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1. Solid pancreas transplant outcomes with increased donor and recipient ages compared with reference ages: a systematic review

Author

Shi Zhou Choo, Kevan R. Polkinghorne, Jonathan E.H. Ling, and John Kanellis

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Graft Survival, Graft thrombosis, Patient survival, Pancreas transplantation, Kidney Transplantation, Tissue Donors, Transplant Recipients, Donor age, Transplantation, Treatment Outcome, medicine.anatomical_structure, Age groups, Internal medicine, Cohort, Internal Medicine, Humans, Medicine, Pancreas Transplantation, business, Pancreas, Aged, Retrospective Studies
Abstract

Increased recipient and donor age are associated with worse solid organ pancreas transplant outcomes. However, donor and recipient age criteria vary between jurisdictions. We systematically reviewed studies reporting the association between transplanting older recipients and donors beyond current Transplantation Society of Australia and New Zealand (TSANZ) limits with solid pancreas transplant outcomes.To review current outcomes of solid pancreas transplantation in recipients and donors over the TSANZ reference ages.Studies comparing transplant outcomes between a reference-age and an older-age donor (45 years) or recipient (≥50 years) cohort for solid pancreas transplantation were included. Primary outcomes were pancreas/kidney graft and patient survival at 1 and 5 years. Secondary outcomes were post-transplant complications (graft thrombosis, acute rejection and relaparotomy rates).Eleven studies were included (two studies assessing solid pancreas outcomes between older vs reference-aged donors and nine studies assessing outcomes between older vs reference-aged recipients). Seven of 11 studies were judged to be at high risk of bias. Primary and secondary outcomes were not significantly different between recipient age groups in nine studies. A sensitivity analysis of older versus reference-aged studies excluding studies at high risk of bias also showed non-inferior primary and secondary outcomes at 1 year. Two studies comparing outcomes by donor age showed worse graft survival but non-inferior patient survival with older donors.Increased donor or recipient age alone should not absolutely contraindicate solid pancreas transplantation, especially if other risk predictors are minimised.

Published
2022

2. Fish oil and aspirin effects on arteriovenous fistula function: Secondary outcomes of the randomised omega-3 fatty acids (Fish oils) and Aspirin in Vascular access OUtcomes in REnal Disease (FAVOURED) trial.

Author

Andrea K Viecelli, Kevan R Polkinghorne, Elaine M Pascoe, Peta-Anne Paul-Brent, Carmel M Hawley, Sunil V Badve, Alan Cass, Lai-Seong Hooi, Peter G Kerr, Trevor A Mori, Loke-Meng Ong, David Voss, David W Johnson, Ashley B Irish, and Omega-3 Fatty Acids (Fish Oils) and Aspirin in Vascular Access Outcomes in Renal Disease (FAVOURED) Study Collaborative Group

Subjects
Medicine, Science
Abstract

BACKGROUND:Arteriovenous fistulas (AVF) for haemodialysis often experience early thrombosis and maturation failure requiring intervention and/or central venous catheter (CVC) placement. This secondary and exploratory analysis of the FAVOURED study determined whether omega-3 fatty acids (fish oils) or aspirin affected AVF usability, intervention rates and CVC requirements. METHODS:In 567 adult participants planned for AVF creation, all were randomised to fish oil (4g/d) or placebo, and 406 to aspirin (100mg/d) or placebo, starting one day pre-surgery and continued for three months. Outcomes evaluated within 12 months included AVF intervention rates, CVC exposure, late dialysis suitability failure, and times to primary patency loss, abandonment and successful cannulation. RESULTS:Final analyses included 536 participants randomised to fish oil or placebo (mean age 55 years, 64% male, 45% diabetic) and 388 randomised to aspirin or placebo. Compared with placebo, fish oil reduced intervention rates (0.82 vs 1.14/1000 patient-days, incidence rate ratio [IRR] 0.72, 95% confidence interval [CI] 0.54-0.97), particularly interventions for acute thrombosis (0.09 vs 0.17/1000 patient-days, IRR 0.53, 95% CI 0.34-0.84). Aspirin significantly reduced rescue intervention rates (IRR 0.45, 95% CI 0.27-0.78). Neither agent significantly affected CVC exposure, late dialysis suitability failure or time to primary patency loss, AVF abandonment or successful cannulation. CONCLUSION:Although fish oil and low-dose aspirin given for 3 months reduced intervention rates in newly created AVF, they had no significant effects on CVC exposure, AVF usability and time to primary patency loss or access abandonment. Reduction in access interventions benefits patients, reduces costs and warrants further study.

Published
2019
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3. The impact of an integrated diabetes and kidney service on patients, primary and specialist health professionals in Australia: A qualitative study.

Author

Edward Zimbudzi, Clement Lo, Tracy Robinson, Sanjeeva Ranasinha, Helena J Teede, Tim Usherwood, Kevan R Polkinghorne, Peter G Kerr, Gregory Fulcher, Martin Gallagher, Stephen Jan, Alan Cass, Rowan Walker, Grant Russell, Greg Johnson, and Sophia Zoungas

Subjects
Medicine, Science
Abstract

BackgroundTo address guideline-practice gaps and improve management of patients with both diabetes and chronic kidney disease (CKD), we involved patients, health professionals and patient advocacy groups in the co-design and implementation of an integrated diabetes-kidney service.ObjectiveIn this study, we explored the experiences of patients and health-care providers, within this integrated diabetes and kidney service.Methods5 focus groups and 2 semi-structured interviews were conducted amongst attending patients, referring primary health professionals, and attending specialist health professionals. Maximal variation sampling was used for both patients and referring primary health professionals to ensure an equal representation of males and females, and patients of different CKD stages. All discussions were audiotaped and transcribed verbatim, before being thematically analysed independently by 2 researchers.ResultsThe mean age (SD) for specialist health professionals, primary care professionals and patients who participated was 45 (11), 44 (15) and 68 (5) years with men being 50%, 80% and 76% of the participants respectively. Key strengths of the diabetes and kidney service were noted to be better integration of care and a perception of improved health and management of health. Whilst some aspects of access such as time between referral and initial appointment and having fewer appointments improved, other aspects such as in-clinic waiting times and parking remained problematic. Specialist health professionals noted that health professional education could be improved. Patient self-management was also noted by to be an issue with some patients requesting more information and some health professionals expressing difficulty in empowering some patients.ConclusionsHealth professionals and patients reported that a co-designed integrated diabetes kidney service improved integration of care and improved health and management of health. However, some aspects of the process of care, health professional education and patient self-management remained challenging.

Published
2019
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4. Long-Term Blood Pressure Variability and Kidney Function in Participants of the ASPREE Trial

Author

Karen L. Margolis, Enayet K. Chowdhury, James B. Wetmore, Rory Wolfe, Robyn L. Woods, Christopher M. Reid, Katherine L Webb, Lawrence J. Beilin, Michelle A. Fravel, Kevan R. Polkinghorne, Michael E. Ernst, and Anne M. Murray

Subjects
Male, medicine.medical_specialty, Aspirin, Long term follow up, business.industry, Australia, Renal function, Blood Pressure, Kidney, medicine.disease, Blood pressure, Internal medicine, Hypertension, Internal Medicine, medicine, Mixed effects, Humans, Female, Renal Insufficiency, Chronic, business, Aged, Glomerular Filtration Rate, Kidney disease, medicine.drug
Abstract

Background Whether long-term blood pressure variability (BPV) predicts kidney function decline in generally healthy older adults is unknown. We investigated this association in ASPirin in Reducing Events in the Elderly (ASPREE) trial participants. Methods Between 2010 and 2014, Australian and US individuals aged ≥70 years (≥65 if US minority) were recruited and followed with annual study visits for a median of 4.7 years. Time-to-event analyses and linear mixed effects models were used to examine associations between incident chronic kidney disease (CKD), and trajectories of estimated glomerular filtration rate (eGFR) and log albumin–creatinine ratio (log ACR) with systolic BPV as a continuous measure, and, by tertile of SD of systolic blood pressure (BP). BPV was estimated using systolic BP measures from baseline through the second annual visit, and kidney outcomes were assessed following this period. Results Incident CKD occurred in 1,829 of 6,759 participants (27.2%), and more commonly in BPV tertiles 2 (27.4%) and 3 (28.3%) than tertile 1 (25.5%); however, the risk was not significantly increased after covariate adjustment (tertile 3 hazard ratio = 1.02; 95% confidence interval: 0.91–1.14). Analysis of eGFR (n = 16,193) and log ACR trajectories (n = 15,213) showed individuals in the highest BPV tertile having the lowest eGFR and highest log ACR, cross-sectionally. However, the trajectories of eGFR and log ACR did not differ across BPV tertiles. Conclusions CKD and markers of reduced kidney function occur more commonly in individuals with higher BPV; however, BPV does not influence trajectory of decline in kidney function over time in older adults who are in generally good health. Clinical trials registration Trial Number NCT01038583 and ISRCTN83772183.

Published
2021

5. Donor Predictors of Donor Pancreas Retrieval and Subsequent Solid Pancreas Transplantation in Australia and New Zealand from 2007 to 2016

Author

John Kanellis, Kevan R. Polkinghorne, and Jonathan E.H. Ling

Subjects
medicine.medical_specialty, Tissue and Organ Procurement, medicine.medical_treatment, Pancreas transplantation, chemistry.chemical_compound, Internal medicine, medicine, Humans, Pancreas, Cause of death, Transplantation, Creatinine, business.industry, Kidney Transplantation, Tissue Donors, medicine.anatomical_structure, chemistry, Donation, Cohort, Surgery, Pancreas Transplantation, business, Body mass index, New Zealand
Abstract

Background Donor characteristics help guide donor pancreas acceptance for solid pancreas-kidney transplantation; however, these criteria vary worldwide. Such variation could result in nonuse of potentially transplantable organs. Using a registry cohort, we identified donor characteristics associated with donor pancreas retrieval and subsequent solid pancreas transplantation in Australia and New Zealand. Methods Australia and New Zealand Organ Donor registry donor data from 2007 to 2016 were used to define cohort 1 (all donors authorized for pancreas retrieval) and cohort 2 (all retrieved donor pancreata considered for solid pancreas transplantation). Donor factors significantly associated with donor pancreas retrieval (cohort 1) and solid pancreas transplantation of retrieved donor pancreata (cohort 2) were determined via multivariable logistic regression. Results Nonretrieval and nonuse of solid organ donor pancreas increased throughout the study period, and nonauthorization for pancreas donation remained stable. Donor body mass index, sex, and viral serology were associated with donor pancreas retrieval but not transplantation. Donor age, cause of death, donation after brain death status, terminal serum creatinine, and donor region were associated with both donor pancreas retrieval and acceptance for solid pancreas transplantation with donation after brain death status being the strongest predictor for both outcomes. Conclusions Donor age, cause of death, donation after brain death status, terminal serum creatinine, and donor region were associated with both donor pancreas retrieval and subsequent transplantation in Australia and New Zealand. Subsequent correlation of these factors with post-pancreas transplant outcomes would help guide pancreas transplant decisions and minimize nonuse of potentially usable donor pancreata.

Published
2021

6. Long-Term Graft and Patient Outcomes Following Kidney Transplantation in End-Stage Kidney Disease Secondary to Hyperoxaluria

Author

Kevan R. Polkinghorne, N. M. Isbel, John Kanellis, Emily J See, Peter G. Kerr, and Vanessa C Heron

Subjects
Adult, Graft Rejection, Male, medicine.medical_specialty, medicine.medical_treatment, Population, Urology, Renal function, Kidney, urologic and male genital diseases, Time, Recurrence, Risk Factors, medicine, Humans, Renal replacement therapy, education, Kidney transplantation, Reflux nephropathy, Hyperoxaluria, Transplantation, education.field_of_study, business.industry, Graft Survival, Australia, Middle Aged, medicine.disease, Kidney Transplantation, female genital diseases and pregnancy complications, Renal Replacement Therapy, Treatment Outcome, surgical procedures, operative, medicine.anatomical_structure, Kidney Failure, Chronic, Female, Surgery, business, Glomerular Filtration Rate, New Zealand, Kidney disease
Abstract

Background End-stage kidney disease secondary to hyperoxaluria presents a major challenge for transplant physicians given concern regarding disease recurrence. Few contemporary studies have reported long-term outcomes following transplantation in this population. Methods This study examined the outcomes of all adult patients with end-stage kidney disease secondary to hyperoxaluria who received a kidney or combined liver-kidney transplant in Australia and New Zealand between 1965 and 2015. Patients with hyperoxaluria were propensity score matched to control patients with reflux nephropathy. The primary outcome was graft survival. Secondary outcomes included graft function, acute rejection, and patient survival. Results Nineteen transplants performed in 16 patients with hyperoxaluria were matched to 57 transplants in patients with reflux nephropathy. Graft survival was inferior in patients with hyperoxaluria receiving a kidney transplant alone (subhazard ratio [SHR] = 3.83, 95% confidence interval [CI], 1.22-12.08, P = .02) but not in those receiving a combined liver-kidney transplant (SHR = 0.63, 95% CI, 0.08-5.21, P = .67). Graft failure risk was particularly high in patients with hyperoxaluria receiving a kidney transplant alone after more than 1 year of renal replacement therapy (SHR = 8.90, 95% CI, 2.35-33.76, P = .001). Posttransplant estimated glomerular filtration rate was lower in patients with hyperoxaluria (10.97 mL/min/1.73 m2, 95% CI, 0.53-21.42, P = .04). There was no difference between groups in the risk of acute rejection or death with a functioning graft. Conclusion Compared to reflux nephropathy, hyperoxaluria was associated with inferior graft survival in patients receiving a kidney transplant alone. Long-term graft function was lower in patients with hyperoxaluria, but the risks of acute rejection and death were not different.

