional, Collins, Ashte' K., additional, Cooper, James E., additional, Correa-Rotter, Ricardo, additional, Cukor, Daniel, additional, Dalal, Monica, additional, Davenport, Andrew, additional, Davis, Scott, additional, Davison, Sara N., additional, Delanaye, Pierre, additional, de Zeeuw, Dick, additional, Dobre, Mirela A., additional, Drawz, Paul, additional, Ebert, Natalie, additional, Eggers, Paul, additional, Ferrè, Silvia, additional, Freedman, Barry I., additional, Furth, Susan L., additional, Gao, Bixia, additional, García-García, Guillermo, additional, Gashti, Casey N., additional, Germino, Gregory G., additional, Goldsmith, David, additional, Golestaneh, Ladan, additional, Goligorsky, Michael S., additional, Greenberg, Arthur, additional, Gregg, L. Parker, additional, Guay-Woodford, Lisa M., additional, Hamm, Lee, additional, Hart, Allyson, additional, Haselby, Danielle, additional, Hedayati, S. Susan, additional, Heerspink, Hiddo J.L., additional, Herzog, Charles A., additional, Hostetter, Thomas H., additional, House, Andrew A., additional, Hruska, Keith A., additional, Ishani, Areef, additional, Isom, Robert T., additional, James, Matthew T., additional, Jhaveri, Kenar D., additional, Johansen, Kirsten, additional, Johnson, Richard J., additional, Kang, Duk-Hee, additional, Kanno, Hiroko, additional, Kanno, Yoshihiko, additional, Karambelkar, Amrita D., additional, Karet Frankl, Fiona E., additional, Khoury, Charbel C., additional, Kimmel, Paul L., additional, Kopp, Jeffrey B., additional, Korbet, Stephen M., additional, Kruzel-Davila, Etty, additional, Kummer, Andrew, additional, LaFave, Laura, additional, Lakkis, Jay I., additional, Lerman, Lilach O., additional, Levin, Adeera, additional, Lew, Susie Q., additional, Luyckx, Valerie A., additional, Mattoo, Tej K., additional, Maynard, Sharon E., additional, McCullough, Peter A., additional, Mehrotra, Rajnish, additional, Meyer, Timothy W., additional, Mitch, William E., additional, Moe, Orson W., additional, Mohandes, Samer, additional, Moss, Alvin H., additional, Moxey-Mims, Marva, additional, Murugapandian, Sangeetha, additional, Nath, Karl A., additional, Neugarten, Joel, additional, Neyra, Javier A., additional, Nissenson, Allen R., additional, Nobakht, Ehsan, additional, Nolin, Thomas D., additional, Norris, Keith C., additional, Norton, Jenna M., additional, Nowak, Kristen L., additional, Ojo, Akinlolu O., additional, Pahl, Madeleine V., additional, Paller, Mark S., additional, Palmer, Biff F., additional, Palmer, Nicholette D., additional, Patel, Samir S., additional, Pecoits-Filho, Roberto, additional, Peitzman, Steven J., additional, Peixoto, Aldo J., additional, Pham, Phuong-Thu T., additional, Pham, Phuong-Chi T., additional, Piraino, Beth, additional, Pisoni, Roberto, additional, Rabelink, Ton, additional, Radhakrishnan, Jai, additional, Rahman, Mahboob, additional, Raj, Dominic S., additional, Ramírez-Sandoval, Juan C., additional, Rangaswami, Janani, additional, Reckelhoff, Jane F., additional, Regunathan-Shenk, Renu, additional, Reule, Scott, additional, Ronco, Claudio, additional, Rosenberg, Mark E., additional, Rosner, Mitchell H., additional, Rovin, Brad, additional, Roy-Chaudhury, Prabir, additional, Ruebner, Rebecca, additional, Rule, Andrew D., additional, Sands, Jeff M., additional, Schlanger, Lynn E., additional, Schrauben, Sarah J., additional, Seliger, Stephen, additional, Shah, Maulin, additional, Sterns, Richard H., additional, Stites, Erik, additional, Sugatani, Toshifumi, additional, Textor, Stephen C., additional, Thadhani, Ravi, additional, Thajudeen, Bijin, additional, Thakar, Surabhi, additional, Thomas, George, additional, Townsend, Raymond R., additional, Turner, Jeffrey, additional, Unruh, Mark L., additional, Urquhart, Bradley L., additional, Vassalotti, Joseph A., additional, Vaziri, Nosratola D., additional, Velasquez, Manuel T., additional, Ver Halen, Nisha, additional, Waddy, Salina P., additional, Wang, Jinwei, additional, Weber, Marc, additional, Weir, Matthew R., additional, White, Christine A., additional, Whittier, William L., additional, Williams, Matthew J., additional, Wiseman, Alexander C., additional, Wymer, David C., additional, Wymer, David T.G., additional, Yee, Jerry, additional, Zhang, Luxia, additional, Zhuang, Shougang, additional, and Ziyadeh, Fuad N., additional
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- 2020
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3. Trends and perspectives for improving quality of chronic kidney disease care: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference
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Eckardt, Kai-Uwe; https://orcid.org/0000-0003-3823-0920, Delgado, Cynthia, Heerspink, Hiddo J L, Pecoits-Filho, Roberto, Ricardo, Ana C, Stengel, Bénédicte, Tonelli, Marcello, Cheung, Michael, Jadoul, Michel, Winkelmayer, Wolfgang C, Kramer, Holly, Conference Participants, Eckardt, Kai-Uwe; https://orcid.org/0000-0003-3823-0920, Delgado, Cynthia, Heerspink, Hiddo J L, Pecoits-Filho, Roberto, Ricardo, Ana C, Stengel, Bénédicte, Tonelli, Marcello, Cheung, Michael, Jadoul, Michel, Winkelmayer, Wolfgang C, Kramer, Holly, and Conference Participants
- Abstract
Chronic kidney disease (CKD) affects over 850 million people globally, and the need to prevent its development and progression is urgent. During the past decade, new perspectives have arisen related to the quality and precision of care for CKD, owing to the development of new tools and interventions for CKD diagnosis and management. New biomarkers, imaging methods, artificial intelligence techniques, and approaches to organizing and delivering healthcare may help clinicians recognize CKD, determine its etiology, assess the dominant mechanisms at given time points, and identify patients at high risk for progression or related events. As opportunities to apply the concepts of precision medicine for CKD identification and management continue to be developed, an ongoing discussion of the potential implications for care delivery is required. The 2022 KDIGO Controversies Conference on Improving CKD Quality of Care: Trends and Perspectives examined and discussed best practices for improving the precision of CKD diagnosis and prognosis, managing the complications of CKD, enhancing the safety of care, and maximizing patient quality of life. Existing tools and interventions currently available for the diagnosis and treatment of CKD were identified, with discussion of current barriers to their implementation and strategies for improving the quality of care delivered for CKD. Key knowledge gaps and areas for research were also identified.
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- 2023
4. The COVID-19 Pandemic Identifies Significant Global Inequities in Hemodialysis Care in Low and Lower-Middle Income Countries-An ISN/DOPPS Survey
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Tannor, Elliot Koranteng, Bieber, Brian, Aylward, Ryan, Luyckx, Valerie, Shah, Dibya Singh, Liew, Adrian, Evans, Rhys, Phiri, Chimota, Guedes, Murilo, Pisoni, Ronald, Robinson, Bruce, Caskey, Fergus, Jha, Vivekanand, Pecoits-Filho, Roberto, Dreyer, Gavin, Tannor, Elliot Koranteng, Bieber, Brian, Aylward, Ryan, Luyckx, Valerie, Shah, Dibya Singh, Liew, Adrian, Evans, Rhys, Phiri, Chimota, Guedes, Murilo, Pisoni, Ronald, Robinson, Bruce, Caskey, Fergus, Jha, Vivekanand, Pecoits-Filho, Roberto, and Dreyer, Gavin
- Abstract
INTRODUCTION It is unknown how the COVID-19 pandemic has affected the care of vulnerable chronic hemodialysis (HD) patients across regions, particularly in low and lower-middle income countries (LLMICs). We aimed to identify global inequities in HD care delivery during the COVID-19 pandemic. METHODS The ISN and the Dialysis Outcomes and Practice Patterns Study (DOPPS) conducted a global online survey of HD units between March and November, 2020, to ascertain practice patterns and access to resources relevant to HD care during the COVID-19 pandemic. Responses were categorized according to World Bank income classification for comparisons. RESULTS Surveys were returned from 412 facilities in 78 countries: 15 (4%) in low-income countries (LICs), 111 (27%) in lower-middle income countries (LMICs), 145 (35%) in upper-middle income countries (UMICs), and 141 (34%) in high-income countries (HICs). Respondents reported that diagnostic tests for SARS-CoV-2 were unavailable or of limited availability in LICs (72%) and LMICs (68%) as compared with UMICs (33%) and HICs (20%). The number of patients who missed HD treatments was reported to have increased during the COVID-19 pandemic in LICs (64%) and LMICs (67%) as compared with UMICs (31%) and HICs (6%). Limited access to HD, intensive care unit (ICU) care, and mechanical ventilation among hospitalized patients on chronic dialysis with COVID-19 were also reportedly higher in LICs and LMICs as compared with UMICs and HICs. Staff in LLMICs reported less routine testing for SARS-CoV-2 when asymptomatic as compared with UMICs and HICs-14% in LICs and 11% in LMICs, compared with 26% and 28% in UMICs and HICs, respectively. Severe shortages of personal protective equipment (PPE) were reported by the respondents from LICs and LMICs compared with UMICs and HICs, especially with respect to the use of the N95 particulate-air respirator masks. CONCLUSION Striking global inequities were identified in the care of chronic HD patients during t
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- 2022
5. An ISN-DOPPS Survey of the Global Impact of the COVID-19 Pandemic on Peritoneal Dialysis Services
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Albakr, Rehab, Bieber, Brian, Aylward, Ryan, Caskey, Fergus J, Dreyer, Gavin, Evans, Rhys, Guedes, Murilo, Jha, Vivekanand, Luyckx, Valerie, Pecoits-Filho, Roberto, Phiri, Chimota, Pisoni, Ronald L, Robinson, Bruce, Shah, Dibya Singh, Tannor, Elliot Koranteng, Liew, Adrian, Perl, Jeffrey, Albakr, Rehab, Bieber, Brian, Aylward, Ryan, Caskey, Fergus J, Dreyer, Gavin, Evans, Rhys, Guedes, Murilo, Jha, Vivekanand, Luyckx, Valerie, Pecoits-Filho, Roberto, Phiri, Chimota, Pisoni, Ronald L, Robinson, Bruce, Shah, Dibya Singh, Tannor, Elliot Koranteng, Liew, Adrian, and Perl, Jeffrey
- Abstract
INTRODUCTION Home dialysis may minimize SARS-CoV2 exposure risks compared to center-based dialysis. We explored how the pandemic may have introduced challenges related to peritoneal dialysis (PD) supply availability, routine patient care, and how facility practices changed during this time. METHODS The PD/Dialysis Outcomes and Practice Patterns Study (PDOPPS/DOPPS) and International Society of Nephrology (ISN) administered a web-based survey from November 2020 to March 2021. Medical director responses were compared across 10 ISN regions. RESULTS One hundered sixy-five PD facilities in 51 countries returned surveys. During the initial COVID-19 wave, the reported frequency of in-person patient visits decreased in 9 of 10 ISN regions. Before the pandemic, most facilities required a mask during PD exchanges which continued over the course of the pandemic. Although most facilities in different regions did not report PD supply disruptions, sites in Africa and South Asia reported major disruptions. Reductions in laparoscopic surgical procedures for PD catheters were reported by facilities in 9 of 10 regions whereas nonsurgical percutaneous procedures increased in facilities in 6 regions. Training of new PD patients declined in facilities in each region. Increased use of remote technology by patients to communicate with clinics was observed in all regions compared to prepandemic levels. CONCLUSION Marked within-region and across-region variability was noted in PD facility burden, clinical practice, and adaptation to the COVID-19 pandemic. This study highlights opportunities to improve routine PD care, adapt to the ongoing pandemic, and increase preparedness for potential future interruptions in PD care.