Published
2021

7. Subgroup analysis of the ASPirin in Reducing Events in the Elderly randomized clinical trial suggests aspirin did not improve outcomes in older adults with chronic kidney disease

Author

Peter Gibbs, Jeff D. Williamson, Erica M. Wood, Raj C. Shah, Rowan G. Walker, Geoffrey Cloud, Suzanne E. Mahady, Robyn L. Woods, Michael E. Ernst, Jessica E. Lockery, Walter P. Abhayaratna, Anne M. Murray, Paul Roderick, John J McNeil, James B. Wetmore, Andrew Tonkin, Hugh Gallagher, Christopher M. Reid, Rory Wolfe, Kevan R. Polkinghorne, Mark Nelson, and Geoffrey A Donnan

Subjects
0301 basic medicine, medicine.medical_specialty, Population, 030232 urology & nephrology, Hemorrhage, urologic and male genital diseases, Placebo, Article, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, medicine, Humans, Dementia, Renal Insufficiency, Chronic, education, Aged, Aged, 80 and over, education.field_of_study, Aspirin, business.industry, Hazard ratio, Australia, medicine.disease, United States, Primary Prevention, 030104 developmental biology, Cardiovascular Diseases, Nephrology, Albuminuria, medicine.symptom, business, medicine.drug, Kidney disease
Abstract

The role of aspirin for primary prevention in older adults with chronic kidney disease (CKD) is unclear. Therefore, post hoc analysis of the randomized controlled trial ASPirin in Reducing Events in the Elderly (ASPREE) was undertaken comparing 100 mg of enteric-coated aspirin daily against matching placebo. Participants were community dwelling adults aged 70 years and older in Australia, 65 years and older in the United States, all free of a history of dementia or cardiovascular disease and of any disease expected to lead to death within five years. CKD was defined as present at baseline if either eGFR under 60mL/min/1.73m(2) or urine albumin to creatinine ratio 3 mg/mmol or more. In 4758 participants with and 13004 without CKD, the rates of a composite endpoint (dementia, persistent physical disability or death), major adverse cardiovascular events and clinically significant bleeding in the CKD participants were almost double those without CKD. Aspirin’s effects as estimated by hazard ratios were generally similar between CKD and non-CKD groups for dementia, persistent physical disability or death, major adverse cardiovascular events and clinically significant bleeding. Thus, in our analysis aspirin did not improve outcomes in older people while increasing the risk of bleeding, with mostly consistent effects in participants with and without CKD.

Published
2021

8. Risk indices predicting graft use, graft and patient survival in solid pancreas transplantation: a systematic review

Author

Jonathan E.H. Ling, John Kanellis, Timothy Coughlan, and Kevan R. Polkinghorne

Subjects
Oncology, Risk, medicine.medical_specialty, Survival, medicine.medical_treatment, MEDLINE, 030230 surgery, Pancreas transplantation, Cochrane Library, Organ acceptance, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Humans, 030212 general & internal medicine, Derivation, lcsh:RC799-869, Pancreas, Retrospective Studies, Risk index, Transplantation, business.industry, Graft Survival, Gastroenterology, General Medicine, Hepatology, Tissue Donors, Treatment Outcome, medicine.anatomical_structure, lcsh:Diseases of the digestive system. Gastroenterology, Pancreas Transplantation, business, Body mass index, Research Article
Abstract

Background Risk indices such as the pancreas donor risk index (PDRI) and pre-procurement pancreas allocation suitability score (P-PASS) are utilised in solid pancreas transplantation however no review has compared all derived and validated indices in this field. We systematically reviewed all risk indices in solid pancreas transplantation to compare their predictive ability for transplant outcomes. Methods Medline Plus, Embase and the Cochrane Library were searched for studies deriving and externally validating risk indices in solid pancreas transplantation for the outcomes of pancreas and patient survival and donor pancreas acceptance for transplantation. Results were analysed descriptively due to limited reporting of discrimination and calibration metrics required to assess model performance. Results From 25 included studies, discrimination and calibration metrics were only reported in 88% and 38% of derivation studies (n = 8) and in 25% and 25% of external validation studies (n = 12) respectively. 21 risk indices were derived with mild to moderate ability to predict risk (C-statistics 0.52–0.78). Donor age, donor body mass index (BMI) and donor gender were the commonest covariates within derived risk indices. Only PDRI and P-PASS were subsequently externally validated, with variable association with post-transplant outcomes. P-PASS was not associated with pancreas graft survival. Conclusion Most of the risk indices derived for use in solid pancreas transplantation were not externally validated (90%). PDRI and P-PASS are the only risk indices externally validated for solid pancreas transplantation, and when validated without reclassification measures, are associated with 1-year pancreas graft survival and donor pancreas acceptance respectively. Future risk indices incorporating recipient and other covariates alongside donor risk factors may have improved predictive ability for solid pancreas transplant outcomes.

Published
2021

9. A Randomized Trial on the Effect of Phosphate Reduction on Vascular End Points in CKD (IMPROVE-CKD)

Author

Improve-Ckd Trial Investigators, Meg Jardine, Geoffrey A. Block, Lai Seong Hooi, Peter G. Kerr, Kenneth K. Lau, Donna Reidlinger, Om Narayan, Eugenia Pedagogos, Elaine M. Pascoe, James D. Cameron, Robert J. Walker, Laura Robison, Dana Jackson, Randall J. Faull, Edward R Smith, Carol A. Pollock, Vlado Perkovic, Nicole Lioufas, Sunil V. Badve, Grahame J Elder, Nigel D Toussaint, Kevan R. Polkinghorne, Katrina L. Campbell, Carmel M. Hawley, Stephen G Holt, David W. Johnson, Neil Boudville, Angela Yee-Moon Wang, Sylvia S.M. Chen, and Andrea Valks

Subjects
Male, Fibroblast growth factor 23, medicine.medical_specialty, 030232 urology & nephrology, Urology, Pulse Wave Analysis, 030204 cardiovascular system & hematology, Placebo, Phosphates, 03 medical and health sciences, Hyperphosphatemia, 0302 clinical medicine, Double-Blind Method, Lanthanum, Up Front Matters, Diabetes mellitus, medicine, Humans, Aorta, Abdominal, Renal Insufficiency, Chronic, Vascular Calcification, Pulse wave velocity, Aged, business.industry, General Medicine, Middle Aged, medicine.disease, Fibroblast Growth Factors, Fibroblast Growth Factor-23, Arterial calcification, Lanthanum carbonate, Parathyroid Hormone, Nephrology, Arterial stiffness, Female, Tomography, X-Ray Computed, business, Glomerular Filtration Rate, medicine.drug
Abstract

Background Hyperphosphatemia is associated with increased fibroblast growth factor 23 (FGF23), arterial calcification, and cardiovascular mortality. Effects of phosphate-lowering medication on vascular calcification and arterial stiffness in CKD remain uncertain.Methods To assess the effects of non-calcium-based phosphate binders on intermediate cardiovascular markers, we conducted a multicenter, double-blind trial, randomizing 278 participants with stage 3b or 4 CKD and serum phosphate >1.00 mmol/L (3.10 mg/dl) to 500 mg lanthanum carbonate or matched placebo thrice daily for 96 weeks. We analyzed the primary outcome, carotid-femoral pulse wave velocity, using a linear mixed effects model for repeated measures. Secondary outcomes included abdominal aortic calcification and serum and urine markers of mineral metabolism.Results A total of 138 participants received lanthanum and 140 received placebo (mean age 63.1 years; 69% male, 64% White). Mean eGFR was 26.6 ml/min per 1.73m(2); 45% of participants had diabetes and 32% had cardiovascular disease. Mean serum phosphate was 1.25 mmol/L (3.87 mg/dl), mean pulse wave velocity was 10.8 m/s, and 81.3% had abdominal aortic calcification at baseline. At 96 weeks, pulse wave velocity did not differ significantly between groups, nor did abdominal aortic calcification, serum phosphate, parathyroid hormone, FGF23, and 24-hour urinary phosphate. Serious adverse events occurred in 63 (46%) participants prescribed lanthanum and 66 (47%) prescribed placebo. Although recruitment to target was not achieved, additional analysis suggested this was unlikely to have significantly affected the principle findings.Conclusions In patients with stage 3b/4 CKD, treatment with lanthanum over 96 weeks did not affect arterial stiffness or aortic calcification compared with placebo. These findings do not support the role of intestinal phosphate binders to reduce cardiovascular risk in patients with CKD who have normophosphatemia.

Published
2020

10. Volume management in haemodialysis patients

Author

Kevan R. Polkinghorne and Emily J See

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, medicine.medical_treatment, 030232 urology & nephrology, Physical examination, Gold standard (test), 030204 cardiovascular system & hematology, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Clinical research, Blood pressure, Nephrology, Extracellular fluid, Internal Medicine, Intravascular volume status, Medicine, business, Intensive care medicine, Hypervolemia, Dialysis
Abstract

Purpose of review Accumulating evidence supports the important contribution of volume-related metrics to morbidity and mortality in patients receiving chronic haemodialysis. The purpose of this review is to summarize recent advances in the understanding and management of volume status in this high-risk group. Recent findings Delivery of optimal volume management involves three key components: accurate estimation of volume status, correction of extracellular fluid overload and prevention of intradialytic instability. The lack of a gold standard for assessing volume status makes accurate estimation difficult to achieve; clinical examination has insufficient sensitivity and specificity, while tools to assist in the objective measurement of extracellular fluid volume require further validation. Hypervolemia is common in patients on chronic haemodialysis and substantially increases the risk of morbidity and mortality. Rapid correction of hypervolemia should be avoided due to the risk of precipitating intradialytic hypotension and hypoperfusion of vital end-organs, including the heart, brain, liver, gut and kidneys. Evidence-based interventions to aid in normalizing extracellular fluid volume are urgently needed; several targeted strategies are currently being evaluated. Many centres have successfully implemented local protocols and programmes to enhance volume management. Summary Achieving normal volume status is a fundamental goal of haemodialysis. Novel methods of assessing and restoring extracellular fluid volume while maintaining intradialytic stability are currently undergoing evaluation. Implementation of volume-related strategies into clinical practice is feasible and may improve patient outcome.

Published
2020

11. The impact of comorbid chronic kidney disease and diabetes on health-related quality-of-life: a 12-year community cohort study

Author

Melanie L R Wyld, Steve Chadban, Kevan R. Polkinghorne, Dianna J. Magliano, Leyla Aouad, and Rachael L. Morton

Subjects
medicine.medical_specialty, 030232 urology & nephrology, Disease, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Internal medicine, Diabetes mellitus, Epidemiology, Diabetes Mellitus, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Renal Insufficiency, Chronic, Transplantation, business.industry, Australia, medicine.disease, Comorbidity, Obesity, Nephrology, Quality of Life, business, Kidney disease, Cohort study
Abstract

Background Quality-of-life is an essential outcome for clinical care. Both chronic kidney disease (CKD) and diabetes have been associated with poorer quality-of-life. The combined impact of having both diseases is less well understood. As diabetes is the most common cause of CKD, it is imperative that we deepen our understanding of their joint impact. Methods This was a prospective, longitudinal cohort study of community-based Australians aged ≥25 years who participated in the Australian Diabetes, Obesity and Lifestyle study. Quality-of-life was measured by physical component summary (PCS) and mental component summary sub-scores of the Short Form (36) Health Survey. Univariate and multivariate linear mixed effect regressions were performed. Results Of the 11 081 participants with quality-of-life measurements at baseline, 1112 had CKD, 1001 had diabetes and of these 271 had both. Of the 1112 with CKD 421 had Stage 1, 314 had Stage 2, 346 had Stage 3 and 31 had Stages 4/5. Adjusted linear mixed effect models showed baseline PCS was lower for those with both CKD and diabetes compared with either disease alone (P Conclusions The combination of CKD and diabetes has a powerful adverse impact on quality-of-life, and participants with both diseases had significantly poorer quality-of-life than those with one condition.

Published
2020

12. Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Author

Jennifer E. Flythe, Tara I. Chang, Martin P. Gallagher, Elizabeth Lindley, Magdalena Madero, Pantelis A. Sarafidis, Mark L. Unruh, Angela Yee-Moon Wang, Daniel E. Weiner, Michael Cheung, Michel Jadoul, Wolfgang C. Winkelmayer, Kevan R. Polkinghorne, Teresa Adragão, Samaya J. Anumudu, Christopher T. Chan, Alfred K. Cheung, Maria Rosa Costanzo, Indranil Dasgupta, Andrew Davenport, Simon J. Davies, Marijke J.E. Dekker, Laura M. Dember, Daniel Gallego, Rafael Gómez, Carmel M. Hawley, Manfred Hecking, Kunitoshi Iseki, Vivekanand Jha, Jeroen P. Kooman, Csaba P. Kovesdy, Eduardo Lacson, Adrian Liew, Charmaine E. Lok, Christopher W. McIntyre, Rajnish Mehrotra, Dana C. Miskulin, Ezio Movilli, Fabio Paglialonga, Roberto Pecoits-Filho, Jeff Perl, Carol A. Pollock, Miguel C. Riella, Patrick Rossignol, Rukshana Shroff, Laura Solá, Henning Søndergaard, Sydney C.W. Tang, Allison Tong, Yusuke Tsukamoto, Suzanne Watnick, Matthew R. Weir, James B. Wetmore, Caroline Wilkie, Martin Wilkie, University of North Carolina [Chapel Hill] (UNC), University of North Carolina System (UNC), Stanford School of Medicine [Stanford], Stanford Medicine, Stanford University-Stanford University, The George Institute for Global Health [Sydney] (GIGH), The University of Sydney, Concord Repatriation General Hospital [Sydney, Australia] (CRGH), Leeds Teaching Hospitals NHS Trust, Instituto Nacional de Cardiologia Ignacio Chavez, Aristotle University of Thessaloniki, The University of New Mexico [Albuquerque], The University of Hong Kong (HKU), Tufts Medical Center [Boston], KDIGO, Cliniques Universitaires Saint-Luc [Bruxelles], Université Catholique de Louvain = Catholic University of Louvain (UCL), Baylor College of Medicine (BCM), Baylor University, Monash University [Clayton], Baylor College of Medecine, York University [Toronto], Australian Catholic University (ACU), Institut de Gestion de Rennes - Institut d'Administration des Entreprises - Rennes (IGR-IAE Rennes), Université de Rennes (UR), University of Delhi, University College of London [London] (UCL), Perelman School of Medicine, University of Pennsylvania, Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], French-Clinical Research Infrastructure Network - F-CRIN [Paris] (Cardiovascular & Renal Clinical Trialists - CRCT ), UCL - SSS/IREC/NEFR - Pôle de Néphrologie, and UCL - (SLuc) Service de néphrologie

Subjects
0301 basic medicine, medicine.medical_specialty, medicine.medical_treatment, 030232 urology & nephrology, Psychological intervention, Article, Peritoneal dialysis, 03 medical and health sciences, 0302 clinical medicine, Quality of life (healthcare), residual kidney function, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, medicine, Medical prescription, Intensive care medicine, Dialysis, patient-reported outcome measures, hemodialysis, business.industry, medicine.disease, 030104 developmental biology, Blood pressure, peritoneal dialysis, quality of life, Nephrology, Hemodialysis, business, Kidney disease
Abstract

International audience; Blood pressure (BP) and volume control are critical components of dialysis care and have substantial impacts on patient symptoms, quality of life, and cardiovascular complications. Yet, developing consensus best practices for BP and volume control have been challenging, given the absence of objective measures of extracellular volume status and the lack of high-quality evidence for many therapeutic interventions. In February of 2019, Kidney Disease: Improving Global Outcomes (KDIGO) held a Controversies Conference titled Blood Pressure and Volume Management in Dialysis to assess the current state of knowledge related to BP and volume management and identify opportunities to improve clinical and patient-reported outcomes among individuals receiving maintenance dialysis. Four major topics were addressed: BP measurement, BP targets, and pharmacologic management of suboptimal BP; dialysis prescriptions as they relate to BP and volume; extracellular volume assessment and management with a focus on technology-based solutions; and volume-related patient symptoms and experiences. The overarching theme resulting from presentations and discussions was that managing BP and volume in dialysis involves weighing multiple clinical factors and risk considerations as well as patient lifestyle and preferences, all within a narrow therapeutic window for avoiding acute or chronic volume-related complications. Striking this challenging balance requires individualizing the dialysis prescription by incorporating comorbid health conditions, treatment hemodynamic patterns, clinical judgment, and patient preferences into decision-making, all within local resource constraints.

Published
2020

13. Patient-led identification and prioritization of exercise interventions for fatigue on dialysis: a workshop report

Author

Karine E. Manera, Nicole Evangelidis, Yeoungjee Cho, Angela Ju, David W. Johnson, Jonathan C. Craig, Kate Wyburn, Shilpanjali Jesudason, Talia Gutman, Andrea K. Viecelli, Martin Howell, Anita van Zwieten, Kevan R. Polkinghorne, Allison Tong, and Nicole Scholes-Robertson

Subjects
medicine.medical_specialty, medicine.medical_treatment, 030232 urology & nephrology, Psychological intervention, patient perspectives, Peritoneal dialysis, 03 medical and health sciences, 0302 clinical medicine, medicine, 030212 general & internal medicine, Treadmill, AcademicSubjects/MED00340, Dialysis, clinical trials, Transplantation, exercise, business.industry, Usability, Original Articles, Clinical trial, Identification (information), Nephrology, Physical therapy, dialysis, fatigue, Hemodialysis, business
Abstract

Background Fatigue is one of the most important symptoms among patients receiving dialysis and is nominated as a core outcome to be reported in all clinical trials in this setting. However, few trials of interventions targeting fatigue have been conducted. Patients historically have rarely been involved in the design of interventions, which can limit acceptability and uptake. When asked, they have indicated a preference for lifestyle interventions, such as exercise, to improve fatigue. While some research has focussed on intradialytic exercise for patients receiving haemodialysis, patients have also indicated a preference for a convenient method of exercising with guidance, but on their own time outside of dialysis hours. In response to this, a mobile phone application was proposed as the method of delivery for a home-based exercise intervention targeting fatigue. Methods We convened a workshop with five breakout group sessions in Australia, with 24 patients on dialysis (16 haemodialysis and 8 peritoneal dialysis) and 8 caregivers to identify, prioritize and discuss exercise interventions for fatigue in patients receiving dialysis and the delivery of this through a mobile application. Results Of the 21 types of exercise identified, the top-ranked were walking outdoors, walking on a treadmill and cardio and resistance training. Six themes were identified: (i) ‘an expectation of tangible gains from exercise’, including strengthening and protecting against bodily deterioration related to dialysis; (ii) ‘overcoming physical limitations’, meaning that comorbidities, baseline fatigue and fluctuating health needed to be addressed to engage in exercise; (iii) ‘fear of risks’, which reinforced the importance of safety and compatibility of exercise with dialysis; (iv) ‘realistic and achievable’ exercise, which would ensure initial readiness for uptake; (v) ‘enhancing motivation and interest’ , which expected to support sustained use of the exercise intervention and (vi) ‘ensuring usability of the mobile application’ , which would require simplicity, convenience and comprehensibility. Conclusion Exercise interventions that are expected by patients to improve health outcomes and that are safe, realistic and easy to adopt may be more acceptable to patients on dialysis.

Published
2020

14. Global Dialysis Perspective: Australia

Author

Matthew J Damasiewicz and Kevan R. Polkinghorne

Subjects
Nephrology, medicine.medical_specialty, Steering committee, medicine.medical_treatment, 030232 urology & nephrology, Hemodialysis, Home, 030204 cardiovascular system & hematology, 03 medical and health sciences, Dialysis access, 0302 clinical medicine, Renal Dialysis, Internal medicine, medicine, Humans, Medical prescription, Kidney transplantation, Process Measures, business.industry, Global Perspectives, Australia, General Medicine, medicine.disease, Family medicine, Hemodialysis, business, Peritoneal Dialysis, Developed country
Abstract

Hemodialysis (HD) was first introduced to Australia in the late 1950s to support patients with AKI, with subsequent establishment of maintenance HD by 1962 (1). Since then, like many other developed countries, Australia has seen an exponential rise in the incidence and prevalence of dialysis-treated ESKD (2). Below we provide a snapshot of the current state of the delivery of dialysis in Australia. An accurate record of the incidence, outcomes, and practice patterns of all patients treated with KRT in Australia has been available since the early days of dialysis through the establishment of the Australian and New Zealand Dialysis and Transplant (ANZDATA) registry (3). The core functions of the registry are funded by the Australian and New Zealand Governments and Kidney Health Australia, a nongovernment organization. This funding covers the costs of the registry infrastructure, personnel and production of registry reports. Data collection is not funded and provided to the registry with “in kind” support of all contributing renal units. Operations are overseen by an Executive Group and a Steering Committee, which reports to the funding bodies, and the Australia and New Zealand Society of Nephrology. Registry data is collected in real time for key events (such as dialysis initiation, kidney transplantation or death) and a more comprehensive cross-sectional survey is conducted yearly on December 31. Areas covered include demographic details, primary renal disease, type of KRT, process measures, and a variety of outcomes. For patients on dialysis, this includes type and location dialysis, dialysis prescription, dry weight, type of dialysis access, and basic biochemistry (hemoglobin, calcium, and phosphate). The registry does not routinely collect data on hospitalizations, although linkage to state-based hospitalizations data has been performed as part of separate research projects. As of December 31, 2018, there were 13,399 people with ESKD on dialysis treatment in Australia, …

Published
2020

15. Risk factors for major adverse kidney events in the first year after acute kidney injury

Author

Nigel D Toussaint, Emily J See, Kevan R. Polkinghorne, R.J. Robbins, Rinaldo Bellomo, Michael Bailey, and David W. Johnson

Subjects
medicine.medical_specialty, medicine.medical_treatment, 030232 urology & nephrology, Renal function, urologic and male genital diseases, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Internal medicine, Diabetes mellitus, death, end-stage kidney disease, medicine, risk factors, 030212 general & internal medicine, Renal replacement therapy, AcademicSubjects/MED00340, Transplantation, Creatinine, business.industry, Proportional hazards model, Hazard ratio, Acute kidney injury, Original Articles, medicine.disease, major adverse kidney events, female genital diseases and pregnancy complications, chemistry, acute kidney injury, Nephrology, business, chronic kidney disease, Kidney disease
Abstract

Background Acute kidney injury (AKI) survivors are at increased risk of major adverse kidney events (MAKEs), including chronic kidney disease (CKD), end-stage kidney disease (ESKD) and death. High-risk AKI patients may benefit from specialist follow-up, but factors associated with increased risk have not been reported. Methods We conducted a retrospective study of AKI patients admitted to a single centre between 2012 and 2016 who had a baseline estimated glomerular filtration rate (eGFR) >30 mL/min/1.73 m2 and were alive and independent of renal replacement therapy (RRT) at 30 days following discharge. AKI was identified using International Classification of Diseases, Tenth Revision codes and staged according to the Kidney Disease: Improving Global Outcomes criteria. Patients were excluded if they were kidney transplant recipients or if AKI was attributed to intrinsic kidney disease. We performed Cox regression models to examine MAKEs in the first year, defined as the composite of CKD (sustained 25% drop in eGFR), ESKD (requirement for chronic RRT or sustained eGFR Results We studied 2101 patients (mean ± SD age 69 ± 15 years, baseline eGFR 72 ± 23 mL/min/1.73 m2). Of these, 767 patients (37%) developed at least one MAKE (429 patients developed CKD, 21 patients developed ESKD, 375 patients died). MAKEs occurred more frequently with older age [hazard ratio (HR) 1.16 per decade, 95% confidence interval (CI) 1.10–1.24], greater severity of AKI (Stage 2 HR 1.38, 95% CI 1.16–1.64; Stage 3 HR 1.62, 95% CI 1.31–2.01), higher serum creatinine at discharge (HR 1.04 per 10 µmol/L, 95% CI 1.03–1.06), chronic heart failure (HR 1.41, 95% CI 1.19–1.67), liver disease (HR 1.68, 95% CI 1.39–2.03) and malignancy (non-metastatic HR 1.44, 95% CI 1.14–1.82; metastatic HR 2.26, 95% CI 1.80–2.83). Traditional risk factors (e.g. diabetes and cardiovascular disease) had limited predictive value. Conclusions More than a third of AKI patients develop MAKEs within the first year. Clinical variables available at the time of discharge can help identify patients at increased risk of such events.

Published
2019

16. Kidney transplant recipients’ attitudes toward COVID‐19 vaccination and barriers and enablers to vaccine acceptance

Author

Claire Dendle, Dhakshayini Tharmaraj, Kevan R. Polkinghorne, and William R. Mulley

Subjects
Adult, Vaccine safety, medicine.medical_specialty, COVID-19 Vaccines, Coronavirus disease 2019 (COVID-19), vaccine intention, Psychological intervention, vaccination promotion, Referral service, Kidney transplant, medicine, Humans, Vaccines, Transplantation, SARS-CoV-2, business.industry, Vaccination, COVID-19, Original Articles, renal transplantation, Vaccine efficacy, Kidney Transplantation, Transplant Recipients, SARS‐CoV2 vaccine, Infectious Diseases, Attitude, Renal transplant, Family medicine, vaccine hesitancy, vaccine refusal, Original Article, business
Abstract

Objective To identify barriers and enablers to COVID‐19 vaccination in renal transplant recipients who are undecided about vaccination. Methods An online survey was distributed to 876 adult kidney transplant recipients at a tertiary referral service, who had not been vaccinated against COVID‐19. The survey assessed willingness to be vaccinated, attitudes toward COVID‐19 vaccines, and barriers and enablers to proceeding with vaccination. Results The survey response rate was 54% (473/876). Three hundred and forty‐six (73.1%) participants planned to receive vaccination (yes group), 105 (22.2%) were undecided, and 22 (4.7%) refused vaccination. The undecided group were younger but were not different in other demographic characteristics to the yes group. The undecided group were less positive toward (34.29% vs. 91.3%, p, 22.2% of transplant recipients were undecided about having the COVID‐19 vaccine. This group were less positive and more concerned about the vaccine. Concerns about vaccine safety, insufficient vaccine information and concerns about vaccine efficacy were barriers to vaccine uptake whereas information and recommendation to have the vaccine by their transplant specialist/team and transplant clinic consultation were enablers of vaccine uptake. The majority (95.1%) would proceed with vaccination with the right supports.