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- 2022
6. The Global Impact of the COVID-19 Pandemic on In-Center Hemodialysis Services: An ISN-Dialysis Outcomes Practice Patterns Study Survey
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Aylward, Ryan, Bieber, Brian, Guedes, Murilo, Pisoni, Ronald, Tannor, Elliot Koranteng, Dreyer, Gavin, Liew, Adrian, Luyckx, Valerie; https://orcid.org/0000-0001-7066-8135, Shah, Dibya Singh, Phiri, Chimota, Evans, Rhys, Albakr, Rehab, Perl, Jeffrey, Jha, Vivekanand, Pecoits-Filho, Roberto, Robinson, Bruce, Caskey, Fergus J, Aylward, Ryan, Bieber, Brian, Guedes, Murilo, Pisoni, Ronald, Tannor, Elliot Koranteng, Dreyer, Gavin, Liew, Adrian, Luyckx, Valerie; https://orcid.org/0000-0001-7066-8135, Shah, Dibya Singh, Phiri, Chimota, Evans, Rhys, Albakr, Rehab, Perl, Jeffrey, Jha, Vivekanand, Pecoits-Filho, Roberto, Robinson, Bruce, and Caskey, Fergus J
- Abstract
Introduction To assess the impact of the COVID-19 pandemic impact on haemodialysis centres, The Dialysis Outcomes and Practice Patterns Study and International Society of Nephrology (ISN) collaborated on a web-survey of centres. Methods A combined approach of random sampling and open invitation was used between March 2020 and March 2021. Responses were obtained from 412 centres in 78 countries and all 10 ISN regions. Results In 8 regions, rates of SARS-CoV-2 infection were <20% in most centres, but in North East Asia and Newly Independent States and Russia rates were ≥20% and ≥30%, respectively. Mortality was ≥10% in most centres in 8 regions, though lower in North America and Caribbean and North East Asia. Diagnostic testing was not available in 33%, 37%, and 61% of centres in Latin America, Africa, and East and Central Europe, respectively. Surgical masks were widely available, but severe shortages of particulate-air filter masks were reported in Latin America (18%) and Africa (30%). Rates of infection in staff ranged from 0% in 90% of centres in North East Asia to ≥50% in 63% of centres in the Middle East and 68% of centres in Newly Independent States and Russia. In most centres <10% of staff died, but in Africa and South Asia 2% and 6% of centres reported ≥50% mortality, respectively. Conclusion There has been wide global variation in SARS-CoV-2 infection rates amongst haemodialysis patients and staff, PPE availability, and testing, and the ways in which services have been redesigned in response to the pandemic.
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- 2022
7. List of Contributors
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Afshinnia, Farsad, primary, Agarwal, Anupam, additional, Appel, Gerald B., additional, Bagby, Susan P., additional, Bailey, James L., additional, Bakris, George L., additional, Barrett, Brendan J., additional, Bauer, Carolyn A., additional, Berl, Tomas, additional, Berns, Jeffrey S., additional, Bomback, Andrew, additional, Bose, Anirban, additional, Brosius, Frank C., additional, Brown, Lee K., additional, Bushinsky, David A., additional, Busse, Laurence W., additional, Campbell, Ruth C., additional, Cathro, Helen, additional, Chawla, Lakhmir S., additional, Chen, Sheldon, additional, Chertow, Glenn M., additional, Chew, Emily, additional, Chonchol, Michel, additional, Clive, David M., additional, Cohen, Debbie L., additional, Cohen, Lewis M., additional, Cohen, Scott D., additional, Collins, Ashte’ K., additional, Combs, Sara, additional, Correa-Rotter, Ricardo, additional, Cukor, Daniel, additional, Dalal, Monica, additional, Dancik, Tavis, additional, Davenport, Andrew, additional, Davison, Sara, additional, Zeeuw, Dick de, additional, Delanaye, Pierre, additional, Dharia, Sushma M., additional, Dobre, Mirela A., additional, Drawz, Paul, additional, Dreisbach, Albert W., additional, Emmett, Michael, additional, Fanton, John H., additional, Felsenfeld, Arnold J., additional, Fernandez, Hilda, additional, Flessner, Michael F., additional, Freedman, Barry I., additional, Fruchter, Yvette, additional, Furth, Susan L., additional, García-García, Guillermo, additional, Germain, Michael J., additional, Germino, Gregory G., additional, Goligorsky, Michael S., additional, Greenberg, Arthur, additional, Guay-Woodford, Lisa M., additional, Hawkins, Katrina, additional, Herzog, Charles A., additional, Holley, Jean L., additional, Hostetter, Thomas H., additional, House, Andrew A., additional, Hruska, Keith A., additional, Huan, Yonghong, additional, Ibrahim, Hassan N., additional, Imran, Nashat, additional, Iñiguez, Jonathan Chávez, additional, Isom, Robert T., additional, Jablonski, Kristen L., additional, Jhaveri, Kenar D., additional, Johansen, Kirsten, additional, Johnson, Richard J., additional, Junghare, Milind Y., additional, Kang, Duk-Hee, additional, Karadsheh, Feras F., additional, Kari, Jameela, additional, Kasiske, Bertram L., additional, Khoury, Charbel C., additional, Kimmel, Paul L., additional, Kopp, Jeffrey B., additional, Kummer, Andrew, additional, Heerspink, Hiddo J.Lambers, additional, Lerman, Lilach O., additional, Levin, Adeera, additional, Levine, Barton S., additional, Lew, Susie Q., additional, Mandayam, Sreedhar, additional, Mattoo, Tej K., additional, Maynard, Sharon E., additional, Meyer, Timothy W., additional, Mitch, William E., additional, Moss, Alvin H., additional, Moxey-Mims, Marva, additional, Muntner, Paul, additional, Murray, Anne M., additional, Nath, Karl A., additional, Neugarten, Joel, additional, No, Gloria, additional, Pahl, Madeleine V., additional, Paller, Mark S., additional, Palmer, Biff F., additional, Parfrey, Patrick S., additional, Patel, Samir S., additional, Pecoits-Filho, Roberto, additional, Peitzman, Steven J., additional, Peixoto, Aldo J., additional, Pham, Phuong-Chi T., additional, Pham, Phuong-Thu T., additional, Rabelink, Ton J., additional, Radhakrishnan, Jai, additional, Raed, Anas, additional, Raj, Dominic S., additional, Ramirez-Sandoval, Juan Carlos, additional, Reckelhoff, Jane F., additional, Ronco, Claudio, additional, Rosenberg, Mark E., additional, Rosner, Mitchell H., additional, Rovin, Brad, additional, Roy-Chaudhury, Prabir, additional, Ruebner, Rebecca, additional, Rule, Andrew D., additional, Sands, Jeff M., additional, Scheinman, Steven J., additional, Schlanger, Lynn E., additional, Seifert, Michael E., additional, Seliger, Stephen, additional, Singh, Ajay K., additional, Stendahl, John C., additional, Surendran, Kameswaran, additional, Textor, Stephen C., additional, Thadhani, Ravi I., additional, Townsend, Raymond R., additional, Unruh, Mark L., additional, Vassalotti, Joseph A., additional, Vaziri, Nosratola D., additional, Velasquez, Manuel T., additional, Ver Halen, Nisha, additional, Wang, Connie J., additional, Wanner, Christoph, additional, Weber, Marc, additional, Weir, Matthew R., additional, Wing, Maria R., additional, Winn, Michelle P., additional, Wymer, David C., additional, Yee, Jerry, additional, and Ziyadeh, Fuad N., additional
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- 2015
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8. Inflammation in Chronic Kidney Disease
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Raj, Dominic S., primary, Pecoits-Filho, Roberto, additional, and Kimmel, Paul L., additional
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- 2015
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9. Adherence to the Kidney Disease: Improving Global Outcomes CKD Guideline in Nephrology Practice Across Countries
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Stengel, Bénédicte Né Dicte, Muenz, Daniel, Tu, Charlotte, Speyer, Elodie, Alencar de Pinho, Natalia, Combe, Christian, yamagata, Kunihiro, Reichel, Helmut, Fliser, Danilo, Massy, Ziad André, Lopes, Antônio Alberto, Jadoul, Michel y., Winkelmayer, Wolfgang C., Pisoni, Ronald L., Pecoits-Filho, Roberto, Lopes, Antonio, Jacquelinet, Christian, Duttlinger, Johannes, Lonnemann, Gerhard, Wada, Takashi, Pisoni, Ron, Robinson, Bruce M., Calice da Silva, Viviane, Sesso, Ricardo, Asahi, Koichi, Hoshino, Junichi, Narita, Ichiei, Perlman, Rachel L., Port, Friedrich K., Sukul, Nidhi, Wong, Michelle M.y., young, Eric W., Zee, Jarcy, Stengel, Bénédicte, Massy, Ziad, Jadoul, Michel, Winkelmayer, Wolfgang, Pisoni, Ronald, Robinson, Bruce, Perlman, Rachel, Port, Friedrich, Wong, Michelle, young, Eric, UCL - SSS/IREC/NEFR - Pôle de Néphrologie, UCL - (SLuc) Service de néphrologie, Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), GlaxoSmithKline, GSK Agence Nationale de la Recherche, ANR: ANR-10-COHO-0001, We thank Janet Leslie, Medical Technical Writer with Arbor Research Collaborative for Health, and Jo-Ann Cahn, independent editor and translator, in revising the presentation of the researchers? results and finalizing the manuscript. Global support for the ongoing DOPPS Programs is provided without restriction on publications by a variety of funders. For details, see https://www.dopps.org/AboutUs/Support.aspx. In France, CKDopps is based on the CKD-REIN study funded by the Agence Nationale de la Recherche (ANR-10-COHO-0001) through the 2010 Cohortes-Investissements d'Avenir program and by the 2010 Programme Hospitalier de Recherche Clinique. CKD-REIN is also supported through a public?private partnership with Amgen, Fresenius Medical Care, and GlaxoSmithKline, since 2012, Lilly France since 2013, and Otsuka Pharmaceutical since 2015, Baxter and Merck Sharp & Dohme-Chibret (MSD France) from 2012 to 2017, Sanofi-Genzyme from 2012 to 2015, and Vifor Fresenius and AstraZeneca since 2018. In Germany, funding support for participation of German CKD clinics in CKDopps is provided by Wissenschaftliches Institut f?r Nephrologie of the Verband Deutsche Nierenzentren. In the United States and Brazil, support for the CKDopps Coordinating Center has been provided by Keryx., Global support for the ongoing DOPPS Programs is provided without restriction on publications by a variety of funders. For details, see https://www.dopps.org/AboutUs/Support.aspx . In France, CKDopps is based on the CKD-REIN study funded by the Agence Nationale de la Recherche (ANR-10-COHO-0001) through the 2010 Cohortes-Investissements d’Avenir program and by the 2010 Programme Hospitalier de Recherche Clinique. CKD-REIN is also supported through a public–private partnership with Amgen, Fresenius Medical Care, and GlaxoSmithKline , since 2012, Lilly France since 2013, and Otsuka Pharmaceutical since 2015, Baxter and Merck Sharp & Dohme-Chibret (MSD France) from 2012 to 2017, Sanofi-Genzyme from 2012 to 2015, and Vifor Fresenius and AstraZeneca since 2018. In Germany, funding support for participation of German CKD clinics in CKDopps is provided by Wissenschaftliches Institut für Nephrologie of the Verband Deutsche Nierenzentren. In the United States and Brazil, support for the CKDopps Coordinating Center has been provided by Keryx., ANR-10-COHO-0001,CKD-REIN,Maladie Rénale Chronique - Réseau Epidémiologie et Information en Néphrologie(2010), and Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)
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Blood pressure control ,Nephrology ,medicine.medical_specialty ,lifestyle ,renin-angiotensin system inhibition ,dietary advice ,030232 urology & nephrology ,Renal function ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,lcsh:RC870-923 ,[SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology ,albuminuria ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,Proteinuria ,business.industry ,Guideline ,blood pressure control ,medicine.disease ,lcsh:Diseases of the genitourinary system. Urology ,3. Good health ,Cohort ,Commentary ,Albuminuria ,medicine.symptom ,business ,chronic kidney disease ,Kidney disease - Abstract
International audience; Introduction: The uptake of the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 chronic kidney disease (CKD) Guideline is not fully described in real-world nephrology practice across the world. Methods: We used baseline data from the CKD Outcomes and Practice Patterns Study (2013–2017), a 4-country cohort of patients with estimated glomerular filtration rate
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- 2021
10. Adherence to the Kidney Disease: Improving Global Outcomes CKD Guideline in Nephrology Practice Across Countries.
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UCL - SSS/IREC/NEFR - Pôle de Néphrologie, UCL - (SLuc) Service de néphrologie, Stengel, Bénédicte, Muenz, Daniel, Tu, Charlotte, Speyer, Elodie, Alencar de Pinho, Natalia, Combe, Christian, Yamagata, Kunihiro, Reichel, Helmut, Fliser, Danilo, Massy, Ziad A, Lopes, Antonio A, Jadoul, Michel, Winkelmayer, Wolfgang C, Pisoni, Ronald L, Robinson, Bruce M, Pecoits-Filho, Roberto, CKDopps investigators, UCL - SSS/IREC/NEFR - Pôle de Néphrologie, UCL - (SLuc) Service de néphrologie, Stengel, Bénédicte, Muenz, Daniel, Tu, Charlotte, Speyer, Elodie, Alencar de Pinho, Natalia, Combe, Christian, Yamagata, Kunihiro, Reichel, Helmut, Fliser, Danilo, Massy, Ziad A, Lopes, Antonio A, Jadoul, Michel, Winkelmayer, Wolfgang C, Pisoni, Ronald L, Robinson, Bruce M, Pecoits-Filho, Roberto, and CKDopps investigators
- Abstract
INTRODUCTION: The uptake of the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 chronic kidney disease (CKD) Guideline is not fully described in real-world nephrology practice across the world. METHODS: We used baseline data from the CKD Outcomes and Practice Patterns Study (2013-2017), a 4-country cohort of patients with estimated glomerular filtration rate <60 ml/min per 1.73 m2 recruited from national samples of nephrology clinics, to describe adherence to measures for monitoring and delaying CKD progression. Data were collected as in clinical practice, except laboratory measures per protocol in France. RESULTS: The mean age ranged from 65 years in Brazil to 72 years in Germany. Albuminuria (mostly proteinuria) was measured routinely in 36% to 43% of patients in Brazil, Germany, and the United States. Blood pressure control (≤140/90 mm Hg) ranged from 49% in France to 76% in Brazil; <40% of patients had blood pressure ≤130/80 mm Hg everywhere but Brazil (52%). More than 40% of nephrologists in Brazil reported a systolic blood pressure target ≤130 mm Hg for nondiabetic patients without proteinuria, but only 19% to 24% elsewhere. Prescription of renin-angiotensin aldosterone system inhibitors ranged from 52% in the United States to 81% in Germany. Dietary advice was more frequent for salt than protein intake; dietitian visits were uncommon. In nondiabetic patients, achievement of all 3 targets including blood pressure ≤130/80 mm Hg, renin-angiotensin aldosterone system inhibition, and dietary advice, ranged from 10% in the United States to 32% in Brazil; in treated diabetic patients, this ranged from 6% to 11% after including hemoglobin A1c target. CONCLUSION: Adherence to recommendations to slow CKD progression is low in typical practice settings, and substantial variation among countries for some indicates opportunities for improvement.