Published
2021

17. Socio-economic disparity, access to care and patient-relevant outcomes after kidney allograft failure

Author

Neil Boudville, Germaine Wong, Esther M.M. Ooi, Matthew A Roberts, Kevan R. Polkinghorne, Stephen P. McDonald, Charmaine E. Lok, David W. Johnson, Wai H. Lim, Andrea K. Viecelli, Yun Hui Sheryl Wong, Carmel M. Hawley, Philip A. Clayton, Rachael C. Walker, and Helen Pilmore

Subjects
medicine.medical_specialty, Allograft failure, medicine.medical_treatment, Kidney, Health Services Accessibility, Renal Dialysis, Internal medicine, medicine, Home dialysis, Humans, Registries, Socioeconomic status, Dialysis, Kidney transplantation, Transplantation, business.industry, Hazard ratio, medicine.disease, Allografts, medicine.anatomical_structure, Treatment Outcome, Social Class, Kidney Failure, Chronic, business
Abstract

Social disparity is a major impediment to optimal health outcomes after kidney transplantation. In this study, we aimed to define the association between socio-economic status (SES) disparities and patient-relevant outcomes after kidney allograft failure. Using data from the Australia and New Zealand Dialysis and Transplant registry, we included patients with failed first-kidney allografts in Australia between 2005 and 2017. The association between residential postcode-derived SES in quintiles (quintile 1-most disadvantaged areas, quintile 5-most advantaged areas) with uptake of home dialysis (peritoneal or home haemodialysis) within the first 12-months post-allograft failure, repeat transplantation and death on dialysis were examined using competing-risk analysis. Of 2175 patients who had experienced first allograft failure, 417(19%) and 505(23%) patients were of SES quintiles 1 and 5, respectively. Compared to patients of quintile 5, quintile 1 patients were less likely to receive repeat transplants (adjusted subdistributional hazard ratio [SHR] 0.70,95%CI 0.55–0.89) and were more likely to die on dialysis (1.37 [1.04–1.81]), but there was no association with the uptake of home dialysis (1.02 [0.77–1.35]). Low SES may have a negative effect on outcomes post-allograft failure and further research is required into how best to mitigate this. However, small-scale variation within SES cannot be accounted for in this study.

Published
2021

18. Associations of Chronic Kidney Disease Markers with Cognitive Function: A 12-Year Follow-Up Study

Author

Kaarin J. Anstey, Julian W. Sacre, Steven J. Chadban, Jonathan E. Shaw, Dianna J. Magliano, Paul Zimmet, and Kevan R. Polkinghorne

Subjects
Male, 0301 basic medicine, Neuropsychological Tests, Kidney, Cognition, 0302 clinical medicine, cohort studies, Risk Factors, cognition disorders, Cognitive decline, education.field_of_study, California Verbal Learning Test, General Neuroscience, General Medicine, Middle Aged, kidney diseases, 3. Good health, Psychiatry and Mental health, Clinical Psychology, Cardiovascular diseases, Female, medicine.symptom, Research Article, Glomerular Filtration Rate, Adult, medicine.medical_specialty, Population, Renal function, 03 medical and health sciences, Memory, Diabetes mellitus, Internal medicine, Reaction Time, medicine, Albuminuria, Humans, Cognitive Dysfunction, Renal Insufficiency, Chronic, Risk factor, education, cognitive impairment, Aged, urogenital system, business.industry, cognitive decline, medicine.disease, 030104 developmental biology, Geriatrics and Gerontology, business, Biomarkers, 030217 neurology & neurosurgery, Follow-Up Studies, Kidney disease
Abstract

Background: The role of chronic kidney disease (CKD) as a risk factor for cognitive impairment independent of their shared antecedents remains controversial. Objective: To determine whether kidney damage (indicated by albuminuria) or kidney dysfunction (estimated glomerular filtration rate [eGFR] 0.10). Conclusions: Albuminuria predicted worse memory function at 12 years follow-up, whereas its effect on processing speed was driven largely by differences in cardiovascular risk. Kidney dysfunction based on eGFR predicted neither cognitive domain.

Published
2019

19. Arteriovenous access practices in Australian and New Zealand dialysis units

Author

Brendan Smyth, Sradha Kotwal, Nicholas A Gray, Martin Gallagher, and Kevan R. Polkinghorne

Subjects
medicine.medical_specialty, Vascular access, Arteriovenous fistula, Health Services Accessibility, Nephrologists, Blood Vessel Prosthesis Implantation, Arteriovenous Shunt, Surgical, Renal Dialysis, Humans, Medicine, Healthcare Disparities, Practice Patterns, Physicians', Intensive care medicine, Surgeons, Practice patterns, business.industry, Australia, medicine.disease, Nephrology, Health Care Surveys, Dialysis unit, Nursing Staff, Surgery, business, Dialysis (biochemistry), New Zealand
Abstract

Background: The creation and maintenance of dialysis vascular access is associated with significant morbidity. Structured management pathways can reduce this morbidity, yet practice patterns in Australia and New Zealand are not known. We aimed to describe the arteriovenous access practices in dialysis units in Australia and New Zealand. Methods: An online survey comprising 51 questions was completed by representatives from dialysis units from both countries. In addition to descriptive analysis, responses were compared between units inside and outside of major cities. Results: Of 64 contacted units, 48 (75%) responded (Australia 43, New Zealand 5), representing 38% of dialysis units in Australia and New Zealand. While 94% of units provided pre-dialysis education, only 60% reported a structured pre-dialysis pathway and 69% had a dedicated vascular access nurse. Most units routinely monitored fistula/graft function using flow rate measurement (73%) or recirculation studies (63%). A minority used routine ultrasound (35%). Thrombectomy, fistuloplasty and peritoneal dialysis catheter insertion were rarely performed by nephrologists (4%, 4% and 17% of units, respectively). Units outside of a major city were less likely to have access to a local vascular access surgeon (6/13 (46%) vs 35/35 (100%), P Conclusion: Much variation exists in unit management of arteriovenous access. Structured pre-dialysis pathways and dedicated vascular access nurses may be underutilised in Australia and New Zealand. The use of regular access blood flow measurement and ultrasound is common in both countries despite a lack of data supporting its effectiveness. There is room for both practice improvement and a need for further evidence to ensure optimal arteriovenous access care.

Published
2019

20. Dialysis catheter management practices in Australia and New Zealand

Author

Brendan Smyth, Kevan R. Polkinghorne, Nicholas A Gray, Martin Gallagher, and Sradha Kotwal

Subjects
medicine.medical_specialty, medicine.medical_treatment, Population, 030232 urology & nephrology, 030204 cardiovascular system & hematology, 03 medical and health sciences, Catheters, Indwelling, 0302 clinical medicine, Renal Dialysis, medicine, Humans, Infection control, Practice Patterns, Physicians', education, Dialysis, Management practices, education.field_of_study, Catheter insertion, business.industry, Australia, General Medicine, Dialysis catheter, Catheter, Nephrology, Catheter-Related Infections, Health Care Surveys, Emergency medicine, business, Central venous catheter, New Zealand
Abstract

Aim: Dialysis catheter-associated infections (CAI) are a serious and costly burden on patients and the health-care system. Many approaches to minimizing catheter use and infection prophylaxis are available and the practice patterns in Australia and New Zealand are not known. We aimed to describe dialysis catheter management practices in dialysis units in Australia and New Zealand. Methods: Online survey comprising 52 questions, completed by representatives from dialysis units from both countries. Results: Of 64 contacted units, 48 (75%) responded (Australia 43, New Zealand 5), representing 79% of the dialysis population in both countries. Nephrologists (including trainees) inserted non-tunnelled catheters at 60% and tunnelled catheters at 31% of units. Prophylactic antibiotics were given with catheter insertion at 21% of units. Heparin was the most common locking solution for both non-tunnelled (77%) and tunnelled catheters (69%), with antimicrobial locks being predominant only in New Zealand (80%). Eight different combinations of exit site dressing were in use, with an antibiotic patch being most common (35%). All units in New Zealand and 84% of those in Australia undertook CAI surveillance. However, only 51% of those units were able to provide a figure for their most recent rate of catheter-associated bacteraemia per 1000 catheter days. Conclusion: There is wide variation in current dialysis catheter management practice and CAI surveillance is suboptimal. Increased attention to the scope and quality of CAI surveillance is warranted and further evidence to guide infection prevention is required.

Published
2019

21. Biochemical comparison of 8 h haemodialysis and 4 h haemodiafiltration, and two dialysis membranes, in a randomized cross‐over trial

Author

Kevan R. Polkinghorne, Peter G. Kerr, and Shi Z Choo

Subjects
Adult, Male, Fibroblast growth factor 23, medicine.medical_specialty, Time Factors, medicine.medical_treatment, 030232 urology & nephrology, Urology, Hemodialysis, Home, Hemodiafiltration, 030204 cardiovascular system & hematology, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Humans, Urea, Medicine, Prospective Studies, Renal Insufficiency, Chronic, Dialysis, Aged, Creatinine, Cross-Over Studies, Dialysis membranes, business.industry, Membranes, Artificial, Equipment Design, General Medicine, Middle Aged, Crossover study, Alternative treatment, Fibroblast Growth Factors, Fibroblast Growth Factor-23, Retinol binding protein, Treatment Outcome, chemistry, Nephrology, Female, business, Body mass index, Biomarkers
Abstract

AIM Extended-hours haemodialysis has long been regarded as the optimal form of dialysis for solute clearance. With emerging benefits of haemodiafiltration, we wanted to compare these two head-to-head. METHODS In this randomized cross-over trial, we recruited existing nocturnal haemodialysis patients, who had not been hospitalized in the prior 3 months. After a baseline 8 h haemodialysis session, subjects were randomized to either 2 weeks of 8 h haemodialysis or 4 h haemodiafiltration with cross-over to the alternative treatment after a 2-week washout period. Subjects were additionally randomized to the Fresenius FX80 or Nipro Elisio in a parallel design. Blood and dialysate samples were collected at baseline and at the end of both study periods. RESULTS Twelve patients completed the study. Mean (SD) age and body mass index were 55.1 ± 11.5 years and 36.4 ± 10.8, respectively. Urea and creatinine reduction ratios were higher with extended-hours haemodialysis compared to haemodiafiltration (difference 14.0%, 95% CI = 10.6, 17.3; P

Published
2019

22. Natural killer cell function predicts severe infection in kidney transplant recipients

Author

Karin A Thursky, Rhonda L. Stuart, Poh-Yi Gan, James Ngui, Claire Dendle, John Kanellis, William R. Mulley, Stephen R. Holdsworth, and Kevan R. Polkinghorne

Subjects
Male, Risk, medicine.medical_specialty, Cytomegalovirus, 030230 surgery, Logistic regression, Gastroenterology, Natural killer cell, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Internal medicine, medicine, Humans, Immunology and Allergy, Cytotoxic T cell, Pharmacology (medical), Prospective Studies, Prospective cohort study, Transplantation, Receiver operating characteristic, business.industry, Incidence, Odds ratio, Middle Aged, Kidney Transplantation, Transplant Recipients, Confidence interval, Killer Cells, Natural, medicine.anatomical_structure, ROC Curve, Area Under Curve, Cytomegalovirus Infections, Cohort, Kidney Failure, Chronic, Regression Analysis, Female, business, Immunosuppressive Agents
Abstract

The aim of this study was to determine if natural killer cell number (CD3- /CD16± /CD56± ) and cytotoxic killing function predicts severity and frequency of infection in kidney transplant recipients. A cohort of 168 kidney transplant recipients with stable graft function underwent assessment of natural killer cell number and functional killing capacity immediately prior to entry into this prospective study. Participants were followed for 2 years for development of severe infection, defined as hospitalization for infection. Area under receiver operating characteristic (AUROC) curves were used to evaluate the accuracy of natural killer cell number and function for predicting severe infection. Adjusted odds ratios were determined by logistic regression. Fifty-nine kidney transplant recipients (35%) developed severe infection and 7 (4%) died. Natural killer cell function was a better predictor of severe infection than natural killer cell number: AUROC 0.84 and 0.75, respectively (P = .018). Logistic regression demonstrated that after adjustment for age, transplant function, transplant duration, mycophenolate use, and increasing natural killer function (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.74-0.90; P

Published
2019

23. Long-term risk of adverse outcomes after acute kidney injury: a systematic review and meta-analysis of cohort studies using consensus definitions of exposure

Author

Rinaldo Bellomo, Michael Bailey, Neil J Glassford, David W. Johnson, Kevan R. Polkinghorne, Emily J See, Kushani Jayasinghe, and Nigel D Toussaint

Subjects
0301 basic medicine, medicine.medical_specialty, Time Factors, 030232 urology & nephrology, Risk Assessment, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Outcome Assessment, Health Care, Severity of illness, medicine, Humans, Health Care Rationing, business.industry, Confounding, Acute kidney injury, Acute Kidney Injury, medicine.disease, Survival Analysis, Survival Rate, Transplantation, 030104 developmental biology, Nephrology, Meta-analysis, Disease Progression, Kidney Failure, Chronic, business, Risk assessment, Kidney disease, Cohort study
Abstract

Reliable estimates of the long-term outcomes of acute kidney injury (AKI) are needed to inform clinical practice and guide allocation of health care resources. This systematic review and meta-analysis aimed to quantify the association between AKI and chronic kidney disease (CKD), end-stage kidney disease (ESKD), and death. Systematic searches were performed through EMBASE, MEDLINE, and grey literature sources to identify cohort studies in hospitalized adults that used standardized definitions for AKI, included a non-exposed comparator, and followed patients for at least 1 year. Risk of bias was assessed by the Newcastle-Ottawa Scale. Random effects meta-analyses were performed to pool risk estimates; subgroup, sensitivity, and meta-regression analyses were used to investigate heterogeneity. Of 4973 citations, 82 studies (comprising 2,017,437 participants) were eligible for inclusion. Common sources of bias included incomplete reporting of outcome data, missing biochemical values, and inadequate adjustment for confounders. Individuals with AKI were at increased risk of new or progressive CKD (HR 2.67, 95% CI 1.99-3.58; 17.76 versus 7.59 cases per 100 person-years), ESKD (HR 4.81, 95% CI 3.04-7.62; 0.47 versus 0.08 cases per 100 person-years), and death (HR 1.80, 95% CI 1.61-2.02; 13.19 versus 7.26 deaths per 100 person-years). A gradient of risk across increasing AKI stages was demonstrated for all outcomes. For mortality, the magnitude of risk was also modified by clinical setting, baseline kidney function, diabetes, and coronary heart disease. These findings establish the poor long-term outcomes of AKI while highlighting the importance of injury severity and clinical setting in the estimation of risk.

Published
2019

24. Patient-reported barriers and outcomes associated with poor glycaemic and blood pressure control in co-morbid diabetes and chronic kidney disease

Author

Sanjeeva Ranasinha, Gregory R. Fulcher, Sophia Zoungas, Alan Cass, Tim Usherwood, Peter G. Kerr, Helena J. Teede, Clement Lo, Grant Russell, Rowan G. Walker, Martin Gallagher, Edward Zimbudzi, and Kevan R. Polkinghorne

Subjects
Adult, Blood Glucose, Male, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Family support, Psychological intervention, 030209 endocrinology & metabolism, Comorbidity, Type 2 diabetes, 030204 cardiovascular system & hematology, Health Services Accessibility, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Quality of life (healthcare), Diabetes mellitus, Internal medicine, Internal Medicine, medicine, Humans, Patient Reported Outcome Measures, Renal Insufficiency, Chronic, Aged, Quality of Health Care, Aged, 80 and over, business.industry, Australia, Primary care physician, Middle Aged, medicine.disease, Self Care, Cross-Sectional Studies, Blood pressure, Diabetes Mellitus, Type 2, Hypertension, Female, Patient Participation, business, Kidney disease
Abstract

In patients with comorbid diabetes and chronic kidney disease, the extent to which patient-reported barriers to health-care and patient reported outcomes influence the quality of health care is not well established. This study explored the association between patient-reported barriers to health-care, patient activation, quality of life and diabetes self-care, with attainment of glycaemic and blood pressure (BP) targets.This cross-sectional study recruited adults with diabetes and CKD (eGFR 20 to60 ml/min/1.73m199 patients, mean age 68.7 (SD 9.6), 70.4% male and 90.0% with type 2 diabetes were studied. Poor glycaemic control was associated with increased odds of patient reported "poor family support" (OR 4.90; 95% CI 1.80 to 13.32, p 0.002). Poor BP control was associated with increased odds of patient reported, "not having a good primary care physician" (OR 6.01; 2.42 to 14.95, p 0.001). The number of barriers was not associated with increased odds of poor control (all p 0.05).Specific patient-reported barriers, lack of patient perceived family and primary care physician support, are associated with increased odds of poor glycaemic and blood pressure control respectively. Interventions addressing these barriers may improve treatment target attainment.

Published
2019

25. Survival on home dialysis in New Zealand.

Author

Mark R Marshall, Rachael C Walker, Kevan R Polkinghorne, and Kelvin L Lynn

Subjects
Medicine, Science
Abstract

BackgroundNew Zealand (NZ) has a high prevalence of both peritoneal dialysis (PD) and home haemodialysis (HD) relative to other countries, and probably less selection bias. We aimed to determine if home dialysis associates with better survival than facility HD by simultaneous comparisons of the three modalities.MethodsWe analysed survival by time-varying dialysis modality in New Zealanders over a 15-year period to 31-Dec-2011, adjusting for patient co-morbidity by Cox proportional hazards multivariate regression.ResultsWe modelled 6,419 patients with 3,254 deaths over 20,042 patient-years of follow-up. Patients treated with PD and facility HD are similar; those on home HD are younger and healthier. Compared to facility HD, home dialysis (as a unified category) associates with an overall 13% lower mortality risk. Home HD associates with a 52% lower mortality risk. PD associates with a 20% lower mortality risk in the early period (3 years), with no overall net effect. There was effect modification and less observable benefit associated with PD in those with diabetes mellitus, co-morbidity, and in NZ Maori and Pacific People. There was no effect modification by age or by era.ConclusionOur study supports the culture of home dialysis in NZ, and suggests that the extent and duration of survival benefit associated with early PD may be greater than appreciated. We are planning further analyses to exclude residual confounding from unmeasured co-morbidity and other sociodemographic factors using database linkage to NZ government datasets. Finally, our results suggest further research into the practice of PD in NZ Maori and Pacific People, as well as definitive study to determine the best timing for switching from PD in the late phase.

Published
2014
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26. The association between body mass index and mortality in incident dialysis patients.

Author

Sunil V Badve, Sanjoy K Paul, Kerenaftali Klein, Philip A Clayton, Carmel M Hawley, Fiona G Brown, Neil Boudville, Kevan R Polkinghorne, Stephen P McDonald, and David W Johnson

Subjects
Medicine, Science
Abstract

To study the body mass index (BMI) trajectory in patients with incident end-stage kidney disease and its association with all-cause mortality.This longitudinal cohort study included 17022 adult patients commencing hemodialysis [HD] (n = 10860) or peritoneal dialysis [PD] (n = 6162) between 2001 and 2008 and had ≥6-month follow-up and ≥2 weight measurements, using the Australia and New Zealand Dialysis and Transplant Registry data. The association of time-varying BMI with all-cause mortality was explored using multivariate Cox regression models.The median follow-up was 2.3 years. There was a non-linear change in the mean BMI (kg/m2) over time, with an initial decrease from 27.6 (95% confidence interval [CI]: 27.5, 27.7) to 26.7 (95% CI: 26.6, 26.9) at 3-month, followed by increments to 27.1 (95% CI: 27, 27.2) at 1-year and 27.2 (95% CI: 26.8, 27.1) at 3-year, and a gradual decrease subsequently. The BMI trajectory was significantly lower in HD patients who died than those who survived, although this pattern was not observed in PD patients. Compared to the reference time-varying BMI category of 25.1-28 kg/m2, the mortality risks of both HD and PD patients were greater in all categories of time-varying BMI 28.1 kg/m2 among HD patients, but only in the category 28.1-31 kg/m2 among PD patients.BMI changed over time in a non-linear fashion in incident dialysis patients. Time-varying measures of BMI were significantly associated with mortality risk in both HD and PD patients.

Published
2014
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27. Measurement of Humoral Immune Competence and the Risk of Sinopulmonary Infection in a Cohort of Kidney Transplant Recipients

Author

Kevan R. Polkinghorne, John Kanellis, Karen L. Laurie, Poh-Yi Gan, Claire Dendle, Stephen R. Holdsworth, Karin A Thursky, J. Ngui, Rhonda L. Stuart, William R. Mulley, and Vivian K.Y. Leung

Subjects
Adult, Male, Risk, medicine.medical_specialty, 030230 surgery, medicine.disease_cause, Cohort Studies, 03 medical and health sciences, Influenza A Virus, H1N1 Subtype, 0302 clinical medicine, Internal medicine, Influenza, Human, medicine, Influenza A virus, Humans, Prospective Studies, 030212 general & internal medicine, Sinusitis, Seroconversion, Prospective cohort study, Kidney transplantation, Transplantation, business.industry, Vaccination, Middle Aged, medicine.disease, Kidney Transplantation, Transplant Recipients, Influenza Vaccines, Cohort, Female, Surgery, business, Cohort study
Abstract

Purpose The aim of this study was to determine if measurement of B cell protective immunity was associated with susceptibility to sinopulmonary infection in kidney transplant recipients. Methods and Materials A prospective cohort of 168 patients with stable graft function (median 4.1 years) underwent assessment of B-lymphocyte antigen CD19 (CD19+) cell number, immunoglobulin G concentration, and seroresponses to influenza vaccination upon study entry. Patients received a single dose of a trivalent, seasonal influenza vaccine. Results After 2 years follow-up, 31 patients (18%) developed sinopulmonary infection. CD19+ cell number was strongly associated with future sinopulmonary infection. A higher proportion of patients with CD19+ cell counts below the fifth percentile for controls developed sinopulmonary infections than those above the fifth percentile, 30% (23 of 77 patients) compared with 9% (7 of 79 patients; P = .001). There was a trend toward a higher proportion of patients with reduced immunoglobulin G concentrations developing infections than in the normal range for controls, 29% (14 of 48 patients) compared with 15% (16 of 108 patients; P = .060). Influenza vaccination seroresponses were poor in patients and controls such that they could not be used to identify a subgroup of patients at high risk for the development of severe pulmonary infection. Conclusions Monitoring B-cell numbers represents a simple, inexpensive means of stratifying transplant recipients' risk of sinopulmonary infection.

Published
2018

28. A co-designed integrated kidney and diabetes model of care improves mortality, glycaemic control and self-care

Author

Grant Russell, Sophia Zoungas, Alan Cass, Edward Zimbudzi, Greg Johnson, Stephen Jan, Gregory R. Fulcher, Kevan R. Polkinghorne, Sanjeeva Ranasinha, Peter G. Kerr, Martin Gallagher, Rowan G. Walker, Clement Lo, Arul Earnest, Helena J. Teede, and Tim Usherwood

Subjects
Adult, medicine.medical_specialty, Renal function, Glycemic Control, Rate ratio, Kidney, Interquartile range, Internal medicine, Diabetes mellitus, medicine, Diabetes Mellitus, Humans, Renal Insufficiency, Chronic, Glycated Hemoglobin, Transplantation, medicine.diagnostic_test, business.industry, Mortality rate, medicine.disease, Integrated care, Self Care, Nephrology, Eye examination, business, Kidney disease, Glomerular Filtration Rate
Abstract

Background Current healthcare models are ill-equipped for managing people with diabetes and chronic kidney disease (CKD). We evaluated the impact of a new diabetes and kidney disease service (DKS) on hospitalization, mortality, clinical and patient-relevant outcomes. Methods Longitudinal analyses of adult patients with diabetes and CKD (Stages 3a–5) were performed using outpatient and hospitalization data from January 2015 to October 2018. Data were handled according to whether patients received the DKS intervention (n = 196) or standard care (n = 7511). The DKS provided patient-centred, coordinated multidisciplinary assessment and management of patients. Primary analyses examined hospitalization and mortality rates between the two groups. Secondary analyses evaluated the impact of the DKS on clinical target attainment, changes in estimated glomerular filtration rate (eGFR), glycated haemoglobin A1c (HbA1c), self-care and patient activation at 12 months. Results Patients who received the intervention had a higher hospitalization rate {incidence rate ratio [IRR] 1.20 [95% confidence interval (CI) 1.13–1.30]; P Conclusions A co-designed, person-centred integrated model of care improved all-cause mortality, kidney function, glycaemic control and self-care for patients with diabetes and CKD.

Published
2021

29. Center-Effect of Incident Hemodialysis Vascular Access Use: Analysis of a Bi-national Registry

Author

Matthew A Roberts, Samantha Ng, Kannaiyan S Rabindranath, Kevan R. Polkinghorne, Elaine M. Pascoe, Philip A. Clayton, David W. Johnson, Andrea K. Viecelli, Ashley Irish, Carmel M. Hawley, and Stephen P. McDonald

Subjects
Adult, Male, Nephrology, medicine.medical_specialty, medicine.medical_treatment, Hemodialysis, Home, Arteriovenous fistula, Peritoneal dialysis, Renal Dialysis, Internal medicine, medicine, Humans, Registries, Aged, Original Investigation, business.industry, General Medicine, Middle Aged, medicine.disease, Catheter, Kidney Failure, Chronic, Hemodialysis, business, Peritoneal Dialysis, Body mass index, Central venous catheter, Kidney disease
Abstract

BACKGROUND: Commencing hemodialysis (HD) with an arteriovenous access is associated with superior patient outcomes compared with a catheter, but the majority of patients in Australia and New Zealand initiate HD with a central venous catheter. This study examined patient and center factors associated with arteriovenous fistula/graft access use at HD commencement. METHODS: We included all adult patients starting chronic HD in Australia and New Zealand between 2004 and 2015. Access type at HD initiation was analyzed using logistic regression. Patient-level factors included sex, age, race, body mass index (BMI), smoking status, primary kidney disease, late nephrologist referral, comorbidities, and prior RRT. Center-level factors included size; transplant capability; home HD proportion; incident peritoneal dialysis (average number of patients commencing RRT with peritoneal dialysis per year); mean weekly HD hours; average blood flow; and achievement of phosphate, hemoglobin, and weekly Kt/V targets. The study included 27,123 patients from 61 centers. RESULTS: Arteriovenous access use at HD commencement varied four-fold from 15% to 62% (median 39%) across centers. Incident arteriovenous access use was more likely in patients aged 51–72 years, males, and patients with a BMI of >25 kg/m(2) and polycystic kidney disease; but use was less likely in patients with a BMI of

Published
2021

30. The impact of antineutrophil cytoplasmic antibody-associated vasculitis on employment and work disability in an Australian population

Author

Jessica Ryan, Kevan R. Polkinghorne, Michael Gingold, Vanessa C Heron, and Arthur R Kitching

Subjects
Adult, Employment, Male, Pediatrics, medicine.medical_specialty, Financial stability, Work Capacity Evaluation, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis, Disease, Efficiency, Cohort Studies, 03 medical and health sciences, Disability Evaluation, 0302 clinical medicine, Rheumatology, Cost of Illness, Sickness Impact Profile, Surveys and Questionnaires, Absenteeism, Medicine, Humans, 030212 general & internal medicine, Fatigue, Anti-neutrophil cytoplasmic antibody, 030203 arthritis & rheumatology, Work productivity, business.industry, Work disability, Australia, Middle Aged, medicine.disease, Australian population, Cohort, Quality of Life, Female, business, Vasculitis
Abstract

Aim Although antineutrophil cytoplasmic antibody-associated vasculitis (AAV) most commonly affects older individuals, many patients develop the disease during their most productive working years. The aim of this study was to examine the effects of AAV on employment and work disability in a cohort of Australian patients of working age. Methods Patients attending a vasculitis clinic located in Melbourne, Australia, completed an employment questionnaire in addition to the Work Productivity and Activity Impairment Questionnaire: Specific Health Problem. Results The average age of the 47 respondents was 47.8 ± 11.9 years (range 22-63 years), with a median disease duration of 60 months (range 10.2-318.5 months). There were 68.1% who were currently employed, but 20.6% of respondents employed at the time of diagnosis were no longer working and 10.6% had experienced a significant reduction in work hours since their diagnosis. There were 12.7% who were dependent on the disability support pension. The rate of work disability was 23.4%. Many participants considered themselves work impaired (41.9%), with 10.1% having missed work in the previous week. Furthermore, 44.7% of respondents reported that their financial stability had been negatively impacted by their vasculitis diagnosis. Fatigue was commonly reported. Work disabled patients were significantly more likely to be obese and less likely to have completed a tertiary education. Work disabled patients tended to be older, myeloperoxidase-antineutrophil cytoplasmic antibody positive, and have renal involvement and lung involvement. Conclusion A proportion of people living with AAV in Australia experience a decline in employment and an increase in work disability when living with this condition.