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- 2021
11. Contributors
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Advani, Andrew, primary, Allon, Michael, additional, Anderson, Amanda Hyre, additional, Appel, Gerald B., additional, Assady, Suheir, additional, Atala, Anthony, additional, Baigent, Colin, additional, Bakkaloglu, Sevcan A., additional, Barletta, Gina-Marie, additional, Becker, Gavin J., additional, Bellomo, Rinaldo, additional, Berns, Jeffrey S., additional, Bhalla, Vivek, additional, Biber, Jürg, additional, Bichet, Daniel G., additional, Bindels, René J.M., additional, Bleicher, Melissa B., additional, Blumenfeld, Jon D., additional, Bonnardeaux, Alain, additional, Bonventre, Joseph V., additional, Boswell, William D., additional, Bowden, Donald W., additional, Brenner, Barry M., additional, Breyer, Matthew D., additional, Breyer, Richard M., additional, Brown, Dennis, additional, Brugnara, Carlo, additional, Bunchman, Timothy E., additional, Bushinsky, David A., additional, Busque, Stéphan, additional, Carrero, Juan Jesús, additional, Cattran, Daniel, additional, Chan, James C., additional, Chandraker, Anil, additional, Chang, Ingrid J., additional, Choudhury, Devasmita, additional, Coe, Fredric L., additional, Collins, John F., additional, Cook, H. Terence, additional, Correa-Rotter, Ricardo, additional, Cowper, Shawn E., additional, Cravedi, Paolo, additional, Cueto-Manzano, Alfonso M., additional, D’Agati, Vivette D., additional, Davids, Mogomat Razeen, additional, Delacroix, Scott E., additional, Denker, Bradley M., additional, Depner, Thomas A., additional, DuBose, Thomas D., additional, Eckardt, Kai-Uwe, additional, Eldehni, Mohamed T., additional, Ellison, David H., additional, Emmett, Michael, additional, Falk, Ronald J., additional, Feldman, Harold I., additional, Fenton, Robert A., additional, Fenves, Andrew Z., additional, Finkel, Kevin W., additional, Fioretto, Paola, additional, Fogarty, Damian G., additional, Foringer, John R., additional, Fouque, Denis, additional, Freedman, Barry I., additional, Frøkiaer, Jørgen, additional, Funder, John W., additional, Game, David S., additional, Gilbert, Richard E., additional, Grantham, Jared J., additional, Halperin, Mitchell L., additional, Hand, Matthew, additional, Hanes, Donna S., additional, Harris, David C.H., additional, Harris, Raymond C., additional, Haynes, Richard, additional, Hoenderop, Joost G.J., additional, Hoorn, Ewout J., additional, Hostetter, Thomas H., additional, Hsu, Chi-yuan, additional, Hua-Lin, Shih, additional, Ibrahim, Hassan N., additional, Israni, Ajay K., additional, Jadvar, Jossein, additional, Jennette, J. Charles, additional, Jonasch, Eric, additional, Kamel, Kamel S., additional, Karumanchi, S. Ananth, additional, Kasiske, Bertram L., additional, Kellum, John A., additional, Kelly, Carolyn J., additional, Khanna, Ramesh, additional, Klassen, David K., additional, Ko, Christine J., additional, Kohli, Harbir Singh, additional, Kost, Curtis K., additional, Krane, L. Spencer, additional, Kreidberg, Jordan, additional, Kwon, Tae-Hwan, additional, Lahoti, Amit, additional, Landray, Martin J., additional, Laragh, John H., additional, Layton, Harold E., additional, Levi, Moshe, additional, Lindholm, Bengt, additional, Liu, Frank, additional, Luyckx, Valerie A., additional, Maddox, David A., additional, Maezawa, Yoshiro, additional, Matas, Arthur J., additional, Mauer, Michael, additional, Maya, Ivan D., additional, Maynard, Sharon E., additional, McDonough, Alicia A., additional, McIntyre, Christopher W., additional, Meyer, Timothy W., additional, Mitch, William E., additional, Moe, Orson W., additional, Moe, Sharon M., additional, Molitoris, Bruce A., additional, Moss, Alvin H., additional, Mount, David B., additional, Munger, Karen A., additional, Nachman, Patrick H., additional, Naicker, Saraladevi, additional, Nielsen, Søren, additional, Neilson, Eric G., additional, Nicolle, Lindsay E., additional, Ornt, Daniel B., additional, Palacín, Manuel, additional, Palevsky, Paul M., additional, Palmer, Suzanne L., additional, Parving, Hans-Henrik, additional, Patrakka, Jaakko, additional, Pearce, David, additional, Pecoits-Filho, Roberto, additional, Peralta, Carmen A., additional, Perico, Norberto, additional, Powe, Neil R., additional, Praditpornsilpa, Kearkiat, additional, Prætorius, Jeppe, additional, Quaggin, Susan E., additional, Quarles, L. Darryl, additional, Radhakrishnan, Jai, additional, Ramadan, Rawi, additional, Reggenenti, Piero, additional, Reich, Heather N., additional, Remuzzi, Andrea, additional, Remuzzi, Giuseppe, additional, Rich, Stephen S., additional, Riella, Miguel C., additional, Ritz, Eberhard, additional, Ronco, Claudio, additional, Rosenblum, Norman D., additional, Rossing, Peter, additional, Rubinger, Dvora, additional, Rude, Robert K., additional, Sabath, Ernesto, additional, Sabbisetti, Venkata, additional, Sakhuja, Vinay, additional, Salama, Alan D., additional, Sands, Jeff M., additional, Santos, Fernando, additional, Sayegh, Mohamed H., additional, Scandling, John D., additional, Schaefer, Franz, additional, Scheinman, Jon I., additional, Schwartz, John C., additional, Sharfuddin, Asif A., additional, Shaw, Susan, additional, Sitprija, Visith, additional, Skorecki, Karl L., additional, Slotki, Itzchak N., additional, Smith, James P., additional, Smogorzewski, Miroslaw J., additional, Sprague, Stuart M., additional, Stenvinkel, Peter, additional, Stokes, John B., additional, Taal, Maarten W., additional, Tamura, Manjula Kurella, additional, Tan, Jane C., additional, Textor, Stephen C., additional, Thadhani, Ravi, additional, Thomson, Scott C., additional, Torres, Vincente E., additional, Tryggvason, Karl, additional, Tuncel, Meryem, additional, Tungsanga, Kriang, additional, Verbalis, Joseph G., additional, Verlander, Jill W., additional, Wadee, Shoyab, additional, Weiner, I. David, additional, Weir, Matthew R., additional, Weisbord, Steven D., additional, Wheeler, David C., additional, Wilcox, Christopher S., additional, Wood, Christopher G., additional, Wright, Stephen H., additional, Yeun, Jane Y., additional, Yu, Alan S.L., additional, Zandi-Nejad, Kambiz, additional, and Zeidel, Mark L., additional
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- 2012
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12. Latin America
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Riella, Miguel C., primary and Pecoits-Filho, Roberto, additional
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- 2012
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13. Inflamación y riesgo cardiovascular en diálisis peritoneal
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Proença de Moraes, Thyago, primary, Carreira Ribeiro, Silvia, additional, and Pecoits Filho, Roberto, additional
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- 2009
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14. Considerable international variation exists in blood pressure control and antihypertensive prescription patterns in chronic kidney disease
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Alencar de Pinho, Natalia, Levin, Adeera, Fukagawa, Masafumi, Hoy, Wendy E, Pecoits-Filho, Roberto, Reichel, Helmut, Robinson, Bruce, Kitiyakara, Chagriya, Wang, Jinwei, Eckardt, Kai-Uwe, Jha, Vivekanand, Oh, Kook-Hwan, Sola, Laura, Eder, Susanne, de Borst, Martin, Taal, Maarten, and Feldman, Harold I.
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Hypertension Keywords: chronic kidney disease ,ACE Inhibitors ,cardiovascular disease ,Epidemiology and Statistics ,CESP ,INSERM U1018 ,Renal and Cardiovascular Epidemiology Team Subject Area: Clinical Nephrology ,diuretics - Abstract
Although blood pressure control is a major goal in chronic kidney disease, no worldwide overview of either its achievement or antihypertensive prescriptions is currently available. To evaluate this we compared crude prevalence of uncontrolled blood pressure among 17 cohort studies, including 34 602 individuals with estimated glomerular filtration rate under 60 ml/min/1.73 m2 and treated hypertension across four continents, and estimated observed to expected prevalence ratios, adjusted for potential confounders. Crude prevalence of blood pressure of 140/90 mm Hg or more varied from 28% to 61% and of blood pressure of 130/80 or more from 54% to 84%. Adjusted prevalence ratios indicated poorer hypertension control than expected in cohorts from European countries, India, and Uruguay, and better control in patients from North American and high-income Asian countries. Four antihypertensive drug classes or more were prescribed to more than 30% of participants in North American and some European cohorts, but this practice was less common elsewhere. Renin angiotensin-aldosterone system inhibitors were the most common antihypertensive drugs, prescribed for 54% to 91% of cohort participants. Differences for other drug classes were much stronger, ranging from 11% to 79% for diuretics, 22% to 70% for beta-blockers, and 27% to 75% for calcium-channel blockers. The confounders studied explain only a part of the international variation in blood pressure control among individuals with chronic kidney disease. Thus, considerable heterogeneity in prescription patterns worldwide calls for further investigation into the impact of different approaches on patient outcomes.
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- 2019
15. Heart failure in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies conference
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House, Andrew A., Wanner, Christoph, Sarnak, Mark J., Piña, Ileana L., McIntyre, Christopher W., Komenda, Paul, Kasiske, Bertram L., Deswal, Anita, deFilippi, Christopher R., Cleland, John G.F., Anker, Stefan D., Herzog, Charles A., Cheung, Michael, Wheeler, David C., Winkelmayer, Wolfgang C., McCullough, Peter A., Abu-Alfa, Ali K., Amann, Kerstin, Aonuma, Kazutaka, Appel, Lawrence J., Baigent, Colin, Bakris, George L., Banerjee, Debasish, Boletis, John N., Bozkurt, Biykem, Butler, Javed, Chan, Christopher T., Costanzo, Maria Rosa, Dubin, Ruth F., Filippatos, Gerasimos, Gikonyo, Betty M., Gikonyo, Dan K., Hajjar, Roger J., Iseki, Kunitoshi, Ishii, Hideki, Knoll, Greg A., Lenihan, Colin R., Lentine, Krista L., Lerma, Edgar V., Macedo, Etienne, Mark, Patrick B., Noiri, Eisei, Palazzuoli, Alberto, Pecoits-Filho, Roberto, Pitt, Bertram, Rigatto, Claudio, Rossignol, Patrick, Setoguchi, Soko, Sood, Manish M., Störk, Stefan, Suri, Rita S., Szummer, Karolina, Tang, Sydney C.W., Tangri, Navdeep, Thompson, Aliza, Vijayaraghavan, Krishnaswami, Walsh, Michael, Wang, Angela Yee-Moon, and Weir, Matthew R.