Published
2021

31. Epidemiology and Outcomes of Acute Kidney Diseases: A Comparative Analysis

Author

Kevan R. Polkinghorne, David W. Johnson, Rinaldo Bellomo, Michael Bailey, Nigel D Toussaint, and Emily J See

Subjects
Adult, Male, medicine.medical_specialty, Renal function, Cohort Studies, Internal medicine, Epidemiology, Medicine, Humans, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Incidence (epidemiology), Hazard ratio, Acute kidney injury, Retrospective cohort study, Acute Kidney Injury, Middle Aged, medicine.disease, Nephrology, Cohort, Acute Disease, Female, Kidney Diseases, business, Kidney disease
Abstract

Introduction: Acute kidney diseases and disorders (AKD) encompass acute kidney injury (AKI) and subacute or persistent alterations in kidney function that occur after an initiating event. Unlike AKI, accurate estimates of the incidence and prognosis of AKD are not available and its clinical significance is uncertain. Methods: We studied the epidemiology and long-term outcome of AKD (as defined by the KDIGO criteria), with or without AKI, in a retrospective cohort of adults hospitalized at a single centre for >24 h between 2012 and 2016 who had a baseline eGFR ≥60 mL/min/1.73 m2 and were alive at 30 days. In patients for whom follow-up data were available, the risks of major adverse kidney events (MAKEs), CKD, kidney failure, and death were examined by Cox and competing risk regression analyses. Results: Among 62,977 patients, 906 (1%) had AKD with AKI and 485 (1%) had AKD without AKI. Follow-up data were available for 36,118 patients. In this cohort, compared to no kidney disease, AKD with AKI was associated with a higher risk of MAKEs (40.25 per 100 person-years; hazard ratio [HR] 2.51, 95% confidence interval [CI] 2.16–2.91), CKD (27.84 per 100 person-years); subhazard ratio [SHR] 3.18, 95% CI 2.60–3.89), kidney failure (0.56 per 100 person-years; SHR 24.84, 95% CI 5.93–104.03), and death (14.86 per 100 person-years; HR 1.52, 95% CI 1.20–1.92). Patients who had AKD without AKI also had a higher risk of MAKEs (36.21 per 100 person-years; HR 2.26, 95% CI 1.89–2.70), CKD (22.94 per 100 person-years; SHR 2.69, 95% CI 2.11–3.43), kidney failure (0.28 per 100 person-years; SHR 12.63, 95% CI 1.48–107.64), and death (14.86 per 100 person-years; HR 1.57, 95% CI 1.19–2.07). MAKEs after AKD were driven by CKD, especially in the first 3 months. Conclusions: These findings establish the burden and poor prognosis of AKD and support prioritisation of clinical initiatives and research strategies to mitigate such risk.

Published
2020

32. Are SGLT2 Inhibitors Safe and Effective in Advanced Diabetic Kidney Disease?

Author

Kevan R. Polkinghorne and Sophia Zoungas

Subjects
Male, medicine.medical_specialty, Time Factors, Epidemiology, medicine.medical_treatment, 030232 urology & nephrology, Disease, 030204 cardiovascular system & hematology, urologic and male genital diseases, Critical Care and Intensive Care Medicine, Kidney, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, Risk Factors, Diabetes mellitus, Health care, medicine, Humans, Diabetic Nephropathies, Canagliflozin, Intensive care medicine, Sodium-Glucose Transporter 2 Inhibitors, Dialysis, Kidney transplantation, Aged, Transplantation, Diabetic kidney, business.industry, Editorials, Acute Kidney Injury, Middle Aged, medicine.disease, female genital diseases and pregnancy complications, medicine.anatomical_structure, Treatment Outcome, Diabetes Mellitus, Type 2, Nephrology, Disease Progression, Female, business, Kidney disease, Glomerular Filtration Rate
Abstract

The Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) trial demonstrated that the sodium glucose cotransporter 2 (SGLT2) inhibitor canagliflozin reduced the risk of kidney failure and cardiovascular events in participants with type 2 diabetes mellitus and CKD. Little is known about the use of SGLT2 inhibitors in patients with eGFR30 ml/min per 1.73 mEffects of eGFR slope through week 130 were analyzed using a piecewise, linear, mixed-effects model. Efficacy was analyzed in the intention-to-treat population, on the basis of Cox proportional hazard models, and safety was analyzed in the on-treatment population. At randomization (an average of 29 days after screening), 174 of 4401 (4%) participants had an eGFR30 ml/min per 1.73 mFrom weeks 3 to 130, there was a 66% difference in the mean rate of eGFR decline with canagliflozin versus placebo (mean slopes, -1.30 versus -3.83 ml/min per 1.73 mThis

Published
2020

33. Initial mycophenolate dose in tacrolimus treated renal transplant recipients, a cohort study comparing leukopaenia, rejection and long-term graft function

Author

John Kanellis, Khai Gene Leong, William R. Mulley, Kevan R. Polkinghorne, and Vatsa Dave

Subjects
Adult, Graft Rejection, Male, medicine.medical_specialty, Time Factors, Immunology, 030232 urology & nephrology, Urology, lcsh:Medicine, Renal function, Mycophenolate, Graft function, Article, Tacrolimus, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, medicine, Humans, In patient, lcsh:Science, Retrospective Studies, Multidisciplinary, business.industry, Incidence (epidemiology), lcsh:R, Leukopenia, Middle Aged, Mycophenolic Acid, Kidney Transplantation, surgical procedures, operative, Nephrology, Renal transplant, Female, lcsh:Q, business, 030217 neurology & neurosurgery, Follow-Up Studies, Cohort study
Abstract

The evidence supporting an initial mycophenolate mofetil (MMF) dose of 2 g daily in tacrolimus-treated renal transplant recipients is limited. In a non-contemporaneous single-centre cohort study we compared the incidence of leukopaenia, rejection and graft dysfunction in patients initiated on MMF 1.5 g and 2 g daily. Baseline characteristics and tacrolimus trough levels were similar by MMF group. MMF doses became equivalent between groups by 12-months post-transplant, driven by dose reductions in the 2 g group. Leukopaenia occurred in 42.4% of patients by 12-months post-transplant. MMF 2 g was associated with a 1.80-fold increased risk of leukopaenia compared to 1.5 g. Rejection occurred in 44.8% of patients by 12-months post-transplantation. MMF 2 g was associated with half the risk of rejection relative to MMF 1.5 g. Over the first 7-years post-transplantation there was no difference in renal function between groups. Additionally, the development of leukopaenia or rejection did not result in reduced renal function at 7-years post-transplant. Leukopaenia was not associated with an increased incidence of serious infections or rejection. This study demonstrates the initial MMF dose has implications for the incidence of leukopaenia and rejection. Since neither dose produced superior long-term graft function, clinical equipoise remains regarding the optimal initial mycophenolate dose in tacrolimus-treated renal transplant recipients.

Published
2020

34. Practice patterns and predictors of outpatient care following acute kidney injury in an Australian healthcare setting

Author

David G Ransley, David W. Johnson, Emily J See, Kevan R. Polkinghorne, Nigel D Toussaint, Ray Robbins, Rinaldo Bellomo, and Michael Bailey

Subjects
Nephrology, Adult, medicine.medical_specialty, urologic and male genital diseases, chemistry.chemical_compound, Ambulatory care, Internal medicine, Health care, Internal Medicine, medicine, Ambulatory Care, Humans, Stage (cooking), Retrospective Studies, Creatinine, Proteinuria, Vascular disease, business.industry, Acute kidney injury, Australia, Acute Kidney Injury, medicine.disease, chemistry, medicine.symptom, business, Delivery of Health Care
Abstract

BACKGROUND: Survivors of acute kidney injury (AKI) are at increased risk of major adverse kidney events and international guidelines recommend individuals be evaluated 3 months following AKI. AIMS: We describe practice patterns and predictors of post-AKI care in an Australian tertiary hospital. METHODS: A retrospective analysis was undertaken of adults with AKI (defined by KDIGO criteria) admitted to a single centre between 2012 and 2016. The primary outcome was outpatient nephrology review at 3 months. Secondary outcomes included inpatient nephrology review, and outpatient serum creatinine and urinary protein measurements. Data were analysed using multivariable logistic and competing risk regression. RESULTS: Only 117 of 2111 patients with AKI (6%) were reviewed by a nephrologist at 3 months. Reviewed patients were more likely to have a higher discharge serum creatinine (OR 1.20 per 10 μmol/L increase, 95% CI 1.16-1.25) or a history of peripheral vascular disease (OR 1.77, 95% CI 1.00-3.14). They were less likely to be older (OR 0.66 per decade, 95% CI 0.57-0.76), or to have a history of liver (OR 0.47, 95% CI 0.26-0.87) or ischaemic heart disease (OR 0.50, 95% CI 0.27-0.94). AKI stage did not predict follow up. The median time from discharge to outpatient serum creatinine testing was 12 days (IQR 4-47) and proteinuria was measured in 538 patients (25%). CONCLUSIONS: A minority of admitted AKI patients receive recommended post-AKI care. Studies in other Australian institutions are required to confirm or refute these concerning findings. This article is protected by copyright. All rights reserved.