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urologic and male genital diseases ,R1 ,female genital diseases and pregnancy complications - Abstract
The incidence and prevalence of heart failure (HF) and chronic kidney disease (CKD) are increasing, and as such a better understanding of the interface between both conditions is imperative for developing optimal strategies for their detection, prevention, diagnosis, and management. To this end, Kidney Disease: Improving Global Outcomes (KDIGO) convened an international, multidisciplinary Controversies Conference titled Heart Failure in CKD. Breakout group discussions included (i) HF with preserved ejection fraction (HFpEF) and nondialysis CKD, (ii) HF with reduced ejection fraction (HFrEF) and nondialysis CKD, (iii) HFpEF and dialysis-dependent CKD, (iv) HFrEF and dialysis-dependent CKD, and (v) HF in kidney transplant patients. The questions that formed the basis of discussions are available on the KDIGO website http://kdigo.org/conferences/heart-failure-in-ckd/, and the deliberations from the conference are summarized here.
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- 2019
16. Increasing access to integrated ESKD care as part of universal health coverage
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Harris, David CH, Davies, Simon J, Finkelstein, Fredric O, Jha, Vivekanand, Donner, Jo-Ann, Abraham, Georgi, Bello, Aminu K, Caskey, Fergus J, Garcia, Guillermo Garcia, Harden, Paul, Hemmelgarn, Brenda, Johnson, David W, Levin, Nathan W, Luyckx, Valerie A, Martin, Dominique E, McCulloch, Mignon I, Moosa, Mohammed Rafique, O'Connell, Paul J, Okpechi, Ikechi G, Pecoits Filho, Roberto, Shah, Kamal D, Sola, Laura, Swanepoel, Charles, Tonelli, Marcello, Twahir, Ahmed, van Biesen, Wim, Varghese, Cherian, Yang, Chih-Wei, Zuniga, Carlos, Abu Alfa, Ali K, Aljubori, Harith M, Alrukhaimi, Mona N, Andreoli, Sharon P, Ashuntantang, Gloria, Bellorin-Font, Ezequiel, Bernieh, Bassam, Ibhais, Fuad M, Blake, Peter G, Brown, Mark, Brown, Edwina, Bunnag, Sakarn, Chan, Tak Mao, Chen, Yuqing, Claure-Del Granado, Rolando, Claus, Stefaan, Collins, Allan, Couchoud, Cecile, Cueto-Manzano, Alfonso, Cullis, Brett, Douthat, Walter, Dreyer, Gavin, Eiam-Ong, Somchai, Eke, Felicia U, Feehally, John, Ghnaimat, Mohammad A, Goh, Bak Leong, Hassan, Mohamed H, Hou, Fan Fan, Jager, Kitty, Kalantar-Zadeh, Kamyar, Kazancioglu, Rumeyza T, Levin, A, Liew, A, McKnight, M, Mengistu, YT, Morton, RL, Muller, E, Murtagh, FEM, Naicker, S, Nangaku, M, Niang, A, Obrador, GT, Ossareh, S, Perl, J, Rahman, M, Rashid, HU, Richards, M, Rondeau, E, Sahay, M, Saleh, A, Schneditz, D, Tchokhonelidze, I, Tesar, V, Trask, M, Tungsanga, K, Vachharajani, T, Walker, RC, Walker, R, Were, AJO, Yao, Q, Yeates, K, Yu, X, Zakharova, E, Zemchenkov, A, Zhao, MH, Harris, David CH, Davies, Simon J, Finkelstein, Fredric O, Jha, Vivekanand, Donner, Jo-Ann, Abraham, Georgi, Bello, Aminu K, Caskey, Fergus J, Garcia, Guillermo Garcia, Harden, Paul, Hemmelgarn, Brenda, Johnson, David W, Levin, Nathan W, Luyckx, Valerie A, Martin, Dominique E, McCulloch, Mignon I, Moosa, Mohammed Rafique, O'Connell, Paul J, Okpechi, Ikechi G, Pecoits Filho, Roberto, Shah, Kamal D, Sola, Laura, Swanepoel, Charles, Tonelli, Marcello, Twahir, Ahmed, van Biesen, Wim, Varghese, Cherian, Yang, Chih-Wei, Zuniga, Carlos, Abu Alfa, Ali K, Aljubori, Harith M, Alrukhaimi, Mona N, Andreoli, Sharon P, Ashuntantang, Gloria, Bellorin-Font, Ezequiel, Bernieh, Bassam, Ibhais, Fuad M, Blake, Peter G, Brown, Mark, Brown, Edwina, Bunnag, Sakarn, Chan, Tak Mao, Chen, Yuqing, Claure-Del Granado, Rolando, Claus, Stefaan, Collins, Allan, Couchoud, Cecile, Cueto-Manzano, Alfonso, Cullis, Brett, Douthat, Walter, Dreyer, Gavin, Eiam-Ong, Somchai, Eke, Felicia U, Feehally, John, Ghnaimat, Mohammad A, Goh, Bak Leong, Hassan, Mohamed H, Hou, Fan Fan, Jager, Kitty, Kalantar-Zadeh, Kamyar, Kazancioglu, Rumeyza T, Levin, A, Liew, A, McKnight, M, Mengistu, YT, Morton, RL, Muller, E, Murtagh, FEM, Naicker, S, Nangaku, M, Niang, A, Obrador, GT, Ossareh, S, Perl, J, Rahman, M, Rashid, HU, Richards, M, Rondeau, E, Sahay, M, Saleh, A, Schneditz, D, Tchokhonelidze, I, Tesar, V, Trask, M, Tungsanga, K, Vachharajani, T, Walker, RC, Walker, R, Were, AJO, Yao, Q, Yeates, K, Yu, X, Zakharova, E, Zemchenkov, A, and Zhao, MH
- Published
- 2019
17. Major Bleeding Rates in an International Cohort of Patients With End-Stage Kidney Disease.
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Coyle CR, Bash LD, Ramey DR, Atkins GB, Barash I, Guedes M, Pecoits-Filho R, Andrews C, Karaboyas A, and Bonaca M
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- 2024
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18. Inhibition of Interleukin-33 to Reduce Glomerular Endothelial Inflammation in Diabetic Kidney Disease.
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Hofherr A, Liarte Marin E, Musial B, Seth A, Slidel T, Conway J, Baker D, Hansen PBL, Challis B, Bartesaghi S, Bhat M, Pecoits-Filho R, Tu X, Selvarajah V, Woollard K, and Heerspink HJL
- Abstract
Introduction: Inflammation is a significant contributor to cardiorenal morbidity and mortality in diabetic kidney disease (DKD). The pathophysiological mechanisms linking systemic, subacute inflammation and local, kidney injury-initiated immune maladaptation is partially understood., Methods: Here, we explored the expression of proinflammatory cytokines in patients with DKD; investigated mouse models of type 1 and type 2 diabetes (T2D); evaluated glomerular signaling in vitro ; performed post hoc analyses of systemic and urinary markers of inflammation; and initiated a phase 2b clinical study (FRONTIER-1; NCT04170543)., Results: Transcriptomic profiling of kidney biopsies from patients with DKD revealed significant glomerular upregulation of interleukin-33 (IL-33). Inhibition of IL-33 signaling reduced glomerular damage and albuminuria in the uninephrectomized db/db mouse model (T2D/DKD). On a cellular level, inhibiting IL-33 improved glomerular endothelial health by decreasing cellular inflammation and reducing release of proinflammatory cytokines. Therefore, FRONTIER-1 was designed to test the safety and efficacy of the IL-33-targeted monoclonal antibody tozorakimab in patients with DKD. So far, 578 patients are enrolled in FRONTIER-1. The baseline inflammation status of participants ( N > 146) was assessed in blood and urine. Comparison to independent reference cohorts ( N > 200) validated the distribution of urinary tumor necrosis factor receptor 1 (TNFR1) and C-C motif chemokine ligand 2 (CCL2). Treatment with dapagliflozin for 6 weeks did not alter these biomarkers significantly., Conclusion: We show that blocking the IL-33 pathway may mitigate glomerular endothelial inflammation in DKD. The findings from the FRONTIER-1 study will provide valuable insights into the therapeutic potential of IL-33 inhibition in DKD., (© 2024 International Society of Nephrology. Published by Elsevier Inc.)
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- 2024
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19. Dialysis ECHO: An Educational Solution to Improve Dialysis Care in Low-Resource and High-Demand Settings.
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Abdalla AE, Abdelrahim AJ, Warrag AS, Farah AS, Mahmoud DS, Abusin SA, Elhassan EA, and Pecoits-Filho R
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- 2024
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20. Risk of Kidney Failure and Mortality in Patients Under Nephrology Care in NonHigh-Income Settings.
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Guedes M, Tu C, Bieber B, Silva VC, Lopes A, Sesso R, De Pinho NA, and Pecoits-Filho R
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- 2023
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21. Trends and perspectives for improving quality of chronic kidney disease care: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.
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Eckardt KU, Delgado C, Heerspink HJL, Pecoits-Filho R, Ricardo AC, Stengel B, Tonelli M, Cheung M, Jadoul M, Winkelmayer WC, and Kramer H
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- Humans, Quality of Life, Kidney, Prognosis, Artificial Intelligence, Renal Insufficiency, Chronic diagnosis, Renal Insufficiency, Chronic therapy, Renal Insufficiency, Chronic complications
- Abstract
Chronic kidney disease (CKD) affects over 850 million people globally, and the need to prevent its development and progression is urgent. During the past decade, new perspectives have arisen related to the quality and precision of care for CKD, owing to the development of new tools and interventions for CKD diagnosis and management. New biomarkers, imaging methods, artificial intelligence techniques, and approaches to organizing and delivering healthcare may help clinicians recognize CKD, determine its etiology, assess the dominant mechanisms at given time points, and identify patients at high risk for progression or related events. As opportunities to apply the concepts of precision medicine for CKD identification and management continue to be developed, an ongoing discussion of the potential implications for care delivery is required. The 2022 KDIGO Controversies Conference on Improving CKD Quality of Care: Trends and Perspectives examined and discussed best practices for improving the precision of CKD diagnosis and prognosis, managing the complications of CKD, enhancing the safety of care, and maximizing patient quality of life. Existing tools and interventions currently available for the diagnosis and treatment of CKD were identified, with discussion of current barriers to their implementation and strategies for improving the quality of care delivered for CKD. Key knowledge gaps and areas for research were also identified., (Copyright © 2023 KDIGO: Kidney Disease Improving Global Outcomes. Published by Elsevier Inc. All rights reserved.)
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- 2023
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22. Regional Variation in Hemoglobin Distribution Among Individuals With CKD: the ISN International Network of CKD Cohorts.
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Canney M, Induruwage D, Tang M, Alencar de Pinho N, Er L, Zhao Y, Djurdjev O, Ahn YH, Behnisch R, Calice-Silva V, Chesnaye NC, de Borst MH, Dember LM, Dionne J, Ebert N, Eder S, Fenton A, Fukagawa M, Furth SL, Hoy WE, Imaizumi T, Jager KJ, Jha V, Kang HG, Kitiyakara C, Mayer G, Oh KH, Onu U, Pecoits-Filho R, Reichel H, Richards A, Schaefer F, Schaeffner E, Scheppach JB, Sola L, Ulasi I, Wang J, Yadav AK, Zhang J, Feldman HI, Taal MW, Stengel B, and Levin A
- Abstract
Introduction: Despite recognized geographic and sex-based differences in hemoglobin in the general population, these factors are typically ignored in patients with chronic kidney disease (CKD) in whom a single therapeutic range for hemoglobin is recommended. We sought to compare the distribution of hemoglobin across international nondialysis CKD populations and evaluate predictors of hemoglobin., Methods: In this cross-sectional study, hemoglobin distribution was evaluated in each cohort overall and stratified by sex and estimated glomerular filtration rate (eGFR). Relationships between candidate predictors and hemoglobin were assessed from linear regression models in each cohort. Estimates were subsequently pooled in a random effects model., Results: A total of 58,613 participants from 21 adult cohorts (median eGFR range of 17-49 ml/min) and 3 pediatric cohorts (median eGFR range of 26-45 ml/min) were included with broad geographic representation. Hemoglobin values varied substantially among the cohorts, overall and within eGFR categories, with particularly low mean hemoglobin observed in women from Asian and African cohorts. Across the eGFR range, women had a lower hemoglobin compared to men, even at an eGFR of 15 ml/min (mean difference 5.3 g/l, 95% confidence interval [CI] 3.7-6.9). Lower eGFR, female sex, older age, lower body mass index, and diabetic kidney disease were all independent predictors of a lower hemoglobin value; however, this only explained a minority of variance (R
2 7%-44% across cohorts)., Conclusion: There are substantial regional differences in hemoglobin distribution among individuals with CKD, and the majority of variance is unexplained by demographics, eGFR, or comorbidities. These findings call for a renewed interest in improving our understanding of hemoglobin determinants in specific CKD populations., (© 2023 Published by Elsevier, Inc., on behalf of the International Society of Nephrology.)- Published
- 2023
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23. Health Care Resource Utilization and Related Costs of Patients With CKD From the United States: A Report From the DISCOVER CKD Retrospective Cohort.
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Garcia Sanchez JJ, James G, Carrero JJ, Arnold M, Lam CSP, Pollock C, Chen HT, Nolan S, Wheeler DC, and Pecoits-Filho R
- Abstract
Introduction: It is well established that chronic kidney disease (CKD) results in a significant burden on patients' health and health care providers. However, detailed estimates of the health care resource utilization (HCRU) of CKD are limited, particularly those which consider severity, comorbidities, and payer type. This study aimed to bridge this evidence gap by reporting contemporary HCRU and costs in patients with CKD across the US health care providers., Methods: Cost and HCRU estimates of CKD and reduced kidney function without CKD (estimated glomerular filtration rate [eGFR]: 60-75 and urine albumin-to-creatinine ratio [UACR]: <30) were derived for US patients included in the DISCOVER CKD cohort study, using linked inpatient and outpatient data from the limited claims-EMR data set (LCED) and TriNetX database. Patients with a history of transplant or undergoing dialysis were not included. HCRU and costs were stratified by CKD severity using UACR and eGFR., Results: Overall health care costs ranged from $26,889 (A1) to $42,139 (A3), and from $28,627 (G2) to $42,902 (G5) per patient per year (PPPY), demonstrating a considerable early disease burden which continued to increase with declining kidney function. The PPPY costs of later stage CKD were particularly notable for patients with concomitant heart failure ($50,191 [A3]) and those covered by commercial payers ($55,735 [A3])., Conclusions: Health care costs and resource use associated with CKD and reduced kidney function pose a substantial burden across health care systems and payers, increasing in line with CKD progression. Early CKD screening, particularly of UACR, paired with proactive disease management may provide both an improvement to patient outcomes and a significant HCRU and cost saving to health care providers., (© 2023 International Society of Nephrology. Published by Elsevier Inc.)
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- 2023
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24. An ISN-DOPPS Survey of the Global Impact of the COVID-19 Pandemic on Peritoneal Dialysis Services.
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Albakr R, Bieber B, Aylward R, Caskey FJ, Dreyer G, Evans R, Guedes M, Jha V, Luyckx V, Pecoits-Filho R, Phiri C, Pisoni RL, Robinson B, Shah DS, Tannor EK, Liew A, and Perl J
- Abstract
Introduction: Home dialysis may minimize SARS-CoV2 exposure risks compared to center-based dialysis. We explored how the pandemic may have introduced challenges related to peritoneal dialysis (PD) supply availability, routine patient care, and how facility practices changed during this time., Methods: The PD/Dialysis Outcomes and Practice Patterns Study (PDOPPS/DOPPS) and International Society of Nephrology (ISN) administered a web-based survey from November 2020 to March 2021. Medical director responses were compared across 10 ISN regions., Results: One hundered sixy-five PD facilities in 51 countries returned surveys. During the initial COVID-19 wave, the reported frequency of in-person patient visits decreased in 9 of 10 ISN regions. Before the pandemic, most facilities required a mask during PD exchanges which continued over the course of the pandemic. Although most facilities in different regions did not report PD supply disruptions, sites in Africa and South Asia reported major disruptions. Reductions in laparoscopic surgical procedures for PD catheters were reported by facilities in 9 of 10 regions whereas nonsurgical percutaneous procedures increased in facilities in 6 regions. Training of new PD patients declined in facilities in each region. Increased use of remote technology by patients to communicate with clinics was observed in all regions compared to prepandemic levels., Conclusion: Marked within-region and across-region variability was noted in PD facility burden, clinical practice, and adaptation to the COVID-19 pandemic. This study highlights opportunities to improve routine PD care, adapt to the ongoing pandemic, and increase preparedness for potential future interruptions in PD care., (© 2022 International Society of Nephrology. Published by Elsevier Inc.)
- Published
- 2022
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25. Understanding International Variations in Kidney Failure Incidence and Initiation of Replacement Therapy.
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Alencar de Pinho N, Henn L, Raina R, Reichel H, Lopes AA, Combe C, Speyer E, Bieber B, Robinson BM, Stengel B, and Pecoits-Filho R
- Abstract
Introduction: Incidence of kidney replacement therapy (KRT) varies widely across countries. Its relations to individual characteristics, nephrology practices for slowing chronic kidney disease (CKD) progression, and KRT access remain unclear., Methods: We investigated intercountry differences in kidney failure (KF) rate, defined by a sustained estimated glomerular filtration rate (eGFR) <15 ml/min per 1.73 m
2 , and separately in KRT incidence, before and after adjusting for risk factors and blood pressure (BP) control or renin-angiotensin-aldosterone system inhibitor (RAASi) prescription practices in the CKD Outcomes and Practice Patterns Study (CKDopps) cohort study., Results: Among 7381 patients with CKD stage 3 to 4 at enrollment, 1297 progressed to KF and 947 initiated KRT over a 3-year follow-up period. Compared to the United States, demographic-adjusted and eGFR-adjusted hazard ratios (HRs) (HRs, 95% confidence intervals [CI]) for a sustained low eGFR were 0.77 (95% CI, 0.57-1.02) in Brazil, 0.90 (95% CI, 0.75-1.08) in France, and 1.03 (95% CI, 0.86-1.03) in Germany. Further adjustment for comorbidities, albuminuria, systolic BP, and RAASi prescription did not substantially change these HRs. In contrast, compared with the United States, the fully-adjusted HR for KRT remained significantly lower in Brazil (0.55, 95% CI 0.39-0.79), higher in Germany (95% CI, 1.36, 1.09-1.69), and similar in France (95% CI, 1.07, 0.81-1.39)., Conclusion: Individual risk factors for CKD progression in nephrology patients appeared to explain most intercountry variations in KF but not KRT incidence. This suggests a prominent role for differences in practices related to KRT initiation or access, but not those for slowing disease progression. This study also shows that using KRT as a KF surrogate may bias estimates of associations with CKD progression risk factors., (© 2022 International Society of Nephrology. Published by Elsevier Inc.)- Published
- 2022
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26. Impact of COVID-19 and malaria coinfection on clinical outcomes: a retrospective cohort study.
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Hussein R, Guedes M, Ibraheim N, Ali MM, El-Tahir A, Allam N, Abuakar H, Pecoits-Filho R, and Kotanko P
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- COVID-19 Testing, Female, Humans, Male, Middle Aged, Retrospective Studies, SARS-CoV-2, COVID-19 complications, Coinfection epidemiology, Malaria complications, Malaria diagnosis, Malaria epidemiology, COVID-19 Drug Treatment
- Abstract
Objectives: Despite the possibility of concurrent infection with COVID-19 and malaria, little is known about the clinical course of coinfected patients. We analysed the clinical outcomes of patients with concurrent COVID-19 and malaria infection., Methods: We conducted a retrospective cohort study that assessed prospectively collected data of all patients who were admitted between May and December 2020 to the Universal COVID-19 treatment center (UCTC), Khartoum, Sudan. UCTC compiled demographic, clinical, laboratory (including testing for malaria), and outcome data in all patients with confirmed COVID-19 hospitalized at that clinic. The primary outcome was all-cause mortality during the hospital stay. We built proportional hazard Cox models with malaria status as the main exposure and stepwise adjustment for age, sex, cardiovascular comorbidities, diabetes, and hypertension., Results: We included 591 patients with confirmed COVID-19 diagnosis who were also tested for malaria. Mean (SD) age was 58 (16.2) years, 446/591 (75.5%) were males. Malaria was diagnosed in 270/591 (45.7%) patients. Most malaria patients were infected by Plasmodium falciparum (140/270; 51.9%), while 121/270 (44.8%) were coinfected with Plasmodium falciparum and Plasmodium vivax. Median follow-up was 29 days. Crude mortality rates were 10.71 and 5.87 per 1000 person-days for patients with and without concurrent malaria, respectively. In the fully adjusted Cox model, patients with concurrent malaria and COVID-19 had a greater mortality risk (hazard ratio 1.43, 95% confidence interval 1.21-1.69)., Discussion: Coinfection with COVID-19 and malaria is associated with increased all-cause in-hospital mortality compared to monoinfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
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- 2022
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27. Low Adherence to Kidney Disease: Improving Global Outcomes 2012 CKD Clinical Practice Guidelines Despite Clear Evidence of Utility.
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James G, Garcia Sanchez JJ, Carrero JJ, Kumar S, Pecoits-Filho R, Heerspink HJL, Nolan S, Lam CSP, Chen H, Kanda E, Kashihara N, Arnold M, Kosiborod MN, Lainscak M, Pollock C, and Wheeler DC
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Introduction: Kidney Disease: Improving Global Outcomes (KDIGO) 2012 guidelines classify chronic kidney disease (CKD) risk or prognosis using estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR). We assessed patient characteristics and outcomes according to the KDIGO classification, using data from DISCOVER CKD (NCT04034992)., Methods: Data were extracted from the US integrated Limited Claims and Electronic Health Record Dataset and TriNetX databases, and the UK Clinical Practice Research Datalink linked to Hospital Episode Statistics and Office for National Statistics databases. Eligible patients were aged ≥18 years with CKD, and identified by 2 consecutive eGFR measures (5 to <75 ml/min/1.73 m
2 ; ≥90 days apart [maximum 730]) from January 2008. Index date was the second eGFR measurement; patients were categorized using the UACR measure closest to the index. Outcomes included patient characteristics, eGFR or UACR measurement frequency, and clinical outcomes per baseline KDIGO classification., Results: Across databases, only 8.6% of patients with 2 eGFR measures had ≥1 UACR measures. Among 123,807 eligible patients, prevalence of heart failure, hypertension, and type 2 diabetes increased with increasing albuminuria. Incidence rates of mortality and adverse cardiovascular and renal outcomes increased with declining baseline eGFR, and particularly with increasing albuminuria. Median number of eGFR and UACR tests per year post-index ranged from 1.6 to 2.5 and 0.5 to 0.6, respectively, across databases; there was no clear increase in UACR testing frequency following the KDIGO 2012 guidelines., Conclusion: Albuminuria monitoring is critical for optimal risk stratification in CKD, and our findings highlight an imperative for more regular UACR testing in clinical practice., (© 2022 International Society of Nephrology. Published by Elsevier Inc.)- Published
- 2022
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28. Effectiveness and Tolerance of Renin-Angiotensin System Inhibitors With Aging in Chronic Kidney Disease.
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Villain C, Metzger M, Liabeuf S, Hamroun A, Laville S, Mansencal N, Combe C, Fouque D, Frimat L, Jacquelinet C, Laville M, Ayav C, Briançon S, Pecoits-Filho R, Hannedouche T, Stengel B, and Massy ZA
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- Aged, Aging, Angiotensin Receptor Antagonists therapeutic use, Angiotensin-Converting Enzyme Inhibitors adverse effects, Antihypertensive Agents therapeutic use, Cohort Studies, Humans, Renin-Angiotensin System, Acute Kidney Injury chemically induced, Acute Kidney Injury complications, Acute Kidney Injury drug therapy, Cardiovascular Diseases drug therapy, Hyperkalemia chemically induced, Hyperkalemia complications, Hyperkalemia drug therapy, Renal Insufficiency, Chronic drug therapy
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Objectives: Renin-angiotensin system inhibitors (RASi) are recommended for slowing chronic kidney disease (CKD) progression to kidney failure. Their effectiveness and tolerance as patients age remain uncertain because older patients have often been excluded from clinical trials., Design: CKD-REIN cohort study., Setting and Participants: We studied 2762 patients with CKD stages 3 and 4 and a clinical indication for RASi enrolled between 2013 and 2016 in 40 nephrology clinics nationally representative in France., Methods: The primary outcome was the occurrence of kidney failure or death. The secondary outcomes were the occurrence of cardiovascular events and hospitalizations with acute kidney injury (AKI) or hyperkalemia. A propensity score analysis was performed. We used Cox models to estimate hazard ratios (HRs) for each outcome associated with RASi prescription and tested interactions with age., Results: Patients' mean age was 67 years, including 841 (30%) aged 75 years and older; 2178 (79%) were prescribed RASi's. During a median follow-up of 4.6 years, 33% of patients reached kidney failure or died. RASi prescription was associated with a lower risk of kidney failure or death (HR 0.79, 95% CI 0.66, 0.95), an association not modified by age (P for interaction = .72). It was not significantly associated with cardiovascular events. During the first 3 years of follow-up, 14% of patients were hospitalized with AKI or hyperkalemia, but risk was not higher among those prescribed RASi's (HR 0.75, 95% CI 0.55-1.02) and age did not modify its effect (P for interaction = .28)., Conclusions and Implications: This study shows that aging does not appear to modify either RASi's beneficial effects on major CKD outcomes or their potential adverse effects., (Copyright © 2021 AMDA — The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)
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- 2022
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29. The COVID-19 Pandemic Identifies Significant Global Inequities in Hemodialysis Care in Low and Lower-Middle Income Countries-An ISN/DOPPS Survey.