Published
2020

35. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Author

Soufiane Boufous, Yousef Veisani, Mehran Asadi-Aliabadi, Sharath Burugina Nagaraja, Maziar Moradi-Lakeh, Getachew Mullu Kassa, Edward J Mills, Dimas Ria Angga Pribadi, William James Dangel, Mohamad-Hani Temsah, Catherine O. Johnson, Gregory A. Roth, Giuseppe Gorini, Fariborz Mansour-Ghanaei, Alberto Ortiz, Samad Azari, Assefa Ayalew Ayalew Ayalew Gebreslassie, Salime Goharinezhad, Stephanie R. M. Zimsen, Peng Zheng, Michael Assmus, Elisabetta Pupillo, Bach Xuan Tran, Lal B. Rawal, Narayanaswamy Venketasubramanian, Noushin Mohammadifard, Stephen S Lim, Ata Rafiee, Maria Inês Schmidt, Vincent C. Iannucci, Suzanne Lyn Barker-Collo, Leah E. Cahill, Tauseef Ahmad, Platon D. Lopukhov, Kazumasa Yamagishi, Abdullah Al Mamun, Iqbal R. F. Elyazar, Giovanni Damiani, Mohammad Hossein Bakhshaei, Mehdi Fazlzadeh, Virginia Núñez-Samudio, Alyssa Pennini, Dietrich Plass, Atkilt Esaiyas Etisso, Gebre Teklemariam Demoz, Alexandrea Watson, Arvin Haj-Mirzaian, Paul S Briant, Frank B. Osei, Blair R. Bumgarner, Maciej Banach, Ravensara S. Travillian, Kai-Lan Chang, Shirin Djalalinia, Hasan Yusefzadeh, Silvano Gallus, Seyyed Meysam Mousavi, Bernhard T. Baune, Aaron van Donkelaar, Azeem Majeed, Hans Kromhout, Robert Ancuceanu, Blessing J. Akombi, Pushpendra Singh, Nayu Ikeda, William M. Gardner, Zahid A Butt, Mohammad Abdollahi, Temesgen Yihunie Akalu, Rahman Shiri, Benn Sartorius, Ai-Min Wu, Bing Fang Hwang, Flavia M. Cicuttini, Hiroyasu Iso, Luis Camera, Amin Soheili, Félix Carvalho, Yun Jin Kim, Caleb Mackay Salpeter Irvine, Mehdi Mirzaei-Alavijeh, Iman Halvaei, Saqib Ali, Giulio Castelpietra, Catalina Liliana Andrei, Ali Kazemi Karyani, Parkes J Kendrick, Hamidreza Haririan, Lucas Guimarães Abreu, Mukhammad David Naimzada, Jeff T. Zhao, Samiah Alam, Sorin Hostiuc, Shaun Wen Huey Lee, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Cyrus Alinia, Takahiro Tabuchi, Manu Raj Mathur, Søren Thorgaard Skou, Thomas Khaled Dwayne Classen, Reza Heidari-Soureshjani, Massimo Cirillo, Nikita Otstavnov, Mehdi Bohluli, Ruth W. Kimokoti, Animut Tagele Tamiru, Masoumeh Sadeghi, Mohammad Ali Jahani, Itamar S. Santos, Mekdes Tigistu Yilma, Lars Johansson, Arielle Wilder Eagan, Nevine El Nahas, Silvia Schiavolin, Kevin D. Shield, Dinh-Toi Chu, Shiva Borzouei, Paul S. F. Yip, Beatrix Haddock, Gianfranco Alicandro, Vasily Vlassov, Deanna Anderlini, Giuseppe Remuzzi, Khalid A Altirkawi, Farahnaz Joukar, Aso Mohammad Darwesh, Ratilal Lalloo, Panniyammakal Jeemon, Rohollah Kalhor, Daniel Youngwhan Cho, Weijia Fu, João Pedro Silva, Rodrigo Sarmiento-Suarez, Seth Christopher Yaw Appiah, Mehdi Ahmadi, Jacob Olusegun Olusanya, José Neves, Gaorui Guo, Tomas Y. Yeheyis, John S. Ji, Charles D. H. Parry, Maryam Ghadimi, Seyed-Mohammad Fereshtehnejad, Serge Resnikoff, Anna E. Torre, Vinod C Nayak, Jamileh Shadid, Susanne Breitner, Mohammad Khammarnia, Mathilde Touvier, Ensiyeh Jenabi, Hosna Janjani, Floriane Ausloos, Irmina Maria Michalek, Alexandra S. Boon-Dooley, Jessica A. Cruz, Syed Mohamed Aljunid, Abiodun M. Adeoye, André Faro, Bartosz Miazgowski, Jobert Richie Nansseu, Erin C Mullany, Giannina Ferrara, Martin McKee, Emmanuel Peprah, Oommen John, Reza Saeedi, Yasser Vasseghian, Dragos Virgil Davitoiu, Sarah Wulf Hanson, Yingxi Zhao, Omid Shafaat, Ali Rajabpour-Sanati, Farid Najafi, Ana Maria Mantilla Herrera, Fatemeh Rajati, Tarun Gupta, Łukasz Szumowski, Mohammed Ibrahim Mohialdeen Gubari, Peter Njenga Keiyoro, Dharmesh Kumar Lal, Zhi Jiang Zhang, Osayomwanbo Osarenotor, Tanvir M. Huda, Perminder S. Sachdev, Farhad Ghamari, Era Upadhyay, Vivek Kumar, Guoqing Hu, Vinay Nangia, Vladimir Andreevich Korshunov, Saeed Shahabi, Golnaz Heidari, Ashraf Nabhan, Robert C. Reiner, Aziz Rezapour, Justin J. Lang, Rakhi Dandona, Josephine W. Ngunjiri, Anna-Karin Danielsson, André Karch, Filippo Ariani, Ahmed Abdelalim, Masih Tajdini, Stefanos Tyrovolas, Mohamed Hsairi, Jae Il Shin, Jasvinder A. Singh, Meghan D. Mooney, Fiona B. Bennitt, Hesam Alizade, Segun Emmanuel Ibitoye, Pradhum Ram, Soraya Siabani, Evanson Z. Sambala, Reza Malekzadeh, Falk Schwendicke, Lalit Dandona, Masoud Moradi, Molly R Nixon, Roya Mirzaei, Rachel Feldman, Hosni Salem, Alberto L. García-Basteiro, Lorainne Tudor Car, Sharareh Eskandarieh, Ramesh Holla, Ritesh G. Menezes, Taraneh Yousefinezhadi, Hai Quang Pham, Hamideh Salimzadeh, Luisa Sorio Flor, Priya Rathi, Ali Bijani, Harvey Whiteford, Shanshan Li, Aleksandr Y. Aravkin, Joshua A. Salomon, Franz Castro, Lisa M. Force, Abdilahi Yousuf Yousuf, Mina Anjomshoa, Ken Takahashi, Maigeng Zhou, Telma Zahirian Moghadam, Maseer Khan, Irina Filip, Santi Martini, Randah R. Hamadeh, Somayeh Bohlouli, Joana Morgado-da-Costa, Tim Driscoll, Jingkai Wei, Hermann Brenner, Reza Rawassizadeh, Radoslaw Sierpinski, Saman Esmaeilnejad, Emmanuel Wandera Okunga, Marisa Freitas, Srikanta Banerjee, Feleke Mekonnen Demeke, Shahin Soltani, Naser Mohammad Gholi Mezerji, Reed J D Sorensen, Elena V. Gnedovskaya, Johan Ärnlöv, Ivo Rakovac, Reza Mohammadpourhodki, Hussain Jafari, Atte Meretoja, Yasir Waheed, Fahad Alanezi, Arya Haj-Mirzaian, Sezer Kisa, Jaifred Christian F. Lopez, Khalid F. Alhabib, Basema Saddik, Michael R. Phillips, Vishnu Renjith, Yafeng Wang, Kevan R. Polkinghorne, Liliana G Ciobanu, Jacek Jerzy Jozwiak, Gelin Xu, Richard C. Franklin, Junjie Wu, Thomas R. Hird, Mohammad Zamani, Diana Silva, Fotis Topouzis, Irena Ilic, Jeffrey D. Stanaway, Hadi Pourjafar, Huong Lan Thi Nguyen, Khaled Khatab, Ammas Siraj Mohammed, Ziyad Al-Aly, A. A. Fomenkov, Charlie Ashbaugh, Mowafa Househ, Paul I. Dargan, Endalkachew Worku Mengesha, Shaimaa I. El-Jaafary, Ernoiz Antriyandarti, Iffat Elbarazi, Dara K. Mohammad, Naznin Hossain, Reza Shirkoohi, João M. Furtado, Arash Ziapour, Morteza Jafarinia, M. Mofizul Islam, Anamika Pandey, Ahmed I. Hasaballah, Tanuj Kanchan, Lee Ling Lim, Muktar Omer Omer, Charles D.A. Wolfe, Ulrich O Mueller, Helen Bitew, V. Prakash, Fereshteh Mehri, Randall V. Martin, Claudiu Herteliu, Constance D. Pond, Min Jeong Shin, Morteza Oladnabi, Antonio Maria Borzì, Yousef Mohammad, Yuichiro Yano, Luke D. Knibbs, Kevin S Ikuta, Maryam Mirzaei, Andreea Mirica, Sofia Boston Redford, Siamak Sabour, Mariya Vladimirovna Titova, Davood Anvari, Ghobad Moradi, Jordi Alonso, Shiwei Liu, Theo Vos, Tuomo J. Meretoja, Ireneous N. Soyiri, Owen R. Cooper, Seyed Sina Naghibi Irvani, Kejia Hu, Hannah J. Henrikson, Sanni Yaya, Robert P. Dellavalle, Chidozie Declan Iwu, Sergey Soshnikov, Jee-Young Jasmine Choi, Satinath Mukhopadhyay, Zabihollah Yousefi, Iman El Sayed, Biresaw Wassihun Alemu, Neeti Kapoor, Ahmad Daryani, Cathleen Keller, Ibrahim Abdollahpour, Nuno Taveira, Masoud Foroutan, Fatemeh Amiri, Mariam Molokhia, Songhomitra Panda-Jonas, Amy E. Peden, Rufus Akinyemi, Ejaz Ahmad Khan, Mostafa Amini-Rarani, J. Becker, Hamidreza Pazoki Toroudi, Ben Lacey, Kidanemaryam Berhe, Simon Yadgir, Spencer L. James, Cory N. Spencer, Aletta E. Schutte, Mu'awiyyah Babale Sufiyan, Arash Tehrani-Banihashemi, Govinda Prasad Dhungana, Fereshteh Ansari, Rixing Xu, Jonathan F. Mosser, Josep Maria Haro, Enrico Rubagotti, Anurag Agrawal, Zahiruddin Quazi Syed, Hoa Thi Do, Ettore Beghi, Seyed Mohammad Kazem Aghamir, Abraham Geremew, Alireza Esteghamati, Paramjit Gill, Farzad Jalilian, J. Jason West, Mikhail Sergeevich Zastrozhin, Albertino Damasceno, Bruce Bartholow Duncan, Nazir Fattahi, Daniel Cury Ribeiro, Michael Brauer, Mark A. Stokes, Veincent Christian Filipino Pepito, Lidia Morawska, Fiona J Charlson, Babak Moazen, Dejana Braithwaite, Jonathan M. Kocarnik, Sergio I. Prada, Andrea Farioli, Zahra Atafar, Heather Orpana, Daniela Balzi, Marco Vacante, Rahmatollah Moradzadeh, Jacek A. Kopec, Iván Landires, Robert G. Weintraub, Leonardo Roever, Yannick Béjot, Markus P. Schlaich, Hamed Zandian, Subramanian Senthilkumaran, Klara Dokova, Vahid Alipour, Sowmya J. Rao, Rakesh Ghosh, Omar Mukhtar Salman, Faris Lami, Marcos Roberto Tovani-Palone, Hamid Reza Tohidinik, Seyed Mohammad Riahi, Adnan Kisa, Ghasem Azarian, Caroline Stein, Zulfiqar A. Bhutta, Sinead Langan, Kunihiro Matsushita, Lauren E. Schaeffer, Kathryn H. Jacobsen, Mehdi Naderi, Mehdi Hosseinzadeh, Nizal Sarrafzadegan, Bahram Armoon, Dan J. Stein, Jessica Fanzo, Morenike Oluwatoyin Folayan, Luca Ronfani, Phetole Walter Mahasha, Nicholas J K Breitborde, Adrian Oţoiu, Arash Sarveazad, Marc L. Serre, Mostafa Hosseini, Nicolas Cherbuin, George D. Thurston, Jalal Arabloo, Mokhtar Mahdavi, Andre Rodrigues Duraes, Ana Laura Manda, Ahmed Abualhasan, Nima Rezaei, Yuan-Pang Wang, Theodore Patrick Younker, Alireza Ansari-Moghaddam, Borhan Mansouri, Adam E. Berman, Khezar Hayat, Rosario Cárdenas, Bolajoko O. Olusanya, Tommi Vasankari, Simon I. Hay, Fatemeh Ghaffarifar, Leo Stockfelt, Ai Koyanagi, Giorgia Giussani, Yuming Guo, Sonia Saxena, Deborah Carvalho Malta, Mehedi Hasan, Negar Rezaei, Maja Pasovic, Jukka Takala, Bogdan Oancea, Sare Safi, A. Werdecker, Florian Fischer, Beatriz Paulina Ayala Quintanilla, Muhammad Shahdaat Bin Sayeed, Takeshi Fukumoto, Maha Atout, Brijesh Sathian, Cristina Bosetti, Mitchell T. Wallin, Agegnehu Bante, Helen Ippolito, Anthony Masaka, Chantal Huynh, Justin Lo, Jordan Weiss, Joemer C. Maravilla, Alberto Raggi, Peter W. Gething, Cristiana Abbafati, Daniela Ribeiro, Mohammad Farahmand, Yetunde O. John-Akinola, Isabela M. Benseñor, Emilie R Maddison, John J. McGrath, Salman Khazaei, Scott B. Patten, Jean Jacques Noubiap, Emmanuela Gakidou, Celine M. Barthelemy, Ashish Badiye, George C. Patton, Obinna Onwujekwe, Peter Allebeck, Victor Aboyans, Olayinka Stephen Ilesanmi, Mousa Yaminfirooz, Neeraj Bedi, Nicholas L S Roberts, Joht Singh Chandan, Hans W. Hoek, Usman Iqbal, Nima Hafezi-Nejad, Haley Lescinsky, Naohiro Yonemoto, Ahmad Ghashghaee, Anders Larsson, David C. Schwebel, Milena Ilic, Richard T. Burnett, Yang Liu, Carlo La Vecchia, Felix Akpojene Ogbo, Morteza Naserbakht, Sangram Kishor Patel, Melanie