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Tannor EK, Bieber B, Aylward R, Luyckx V, Shah DS, Liew A, Evans R, Phiri C, Guedes M, Pisoni R, Robinson B, Caskey F, Jha V, Pecoits-Filho R, and Dreyer G
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Introduction: It is unknown how the COVID-19 pandemic has affected the care of vulnerable chronic hemodialysis (HD) patients across regions, particularly in low and lower-middle income countries (LLMICs). We aimed to identify global inequities in HD care delivery during the COVID-19 pandemic., Methods: The ISN and the Dialysis Outcomes and Practice Patterns Study (DOPPS) conducted a global online survey of HD units between March and November, 2020, to ascertain practice patterns and access to resources relevant to HD care during the COVID-19 pandemic. Responses were categorized according to World Bank income classification for comparisons., Results: Surveys were returned from 412 facilities in 78 countries: 15 (4%) in low-income countries (LICs), 111 (27%) in lower-middle income countries (LMICs), 145 (35%) in upper-middle income countries (UMICs), and 141 (34%) in high-income countries (HICs). Respondents reported that diagnostic tests for SARS-CoV-2 were unavailable or of limited availability in LICs (72%) and LMICs (68%) as compared with UMICs (33%) and HICs (20%). The number of patients who missed HD treatments was reported to have increased during the COVID-19 pandemic in LICs (64%) and LMICs (67%) as compared with UMICs (31%) and HICs (6%). Limited access to HD, intensive care unit (ICU) care, and mechanical ventilation among hospitalized patients on chronic dialysis with COVID-19 were also reportedly higher in LICs and LMICs as compared with UMICs and HICs. Staff in LLMICs reported less routine testing for SARS-CoV-2 when asymptomatic as compared with UMICs and HICs-14% in LICs and 11% in LMICs, compared with 26% and 28% in UMICs and HICs, respectively. Severe shortages of personal protective equipment (PPE) were reported by the respondents from LICs and LMICs compared with UMICs and HICs, especially with respect to the use of the N95 particulate-air respirator masks., Conclusion: Striking global inequities were identified in the care of chronic HD patients during the pandemic. Urgent action is required to address these inequities which disproportionately affect LLMIC settings thereby exacerbating pre-existing vulnerabilities that may contribute to poorer outcomes., (© 2022 International Society of Nephrology. Published by Elsevier Inc.)
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- 2022
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30. Early Identification of CKD-A Scoping Review of the Global Populations.
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Okpechi IG, Caskey FJ, Gaipov A, Tannor EK, Noubiap JJ, Effa E, Ekrikpo UE, Hamonic LN, Ashuntantang G, Bello AK, Donner JA, Figueiredo AE, Inagi R, Madero M, Malik C, Moorthy M, Pecoits-Filho R, Tesar V, Levin A, and Jha V
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Introduction: Decisions on whether to screen for chronic kidney disease (CKD) or not remain contentious in nephrology. This study provides a global overview of early CKD identification efforts., Methods: Guidelines for scoping reviews were followed and studies were identified by searching MEDLINE, EMBASE, Cochrane Library, CINAHL, ISI Web of Science, and PsycINFO. Data extracted from included studies focused on the following 4 themes: study population, measurement methods, interventions used, and available policies., Results: We identified 290 CKD screening and detection programs from 83 countries. Overall sample size was 3.72 million (North East Asia: 1.19 million), detection of CKD was the aim in 97.6%, 63.1% used population-based screening methods, and only 12.4% were in rural populations. Reported CKD prevalence (stages 3-5) was higher in targeted- (14.8%) than population-based studies (8.0%). Number of persons needed to screen (NNS) to identify 1 case was also lower in targeted studies (7 vs. 13). Single measurements (80%) and the combination of estimation of glomerular filtration rate with a urine test (albuminuria/proteinuria) (71.4%) were frequently used to detect CKD. Only 2.8% of studies included an intervention such as pharmacotherapy in identified cases. Policies on early identification were available in 30.1% of countries included., Conclusion: Methods for early CKD identification vary worldwide, often leading to wide variations in the reported prevalence. Efforts to standardize measurement methods for early detection focusing on high-risk populations and ensuring appropriate interventions are available to those identified with CKD will improve the value of programs and improve patient outcomes., (© 2022 International Society of Nephrology. Published by Elsevier Inc.)
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- 2022
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31. The Global Impact of the COVID-19 Pandemic on In-Center Hemodialysis Services: An ISN-Dialysis Outcomes Practice Patterns Study Survey.
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Aylward R, Bieber B, Guedes M, Pisoni R, Tannor EK, Dreyer G, Liew A, Luyckx V, Shah DS, Phiri C, Evans R, Albakr R, Perl J, Jha V, Pecoits-Filho R, Robinson B, and Caskey FJ
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Introduction: To assess the impact of the COVID-19 pandemic impact on hemodialysis (HD) centers, The Dialysis Outcomes and Practice Patterns Study and ISN collaborated on a web-survey of centers., Methods: A combined approach of random sampling and open invitation was used between March 2020 and March 2021. Responses were obtained from 412 centers in 78 countries and all 10 ISN regions., Results: In 8 regions, rates of SARS-CoV-2 infection were <20% in most centers, but in North East Asia (NE Asia) and Newly Independent States and Russia (NIS & Russia), rates were ≥20% and ≥30%, respectively. Mortality was ≥10% in most centers in 8 regions, although lower in North America and Caribbean (N America & Caribbean) and NE Asia. Diagnostic testing was not available in 33%, 37%, and 61% of centers in Latin America, Africa, and East and Central Europe, respectively. Surgical masks were widely available, but severe shortages of particulate-air filter masks were reported in Latin America (18%) and Africa (30%). Rates of infection in staff ranged from 0% in 90% of centers in NE Asia to ≥50% in 63% of centers in the Middle East and 68% of centers in NIS & Russia. In most centers, <10% of staff died, but in Africa and South Asia (S Asia), 2% and 6% of centers reported ≥50% mortality, respectively., Conclusion: There has been wide global variation in SARS-CoV-2 infection rates among HD patients and staff, personal protective equipment (PPE) availability, and testing, and the ways in which services have been redesigned in response to the pandemic., (© 2021 International Society of Nephrology. Published by Elsevier Inc.)
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- 2022
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32. Diabetes Prevalence, Treatment, Control, and Outcomes Among Hemodialysis Patients in the Gulf Cooperation Council Countries.
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Al-Ghamdi SMG, Bieber B, AlRukhaimi M, AlSahow A, Al Salmi I, Al Ali F, Al Aradi A, Pecoits-Filho R, Robinson BM, and Pisoni RL
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Introduction: Diabetes mellitus (DM) is a leading cause of end-stage kidney disease (ESKD). We provide the first description of DM prevalence, related outcomes, and the hemoglobin A1c (HbA1c)/mortality relationship in national hemodialysis (HD) patient samples across the Gulf Cooperation Council (GCC) countries., Methods: We analyzed data from the prospective Dialysis Outcomes and Practice Patterns Study (DOPPS) in the GCC (2012-2018, N = 2274 HD patients ≥18 years old). Descriptive statistics were calculated, and all-cause mortality was analyzed for patients with DM versus without DM and by HbA1c levels in patients with DM by Cox regression with progressive confounder adjustments., Results: DM in the GCC ranged from 45% to 74% in patients with HD by country. Patients with DM were 13 years older (59.9 vs. 46.7 years) and had greater body mass index (BMI), shorter median years on dialysis (1.5 vs. 3.0 years), and higher comorbidity burden. In patients with DM, insulin use was 26% to 50% across countries, with variable oral antidiabetic drug use (2%-32%); median HbA1c levels were 6.1% to 7.5% across countries. Patients with DM (vs. without DM) had higher crude death rates (15.6 vs. 6.2 deaths per 100 patient-years, mean follow-up 1.3 years) and adjusted mortality (hazard ratio [HR] = 1.72 [95% CI 1.23-2.39]). In patients with DM, mortality was lowest at HbA1c 6.5% to 7.5%, with mortality particularly elevated at high HbA1c >9% (HR = 2.13 [95% CI 1.10-4.10])., Conclusion: Patients with DM in the GCC have high comorbidity burden and mortality rates despite a relatively young mean age. In GCC countries, a holistic strategy for improving diabetes care and outcomes for HD patients is needed at the primary, secondary, and tertiary levels., (© 2022 International Society of Nephrology. Published by Elsevier Inc.)
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- 2022
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33. Challenges and Opportunities of a Virtual Nephrology Meeting: The ISN World Congress of Nephrology 2021.
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Claure-Del Granado R, Anandh U, Lerma E, Conjeevaram A, Arce-Amaré F, Dos Santos ACS Jr, Basu G, Bek S, Dhakal AK, Gawad MA, AkL A, Turgut D, Karam S, Bajpai D, Pecoits-Filho R, and Parikh N
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- 2022
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34. Sex-Specific Differences in Mortality and Incident Dialysis in the Chronic Kidney Disease Outcomes and Practice Patterns Study.
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Hecking M, Tu C, Zee J, Bieber B, Hödlmoser S, Reichel H, Sesso R, Port FK, Robinson BM, Carrero JJ, Tong A, Combe C, Stengel B, and Pecoits-Filho R
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Introduction: More men than women start kidney replacement therapy (KRT) although the prevalence of chronic kidney disease (CKD) is higher in women than men. We therefore aimed at analyzing sex-specific differences in clinical outcomes among 8237 individuals with CKD in stages 3 to 5 from Brazil, France, Germany, and the United States participating in the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps)., Methods: Fine and Gray models, evaluating the effect of sex on time to events, were adjusted for age, Black race (model A); plus diabetes, cardiovascular disease, albuminuria (model B); plus estimated glomerular filtration rate (eGFR) slope during the first 12 months after enrollment and first eGFR after enrollment (model C)., Results: There were more men than women at baseline (58% vs. 42%), men were younger than women, and men had higher eGFR (28.9 ± 11.5 vs. 27.0 ± 10.8 ml/min per 1.73 m
2 ). Over a median follow-up of 2.7 and 2.5 years for men and women, respectively, the crude dialysis initiation and pre-emptive transplantation rates were higher in men whereas that of pre-KRT death was more similar. The adjusted subdistribution hazard ratios (SHRs) between men versus women for dialysis were 1.51 (1.27-1.80) (model A), 1.32 (1.10-1.59) (model B), and 1.50 (1.25-1.80) (model C); for pre-KRT death, were 1.25 (1.02-1.54) (model A), 1.14 (0.92-1.40) (model B), and 1.15 (0.93-1.42) (model C); for transplantation, were 1.31 (0.73-2.36) (model A), 1.44 (0.76-2.74) (model B), and 1.53 (0.79-2.94) (model C)., Conclusion: Men had a higher probability of commencing dialysis before death, unexplained by CKD progression alone. Although the causal mechanisms are uncertain, this finding helps interpret the preponderance of men in the dialysis population., (© 2021 International Society of Nephrology. Published by Elsevier Inc.)- Published
- 2021
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35. Nephrologists' Perspectives on Gender Disparities in CKD and Dialysis.
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Tong A, Evangelidis N, Kurnikowski A, Lewandowski M, Bretschneider P, Oberbauer R, Baumgart A, Scholes-Robertson N, Stamm T, Carrero JJ, Pecoits-Filho R, and Hecking M
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Introduction: Globally, there are more women with chronic kidney disease (CKD), yet they comprise only 40% of patients receiving kidney replacement therapy by dialysis. We aimed to describe the perspectives of nephrologists on gender disparities in access to care and outcomes in CKD and dialysis., Methods: We conducted semistructured interviews with 51 nephrologists (28, 55% women) from 22 countries from October 2019 to April 2020. Transcripts were analyzed thematically., Results: We identified 6 themes. Related to women were primary commitment to caregiving (with subthemes of coordinating care, taking charge of health management, deprioritizing own health, centrality of family in decision-making); vigilance and self-reliance (diligence and conscientiousness, stoicism and tolerating symptoms, avoiding burden on family, isolation and coping alone); and stereotyping, stigma, and judgment (body image, dismissed as anxiety, shame and embarrassment, weakness and frailty). Related to men was protecting masculinity (safeguarding the provider role, clinging to control, self-regard, and entitled). Decisional power and ownership included men's dominance in decision-making and women's analytical approach in treatment decisions. Inequities compounded by social disadvantage (financial and transport barriers, without social security, limited literacy, entrenched discrimination, vulnerability) were barriers to care for women, particularly in socioeconomically disadvantaged communities., Conclusion: Nephrologists perceived that women with CKD faced many challenges in accessing care related to social norms and roles of caregiving responsibilities, disempowerment, lack of support, stereotyping by clinicians, and entrenched social and economic disadvantage. Addressing power differences, challenging systemic patriarchy, and managing unconscious bias may help to improve equitable care and outcomes for all people with CKD., (© 2021 International Society of Nephrology. Published by Elsevier Inc.)
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- 2021
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36. A pre-specified analysis of the DAPA-CKD trial demonstrates the effects of dapagliflozin on major adverse kidney events in patients with IgA nephropathy.
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Wheeler DC, Toto RD, Stefánsson BV, Jongs N, Chertow GM, Greene T, Hou FF, McMurray JJV, Pecoits-Filho R, Correa-Rotter R, Rossing P, Sjöström CD, Umanath K, Langkilde AM, and Heerspink HJL
- Subjects
- Benzhydryl Compounds, Glomerular Filtration Rate, Glucosides, Humans, Kidney, Middle Aged, Diabetes Mellitus, Type 2, Glomerulonephritis, IGA drug therapy, Renal Insufficiency, Chronic complications, Renal Insufficiency, Chronic diagnosis, Renal Insufficiency, Chronic drug therapy, Sodium-Glucose Transporter 2 Inhibitors
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Immunoglobulin A (IgA) nephropathy is a common form of glomerulonephritis, which despite use of renin-angiotensin-aldosterone-system blockers and immunosuppressants, often progresses to kidney failure. In the Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease trial, dapagliflozin reduced the risk of kidney failure and prolonged survival in participants with chronic kidney disease with and without type 2 diabetes, including those with IgA nephropathy. Participants with estimated glomerular filtration rate (eGFR) 25-75 mL/min/1.73m
2 and urinary albumin-to-creatinine ratio 200-5000 mg/g (22.6-565 mg/mol) were randomized to dapagliflozin 10mg or placebo, as adjunct to standard care. The primary composite endpoint was a sustained decline in eGFR of 50% or more, end-stage kidney disease, or death from a kidney disease-related or cardiovascular cause. Of 270 participants with IgA nephropathy (254 [94%] confirmed by previous biopsy), 137 were randomized to dapagliflozin and 133 to placebo, and followed for median 2.1 years. Overall, mean age was 51.2 years; mean eGFR, 43.8 mL/min/1.73m2 ; and median urinary albumin-to-creatinine ratio, 900 mg/g. The primary outcome occurred in six (4%) participants on dapagliflozin and 20 (15%) on placebo (hazard ratio, 0.29; 95% confidence interval, 0.12, 0.73). Mean rates of eGFR decline with dapagliflozin and placebo were -3.5 and -4.7 mL/min/1.73m2 /year, respectively. Dapagliflozin reduced the urinary albumin-to-creatinine ratio by 26% relative to placebo. Adverse events leading to study drug discontinuation were similar with dapagliflozin and placebo. There were fewer serious adverse events with dapagliflozin, and no new safety findings in this population. Thus, in participants with IgA nephropathy, dapagliflozin reduced the risk of chronic kidney disease progression with a favorable safety profile., (Copyright © 2021 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)- Published
- 2021
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37. Prescription of Direct Oral Anticoagulants to Patients With Moderate-to-Advanced CKD: Too Little or Just Right?
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Liabeuf S, Laville SM, Bieber B, Tu C, Stengel B, Wong MMY, Calice da Silva V, Fliser D, Robinson BM, Pecoits-Filho R, and Massy ZA
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- 2021
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38. International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Latin America.
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Wainstein M, Bello AK, Jha V, Harris DCH, Levin A, Gonzalez-Bedat MC, Rosa-Diez GJ, Ferreiro Fuentes A, Sola L, Pecoits-Filho R, Claure-Del Granado R, Madero M, Osman MA, Saad S, Zaidi D, Lunney M, Ye F, Katz IJ, Khan M, Shrapnel S, Tonelli M, Okpechi IG, and Johnson DW
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Latin America is a region with a widely variable socioeconomic landscape, facing a surge in noncommunicable diseases, including chronic kidney disease and kidney failure, exposing significant limitations in the delivery of care. Despite region-wide efforts to explore and address these limitations, much uncertainty remains as to the capacity, accessibility, and quality of kidney failure care in Latin America. Through this second iteration of the International Society of Nephrology Global Kidney Health Atlas, we aimed to report on these indicators to provide a comprehensive map of kidney failure care in the region. Survey responses were received from 18 (64.2%) countries, representing 93.8% of the total population in Latin America. The median prevalence and incidence of treated kidney failure in Latin America were 715 and 157 per million population, respectively, the latter being higher than the global median (142 per million population), with Puerto Rico, Mexico, and El Salvador experiencing much of this growing burden. In most countries, public and private systems collectively funded most aspects of kidney replacement therapy (dialysis and transplantation) care, with patients incurring at least 1% to 25% of out-of-pocket costs. In most countries, >90% of dialysis patients able to access kidney replacement therapy received hemodialysis (n = 11; 5 high income and 6 upper-middle income), and only a small minority began with peritoneal dialysis (1%-10% in 67% of countries; n = 12). Few countries had chronic kidney disease registries or targeted detection programs. There is a large variability in the availability, accessibility, and quality of kidney failure care in Latin America, which appears to be subject to individual countries' funding structures, underreliance on cheap kidney replacement therapy, such as peritoneal dialysis, and limited chronic kidney disease surveillance and management initiatives., (© 2021 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)
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- 2021
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39. Executive summary of the KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease.
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Cheung AK, Chang TI, Cushman WC, Furth SL, Hou FF, Ix JH, Knoll GA, Muntner P, Pecoits-Filho R, Sarnak MJ, Tobe SW, Tomson CRV, Lytvyn L, Craig JC, Tunnicliffe DJ, Howell M, Tonelli M, Cheung M, Earley A, and Mann JFE
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- Antihypertensive Agents therapeutic use, Blood Pressure, Child, Humans, Life Style, Renal Dialysis adverse effects, Renal Insufficiency, Chronic drug therapy, Renal Insufficiency, Chronic therapy
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The Kidney Disease: Improving Global Outcomes (KDIGO) 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease for patients not receiving dialysis represents an update to the KDIGO 2012 guideline on this topic. Development of this guideline update followed a rigorous process of evidence review and appraisal. Guideline recommendations are based on systematic reviews of relevant studies and appraisal of the quality of the evidence. The strength of recommendations is based on the "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) approach. The scope includes topics covered in the original guideline, such as optimal blood pressure targets, lifestyle interventions, antihypertensive medications, and specific management in kidney transplant recipients and children. Some aspects of general and cardiovascular health, such as lipid and smoking management, are excluded. This guideline also introduces a chapter dedicated to proper blood pressure measurement since all large randomized trials targeting blood pressure with pivotal outcomes used standardized preparation and measurement protocols adhered to by patients and clinicians. Based on previous and new evidence, in particular the Systolic Blood Pressure Intervention Trial (SPRINT) results, we propose a systolic blood pressure target of less than 120 mm Hg using standardized office reading for most people with chronic kidney disease (CKD) not receiving dialysis, the exception being children and kidney transplant recipients. The goal of this guideline is to provide clinicians and patients a useful resource with actionable recommendations supplemented with practice points. The burden of the recommendations on patients and resources, public policy implications, and limitations of the evidence are taken into consideration. Lastly, knowledge gaps and recommendations for future research are provided., (Copyright © 2021 KDIGO. Published by Elsevier Inc. All rights reserved.)
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- 2021
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40. Adherence to the Kidney Disease: Improving Global Outcomes CKD Guideline in Nephrology Practice Across Countries.
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Stengel B, Muenz D, Tu C, Speyer E, Alencar de Pinho N, Combe C, Yamagata K, Reichel H, Fliser D, Massy ZA, Lopes AA, Jadoul M, Winkelmayer WC, Pisoni RL, Robinson BM, and Pecoits-Filho R
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Introduction: The uptake of the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 chronic kidney disease (CKD) Guideline is not fully described in real-world nephrology practice across the world., Methods: We used baseline data from the CKD Outcomes and Practice Patterns Study (2013-2017), a 4-country cohort of patients with estimated glomerular filtration rate <60 ml/min per 1.73 m
2 recruited from national samples of nephrology clinics, to describe adherence to measures for monitoring and delaying CKD progression. Data were collected as in clinical practice, except laboratory measures per protocol in France., Results: The mean age ranged from 65 years in Brazil to 72 years in Germany. Albuminuria (mostly proteinuria) was measured routinely in 36% to 43% of patients in Brazil, Germany, and the United States. Blood pressure control (≤140/90 mm Hg) ranged from 49% in France to 76% in Brazil; <40% of patients had blood pressure ≤130/80 mm Hg everywhere but Brazil (52%). More than 40% of nephrologists in Brazil reported a systolic blood pressure target ≤130 mm Hg for nondiabetic patients without proteinuria, but only 19% to 24% elsewhere. Prescription of renin-angiotensin aldosterone system inhibitors ranged from 52% in the United States to 81% in Germany. Dietary advice was more frequent for salt than protein intake; dietitian visits were uncommon. In nondiabetic patients, achievement of all 3 targets including blood pressure ≤130/80 mm Hg, renin-angiotensin aldosterone system inhibition, and dietary advice, ranged from 10% in the United States to 32% in Brazil; in treated diabetic patients, this ranged from 6% to 11% after including hemoglobin A1c target., Conclusion: Adherence to recommendations to slow CKD progression is low in typical practice settings, and substantial variation among countries for some indicates opportunities for improvement., (© 2020 International Society of Nephrology. Published by Elsevier Inc.)- Published
- 2020
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41. Capturing and monitoring global differences in untreated and treated end-stage kidney disease, kidney replacement therapy modality, and outcomes.
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Pecoits-Filho R, Okpechi IG, Donner JA, Harris DCH, Aljubori HM, Bello AK, Bellorin-Font E, Caskey FJ, Collins A, Cueto-Manzano AM, Feehally J, Goh BL, Jager KJ, Nangaku M, Rahman M, Sahay M, Saleh A, Sola L, Turan Kazancioglu R, Walker RC, Walker R, Yao Q, Yu X, Zhao MH, and Johnson DW
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A large gap between the number of people with end-stage kidney disease (ESKD) who received kidney replacement therapy (KRT) and those who needed it has been recently identified, and it is estimated that approximately one-half to three-quarters of all people with ESKD in the world may have died prematurely because they could not receive KRT. This estimate is aligned with a previous report that estimated that >3 million people in the world died each year because they could not access KRT. This review discusses the reasons for the differences in treated and untreated ESKD and KRT modalities and outcomes and presents strategies to close the global KRT gap by establishing robust health information systems to guide resource allocation to areas of need, inform KRT service planning, enable policy development, and monitor KRT health outcomes., (© 2020 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)
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- 2020
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42. Dialysis funding, eligibility, procurement, and protocols in low- and middle-income settings: results from the International Society of Nephrology collection survey.
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Luyckx VA, Smyth B, Harris DCH, and Pecoits-Filho R
- Abstract
Dialysis provisions and end-stage kidney disease (ESKD) care represents an important challenge, particularly in low-resource settings. The purpose of this project was to survey nephrologists from low- and lower middle-income countries about their experiences in the following domains: (i) Dialysis funding and eligibility ; (ii) dialysis-procurement mechanisms ; (iii) clinical protocols for dialysis ; (iv) monitoring of dialysis outcomes ; and (v) barriers to care for ESKD. One hundred and twenty responses from 31 low- and middle-income countries, from 8 ISN regions, were included in the analysis. When stratified by World Bank country income status, responses were received from 7 low-income countries, 12 lower middle-income countries, and 12 upper middle-income countries. Eighty-eight documents from 18 countries were uploaded, including country or institutional guidelines, protocols, and standard operating procedures. The International Society of Nephrology aims to develop a set of guidance documents that put forward a considered approach to dialysis provisions and ESKD care within resource limitations. As an initial step in this project, local practitioners from low-resource settings were surveyed about their experiences with dialysis funding, eligibility, procurement and their use of guidance documents, and how practices and procedures may have been developed with adaptations to the local circumstances. In this manuscript we describe the methodology and the main findings from the survey using an integrated quantitative and qualitative approach., (© 2020 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)
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- 2020
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43. Development of a framework for minimum and optimal safety and quality standards for hemodialysis and peritoneal dialysis.
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Sola L, Levin NW, Johnson DW, Pecoits-Filho R, Aljubori HM, Chen Y, Claus S, Collins A, Cullis B, Feehally J, Harden PN, Hassan MH, Ibhais F, Kalantar-Zadeh K, Levin A, Saleh A, Schneditz D, Tchokhonelidze I, Turan Kazancioglu R, Twahir A, Walker R, Were AJO, Yu X, and Finkelstein FO
- Abstract
Substantial heterogeneity in practice patterns around the world has resulted in wide variations in the quality and type of dialysis care delivered. This is particularly so in countries without universal standards of care and governmental (or other organizational) oversight. Most high-income countries have developed such oversight based on documentation of adherence to standardized, evidence-based guidelines. Many low- and lower-middle-income countries have no or only limited organized oversight systems to ensure that care is safe and effective. The implementation and oversight of basic standards of care requires sufficient infrastructure and appropriate workforce and financial resources to support the basic levels of care and safety practices. It is important to understand how these standards then can be reasonably adapted and applied in low- and lower-middle-income countries., (© 2020 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)
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- 2020
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44. Uremic toxins promote accumulation of oxidized protein and increased sensitivity to hydrogen peroxide in endothelial cells by impairing the autophagic flux.
- Author
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Rodrigues SD, Santos SS, Meireles T, Romero N, Glorieux G, Pecoits-Filho R, Zhang DD, and Nakao LS
- Subjects
- Animals, Apoptosis drug effects, Cell Survival drug effects, Cells, Cultured, Endothelial Cells drug effects, Endothelial Cells metabolism, Humans, Lysosomes drug effects, Lysosomes metabolism, Mice, NIH 3T3 Cells, Oxidative Stress drug effects, Cresols pharmacology, Hydrogen Peroxide pharmacology, Indican pharmacology, Indoleacetic Acids pharmacology, RNA-Binding Proteins metabolism, Sulfuric Acid Esters pharmacology, Toxins, Biological pharmacology
- Abstract
Chronic kidney disease (CKD) is associated with high mortality rates, mainly due to cardiovascular diseases (CVD). Uremia has been considered a relevant risk factor for CVD in CKD patients, since uremic toxins (UTs) promote systemic and vascular inflammation, oxidative stress and senescence. Here, we demonstrate that uremic toxins indoxyl sulfate (IxS), p-cresyl sulfate (pCS) and indole acetic acid (IAA) are incorporated by human endothelial cells and inhibit the autophagic flux, demonstrated by cellular p62 accumulation. Moreover, isolated and mixed UTs impair the lysosomal stage of autophagy, as determined by cell imaging of the mRFP-GFP-LC3 protein. Endothelial cells exposed to UTs display accumulation of carbonylated proteins and increased sensitivity to hydrogen peroxide. Rapamycin, an autophagy activator which induces both autophagosome formation and clearance, prevented these effects. Collectively, our findings demonstrate that accumulation of oxidized proteins and enhanced cell sensitivity to hydrogen peroxide are consequences of impaired autophagic flux. These data provide evidence that UTs-induced impaired autophagy may be a novel contributor to endothelial dysfunction., Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2019 Elsevier Inc. All rights reserved.)
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- 2020
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45. Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.
- Author
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Clase CM, Carrero JJ, Ellison DH, Grams ME, Hemmelgarn BR, Jardine MJ, Kovesdy CP, Kline GA, Lindner G, Obrador GT, Palmer BF, Cheung M, Wheeler DC, Winkelmayer WC, and Pecoits-Filho R
- Subjects
- Cardiovascular Diseases blood, Cardiovascular Diseases etiology, Cardiovascular Diseases physiopathology, Congresses as Topic, Glomerular Filtration Rate physiology, Humans, Hyperkalemia blood, Hyperkalemia etiology, Hyperkalemia metabolism, Hypokalemia blood, Hypokalemia etiology, Hypokalemia metabolism, Kidney Diseases blood, Kidney Diseases physiopathology, Potassium administration & dosage, Potassium blood, Renal Elimination physiology, Cardiovascular Diseases prevention & control, Hyperkalemia therapy, Hypokalemia therapy, Kidney Diseases complications, Potassium metabolism
- Abstract
Potassium disorders are common in patients with kidney disease, particularly in patients with tubular disorders and low glomerular filtration rate. A multidisciplinary group of researchers and clinicians met in October 2018 to identify evidence and address controversies in potassium management. The issues discussed encompassed our latest understanding of the regulation of tubular potassium excretion in health and disease; the relationship of potassium intake to cardiovascular and kidney outcomes, with increasing evidence showing beneficial associations with plant-based diet and data to suggest a paradigm shift from the idea of dietary restriction toward fostering patterns of eating that are associated with better outcomes; the paucity of data on the effect of dietary modification in restoring abnormal serum potassium to the normal range; a novel diagnostic algorithm for hypokalemia that takes into account the ascendency of the clinical context in determining cause, aligning the educational strategy with a practical approach to diagnosis; and therapeutic approaches in managing hyperkalemia when chronic and in the emergency or hospital ward. In sum, we provide here our conference deliberations on potassium homeostasis in health and disease, guidance for evaluation and management of dyskalemias in the context of kidney diseases, and research priorities in each of the above areas., (Copyright © 2019 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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46. Considerable international variation exists in blood pressure control and antihypertensive prescription patterns in chronic kidney disease.
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Alencar de Pinho N, Levin A, Fukagawa M, Hoy WE, Pecoits-Filho R, Reichel H, Robinson B, Kitiyakara C, Wang J, Eckardt KU, Jha V, Oh KH, Sola L, Eder S, de Borst M, Taal M, Feldman HI, and Stengel B
- Subjects
- Adult, Aged, Aged, 80 and over, Antihypertensive Agents standards, Asia epidemiology, Blood Pressure drug effects, Blood Pressure physiology, Europe epidemiology, Female, Glomerular Filtration Rate physiology, Humans, Hypertension epidemiology, India epidemiology, Male, Middle Aged, North America epidemiology, Practice Guidelines as Topic, Practice Patterns, Physicians' standards, Prevalence, Renal Insufficiency, Chronic drug therapy, Renal Insufficiency, Chronic physiopathology, Urology standards, Urology statistics & numerical data, Uruguay epidemiology, Antihypertensive Agents therapeutic use, Drug Prescriptions statistics & numerical data, Hypertension prevention & control, Practice Patterns, Physicians' statistics & numerical data, Renal Insufficiency, Chronic complications
- Abstract
Although blood pressure control is a major goal in chronic kidney disease, no worldwide overview of either its achievement or antihypertensive prescriptions is currently available. To evaluate this we compared crude prevalence of uncontrolled blood pressure among 17 cohort studies, including 34 602 individuals with estimated glomerular filtration rate under 60 ml/min/1.73 m
2 and treated hypertension across four continents, and estimated observed to expected prevalence ratios, adjusted for potential confounders. Crude prevalence of blood pressure of 140/90 mm Hg or more varied from 28% to 61% and of blood pressure of 130/80 or more from 54% to 84%. Adjusted prevalence ratios indicated poorer hypertension control than expected in cohorts from European countries, India, and Uruguay, and better control in patients from North American and high-income Asian countries. Four antihypertensive drug classes or more were prescribed to more than 30% of participants in North American and some European cohorts, but this practice was less common elsewhere. Renin angiotensin-aldosterone system inhibitors were the most common antihypertensive drugs, prescribed for 54% to 91% of cohort participants. Differences for other drug classes were much stronger, ranging from 11% to 79% for diuretics, 22% to 70% for beta-blockers, and 27% to 75% for calcium-channel blockers. The confounders studied explain only a part of the international variation in blood pressure control among individuals with chronic kidney disease. Thus, considerable heterogeneity in prescription patterns worldwide calls for further investigation into the impact of different approaches on patient outcomes., (Copyright © 2019 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)- Published
- 2019
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47. The authors reply.
- Author
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Pecoits-Filho R, Sola L, Correa-Rotter R, Claure-Del Granado R, Douthat WG, and Bellorin-Font E
- Subjects
- Humans, Latin America, Kidney Diseases, Nephrology
- Published
- 2019
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48. An international Delphi survey helped develop consensus-based core outcome domains for trials in peritoneal dialysis.
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Manera KE, Tong A, Craig JC, Shen J, Jesudason S, Cho Y, Sautenet B, Teixeira-Pinto A, Howell M, Wang AY, Brown EA, Brunier G, Perl J, Dong J, Wilkie M, Mehrotra R, Pecoits-Filho R, Naicker S, Dunning T, Scholes-Robertson N, and Johnson DW
- Subjects
- Adolescent, Adult, Aged, Decision Making, Shared, Delphi Technique, Female, Humans, Male, Middle Aged, Quality of Life, Surveys and Questionnaires, Young Adult, Consensus, Kidney Failure, Chronic therapy, Outcome Assessment, Health Care standards, Peritoneal Dialysis adverse effects, Randomized Controlled Trials as Topic standards
- Abstract
Shared decision-making about clinical care options in end-stage kidney disease is limited by inconsistencies in the reporting of outcomes and the omission of patient-important outcomes in trials. Here we generated a consensus-based prioritized list of outcomes to be reported during trials in peritoneal dialysis (PD). In an international, online, three-round Delphi survey, patients/caregivers and health professionals rated the importance of outcomes using a 9-point Likert scale (with 7-9 indicating critical importance) and provided comments. Using a Best-Worst Scale (BWS), the relative importance of outcomes was estimated. Comments were analyzed thematically. In total, 873 participants (207 patients/caregivers and 666 health professionals) from 68 countries completed round one, 629 completed round two and 530 completed round three. The top outcomes were PD-related infection, membrane function, peritoneal dialysis failure, cardiovascular disease, death, catheter complications, and the ability to do usual activities. Compared with health professionals, patients/caregivers gave higher priority to six outcomes: blood pressure (mean difference, 0.4), fatigue (0.3), membrane function (0.3), impact on family/friends (0.1), peritoneal thickening (0.1) and usual activities (0.1). Four themes were identified that underpinned the reasons for ratings: contributing to treatment longevity, preserving quality of life, escalating morbidity, and irrelevant and futile information and treatment. Patients/caregivers and health professionals gave highest priority to clinical outcomes. In contrast to health professionals, patients/caregivers gave higher priority to lifestyle-related outcomes including the impact on family/friends and usual activities. Thus, prioritization will inform a core outcome set to improve the consistency and relevance of outcomes for trials in PD., (Copyright © 2019 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
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49. Blood pressure in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.
- Author
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Cheung AK, Chang TI, Cushman WC, Furth SL, Ix JH, Pecoits-Filho R, Perkovic V, Sarnak MJ, Tobe SW, Tomson CRV, Cheung M, Wheeler DC, Winkelmayer WC, and Mann JFE
- Subjects
- Blood Pressure drug effects, Clinical Trials as Topic, Congresses as Topic, Humans, Renal Insufficiency, Chronic physiopathology, Treatment Outcome, Antihypertensive Agents therapeutic use, Blood Pressure physiology, Blood Pressure Determination standards, Practice Guidelines as Topic, Renal Insufficiency, Chronic therapy
- Abstract
In September 2017, KDIGO (Kidney Disease: Improving Global Outcomes) convened a Controversies Conference titled Blood Pressure in Chronic Kidney Disease (CKD). The purpose of the meeting was to consider which recommendations from the 2012 KDIGO Clinical Practice Guideline for the Management of Blood Pressure in CKD should be reevaluated based on new evidence from clinical trials. Participants included a multidisciplinary panel of clinical and scientific experts. Discussions focused on the optimal means for measuring blood pressure (BP) as well as managing BP in CKD patients. Consistent with the 2012 Guideline, the conference did not address BP management in patients on maintenance dialysis., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
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50. Increasing access to integrated ESKD care as part of universal health coverage.
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Harris DCH, Davies SJ, Finkelstein FO, Jha V, Donner JA, Abraham G, Bello AK, Caskey FJ, Garcia GG, Harden P, Hemmelgarn B, Johnson DW, Levin NW, Luyckx VA, Martin DE, McCulloch MI, Moosa MR, O'Connell PJ, Okpechi IG, Pecoits Filho R, Shah KD, Sola L, Swanepoel C, Tonelli M, Twahir A, van Biesen W, Varghese C, Yang CW, and Zuniga C
- Subjects
- Conservative Treatment, Global Burden of Disease, Global Health, Health Occupations education, Health Policy, Health Workforce, Humans, Kidney Failure, Chronic epidemiology, Kidney Failure, Chronic prevention & control, Patient Advocacy, Renal Replacement Therapy adverse effects, Renal Replacement Therapy ethics, Renal Replacement Therapy standards, Developing Countries, Health Planning, Health Services Accessibility economics, Health Services Accessibility ethics, Kidney Failure, Chronic therapy, Renal Replacement Therapy economics, Universal Health Insurance economics
- Abstract
The global nephrology community recognizes the need for a cohesive strategy to address the growing problem of end-stage kidney disease (ESKD). In March 2018, the International Society of Nephrology hosted a summit on integrated ESKD care, including 92 individuals from around the globe with diverse expertise and professional backgrounds. The attendees were from 41 countries, including 16 participants from 11 low- and lower-middle-income countries. The purpose was to develop a strategic plan to improve worldwide access to integrated ESKD care, by identifying and prioritizing key activities across 8 themes: (i) estimates of ESKD burden and treatment coverage, (ii) advocacy, (iii) education and training/workforce, (iv) financing/funding models, (v) ethics, (vi) dialysis, (vii) transplantation, and (viii) conservative care. Action plans with prioritized lists of goals, activities, and key deliverables, and an overarching performance framework were developed for each theme. Examples of these key deliverables include improved data availability, integration of core registry measures and analysis to inform development of health care policy; a framework for advocacy; improved and continued stakeholder engagement; improved workforce training; equitable, efficient, and cost-effective funding models; greater understanding and greater application of ethical principles in practice and policy; definition and application of standards for safe and sustainable dialysis treatment and a set of measurable quality parameters; and integration of dialysis, transplantation, and comprehensive conservative care as ESKD treatment options within the context of overall health priorities. Intended users of the action plans include clinicians, patients and their families, scientists, industry partners, government decision makers, and advocacy organizations. Implementation of this integrated and comprehensive plan is intended to improve quality and access to care and thereby reduce serious health-related suffering of adults and children affected by ESKD worldwide., (Copyright © 2019 International Society of Nephrology. All rights reserved.)
- Published
- 2019
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