S. Hammer, Prasanna Mithra, Mohammad Amin Bahrami, Kanyin L. Ong, Mona Pathak, Afshin Maleki, Saeid Safiri, Masood Ali Shaikh, Kate Causey, Michael R.M. Abrigo, Jost B. Jonas, Dian Kusuma, Jagadish Rao Padubidri, Mihajlo Jakovljevic, Ali S. Shalash, Abdiwahab Hashi, Ionut Negoi, Nataliya A. Foigt, Andrey Nikolaevich Briko, François Alla, Giuseppe Grosso, Houman Goudarzi, Di H. Cross, Vera Marisa Costa, Eduarda Fernandes, Chandrashekhar T Sreeramareddy, Odgerel Chimed-Ochir, Sonia Rodríguez-Ramírez, Bo Norrving, Kerem Shuval, Jacob L. Stubbs, Muhammad Ali, Shuhei Nomura, Man Mohan Mehndiratta, Chisom Joyqueenet Akunna, Abdollah Mohammadian-Hafshejani, Navid Rabiee, Dana Bryazka, Hussen Mohammed, Asadollah Gholamian, Ashley Marks, Rizwan Kalani, Molly E. Herbert, Islam Y. Elgendy, Moritz U. G. Kraemer, Chuanhua Yu, Suzanne Polinder, Pascual R. Valdez, Jennifer Rickard, Kylie Ball, Turki Alanzi, Mohsen Bayati, Hamed Mirzaei, Christopher M Odell, Amira Shaheen, Ziad A. Memish, Thirunavukkarasu Sathish, Michael A. Piradov, Hamed Kalani, Lorenzo Monasta, Christopher S Yilgwan, Desalegn Getnet Demsie, Riaz Uddin, Rizwan Suliankatchi Abdulkader, Vinay Srinivasan, Hamid Ahmadieh, Claudio Alberto Dávila-Cervantes, Raffaele Palladino, Chukwudi A Nnaji, Mika Shigematsu, Stein Emil Vollset, Abbas Sheikhtaheri, Paulo A. Lotufo, Nasir Salam, Binyam Minuye Birihane, Mohammad Ali Mansournia, Tomislav Mestrovic, Samer Hamidi, Rajesh Sagar, Mayowa O. Owolabi, Kara Estep, Ester Cerin, Michael T. Chung, Simon Øverland, Amir Taherkhani, Sheng Chia Chung, Martin Amogre Ayanore, Nikolaos Dervenis, Joan B. Soriano, Tahereh Javaheri, Victor Adekanmbi, Seid Tiku Mereta, Gbenga A. Kayode, Christopher R. Cederroth, Razique Anwer, Rajan Nikbakhsh, Kaja Abbas, Fatemeh Heydarpour, Louisa Degenhardt, Tahiya Alam, Mohammad Miri, Alibek Mereke, David Laith Rawaf, Ippazio Cosimo Antonazzo, Erkin M. Mirrakhimov, Seyed Hossein Yahyazadeh Jabbari, Desta Debalkie Atnafu, Davide Sattin, Moslem Soofi, Edris Hasanpoor, Krittika Bhattacharyya, Mika Kivimäki, Nikolay Ivanovich Briko, Joanna L Whisnant, Christopher J L Murray, Simin Mouodi, Alize J. Ferrari, Damian Santomauro, Katrin Burkart, Tudorel Andrei, Alberto Baldasseroni, Hafiz Ansar Rasul Suleria, Valery L. Feigin, Nauman Khalid, Ewerton Cousin, S. Mohammad Sajadi, Francisco Rogerlândio Martins-Melo, Shankar M Bakkannavar, Themba G.G. Ginindza, Sadaf G. Sepanlou, Sheikh Mohammed Shariful Islam, Sanjay Basu, Getinet Ayano, Paula Moraga, Soheil Hassanipour, Jason A. Anderson, Catherine Bisignano, Iyad Sultan, Deepak Kumar Pasupula, Keivan Ahmadi, Fariba Dorostkar, Rajeev Gupta, David M. Pereira, Mustafa Z. Younis, Adel Spotin, Rasmus Havmoeller, Yeshambel T. Nigatu, Barthelemy Kuate Defo, Mithila Faruque, Alan D. Lopez, Shailesh Advani, Behshad Naghshtabrizi, Shane D. Morrison, Inga Dora Sigfusdottir, Konrad Pesudovs, Anna Gershberg Hayoon, Raaj Kishore Biswas, Reshmi Bhageerathy, H. Dean Hosgood, Giulia Carreras, Sarika Chaturvedi, James L. Fisher, In-Hwan Oh, G Anil Kumar, Christoph Nowak, Vijay Kumar Chattu, Puja C Rao, Marcel Ausloos, Ali Kabir, Rannveig Sigurvinsdottir, Leeberk Raja Inbaraj, Edgar Denova-Gutiérrez, Rafael Tabarés-Seisdedos, Minh Nguyen, Ashkan Afshin, Payman Salamati, Colin Angus, Mona M. Khater, Ehsan Sadeghi, Mahalaqua Nazli Khatib, Antonio Biondi, Valentin Yurievich Skryabin, Mohsen Abbasi-Kangevari, Andrew T Olagunju, Amir Radfar, Laith J. Abu-Raddad, Marcello Tonelli, Hesam Ghiasvand, Hanne Christensen, Juan Jesus Carrero, Maryam Adabi, Saravanan Muthupandian, Kurt Straif, Hossein Samadi Kafil, Lope H Barrero, Harish Chander Gugnani, Mohammad Fareed, Morteza Shamsizadeh, Jemal Abdu Mohammed, Juan A Rivera, Shai Linn, Saad M.A. Dahlawi, Janni Leung, Shokofeh Maleki, Mohd Anisul Karim, Kamarul Imran Musa, Farshad Pourmalek, Dietrich Rothenbacher, Kiomars Sharafi, Alessandra C. Goulart, Leila Doshmangir, Gabriele Nagel, Helena Manguerra, Olatunji O. Adetokunboh, Srinivasa Vittal Katikireddi, Nermin Ghith, Maha El Tantawi, Awoke Misganaw, Yunquan Zhang, Carl Abelardo T. Antonio, Vahid Rashedi, Mehran Shams-Beyranvand, Bhaskaran Unnikrishnan, Holly E. Erskine, Ann Kristin Knudsen, Marissa B Reitsma, Getayeneh Antehunegn Tesema, Javad Javidnia, Ismael R. Campos-Nonato, Biniyam Sahiledengle Geberemariyam, Godfrey Mutashambara Rwegerera, Alaa Badawi, James Leigh, Morteza Arab-Zozani, Kyle E. Simpson, Muluken Bekele Sorrie, Roghiyeh Faridnia, Vivekanand Jha, Tomasz Miazgowski, Aaron J Cohen, Chukwuma David Umeokonkwo, Alessandra Lugo, Adhanom Gebreegziabher Baraki, Akshaya Srikanth Bhagavathula, Caitlyn Steiner, Gholamreza Roshandel, Cuong Tat Nguyen, Tania G Sánchez-Pimienta, Ahamarshan Jayaraman Nagarajan, Laura Kemmer, Ihoghosa Osamuyi Iyamu, Seyedeh Zahra Masoumi, Vivian Chia-Rong Hsieh, Kris J. Krohn, Phoebe Anne Rhinehart, Sarah Wozniak, Sahar Saeedi Moghaddam, Kate E. LeGrand, Christian Kieling, Vahid Yazdi-Feyzabadi, Robin Room, Zelalem Nigussie Azene, Kelly Cercy, Paul H. Lee, Stanislav S. Otstavnov, Dinesh Bhandari, Rafael Alves Guimarães, Zemenu Tadesse Tessema, Aziz Sheikh, Michellr L. Bell, Marwa Rashad Salem, Kirsten E. Wiens, Emma U.R. Smith, Hassan Abolhassani, Cristiano Piccinelli, Kedir Hussein Abegaz, G.K. Mini, Christian Razo, Manuela L. Ferreira, Diego De Leo, Francesco Saverio Violante, Aristidis Tsatsakis, Zahra Sadat Dibaji Forooshani, Tea Lallukka, Dickson A. Amugsi, Anna Poznańska, Graeme J. Hankey, Kewal Krishan, Maryam Zamanian, Eirini Skiadaresi, Jai K Das, Felix Greaves, Tessa M. Pilz, Sameer Vali Gopalani, Mansour Ghafourifard, M. DeLang, Morteza Mahmoudi, Alton Lu, Brian J. Hall, Ravi Prakash Jha, David Edvardsson, Xiu Ju George Zhao, Farshad Farzadfar, Hadi Hassankhani, Samuel M. Ostroff, Gerhard Sulo, Keyghobad Ghadiri, Neeraj Bhala, Stefan Lorkowski, Mohammad Rabiee, Sivan Yegnanarayana Iyer Saraswathy, Amirhossein Sahebkar, Rashid Abdi Guled, Abdallah M. Samy, Roman Topor-Madry, Michal Grivna, Afsaneh Arzani, Ayesha Humayun, Simin Liu, Maryam Khayamzadeh, Davoud Adham, Ahad Bakhtiari, Shafiu Mohammed, Paolo Lauriola, Abbas Mosapour, Sophia Emmons-Bell, Khurshid Alam, Rajat Das Gupta, Matilde Leonardi, Muktar Beshir Ahmed, Jeffrey V. Lazarus, Mohamed M. Gad, Kelly Compton, Leila R Kalankesh, Abdelrahman Ibrahim Abushouk, Mikk Jürisson, Catherine M. Antony, Ali A. Asadi-Pooya, Daniel Diaz, Salman Rawaf, Gina Agarwal, Ted R. Miller, Rebecca Ivers, João Vasco Santos, Savita Lasrado, Abdul Moiz Hafiz, Amir Almasi-Hashiani, Praveen Hoogar, Fares Alahdab, Om P Kurmi, Anbissa Muleta Senbeta, Tomi Akinyemiju, Boris Bikbov, Muhammad Aziz Rahman, Amin Mousavi Khaneghah, Yahya Safari, Guilherme Borges, Carlos A Castañeda-Orjuela, Kenji Shibuya, Bahman Yousefi, Berrin Serdar, Karen M. Tabb, Sonali Kochhar, Till Bärnighausen, Kala M. Mehta, Mostafa Dianatinasab, Arash Etemadi, Melissa Y. Wei, Kiana Ramezanzadeh, Lingkan Barua, Zubair Kabir, Rade Vukovic, Hesham M. Al-Mekhlafi, Shoshana H. Ballew, Miriam Levi, Zainab Samad, Florentino Luciano Caetano dos Santos, Juan Sanabria, Ramu Rawat, Chinwe Juliana Iwu, Gabrielle B. Britton, Colm McAlinden, Mohsen Naghavi, Maarten J. Postma, Chhabi Lal Ranabhat, Jalil Jaafari, Walter Mendoza, Mahesh P A, Pallab K. Maulik, Ali H. Mokdad, Andre M. N. Renzaho, Milena Santric-Milicevic, Parvaiz A Koul, Foad Abd-Allah, Mihaela Hostiuc, Richard G. Cowden, Ronny Westerman, Meghdad Pirsaheb, Department of Earth Observation Science, UT-I-ITC-ACQUAL, Faculty of Geo-Information Science and Earth Observation, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), Tampere University, Tays Research Services, Health Sciences, Murray, C. J. L., Aravkin, A. Y., Zheng, P., Abbafati, C., Abbas, K. M., Abbasi-Kangevari, M., Abd-Allah, F., Abdelalim, A., Abdollahi, M., Abdollahpour, I., Abegaz, K. H., Abolhassani, H., Aboyans, V., Abreu, L. G., Abrigo, M. R. M., Abualhasan, A., Abu-Raddad, L. J., Abushouk, A. I., Adabi, M., Adekanmbi, V., Adeoye, A. M., Adetokunboh, O. O., Adham, D., Advani, S. 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Saeedi Moghaddam, S, Safari, Y, Safi, S, Safiri, S, Sagar, R, Sahebkar, A, Sajadi, S, Salam, N, Salamati, P, Salem, H, Salem, M, Salimzadeh, H, Salman, O, Salomon, J, Samad, Z, Samadi Kafil, H, Sambala, E, Samy, A, Sanabria, J, Sanchez-Pimienta, T, Santomauro, D, Santos, I, Santos, J, Santric-Milicevic, M, Saraswathy, S, Sarmiento-Suarez, R, Sarrafzadegan, N, Sarveazad, A, Sathian, B, Sathish, T, Sattin, D, Saxena, S, Schaeffer, L, Schiavolin, S, Schlaich, M, Schmidt, M, Schutte, A, Schwebel, D, Schwendicke, F, Senbeta, A, Senthilkumaran, S, Sepanlou, S, Serdar, B, Serre, M, Shadid, J, Shafaat, O, Shahabi, S, Shaheen, A, Shaikh, M, Shalash, A, Shams-Beyranvand, M, Shamsizadeh, M, Sharafi, K, Sheikh, A, Sheikhtaheri, A, Shibuya, K, Shield, K, Shigematsu, M, Shin, J, Shin, M, Shiri, R, Shirkoohi, R, Shuval, K, Siabani, S, Sierpinski, R, Sigfusdottir, I, Sigurvinsdottir, R, Silva, J, Simpson, K, Singh, J, Singh, P, Skiadaresi, E, Skou, S, Skryabin, V, Smith, E, Soheili, A, Soltani, S, Soofi, M, Sorensen, R, Soriano, J, Sorrie, M, Soshnikov, S, Soyiri, I, Spencer, C, Spotin, A, Sreeramareddy, C, Srinivasan, V, Stanaway, J, Stein, C, Stein, D, Steiner, C, Stockfelt, L, Stokes, M, Straif, K, Stubbs, J, Sufiyan, M, Suleria, H, Suliankatchi Abdulkader, R, Sulo, G, Sultan, I, Tabares-Seisdedos, R, Tabb, K, Tabuchi, T, Taherkhani, A, Tajdini, M, Takahashi, K, Takala, J, Tamiru, A, Taveira, N, Tehrani-Banihashemi, A, Temsah, M, Tesema, G, Tessema, Z, Thurston, G, Titova, M, Tohidinik, H, Tonelli, M, Topor-Madry, R, Topouzis, F, Torre, A, Touvier, M, Tovani-Palone, M, Tran, B, Travillian, R, Tsatsakis, A, Tudor Car, L, Tyrovolas, S, Uddin, R, Umeokonkwo, C, Unnikrishnan, B, Upadhyay, E, Vacante, M, Valdez, P, van Donkelaar, A, Vasankari, T, Vasseghian, Y, Veisani, Y, Venketasubramanian, N, Violante, F, Vlassov, V, Vollset, S, Vos, T, Vukovic, R, Waheed, Y, Wallin, M, Wang, Y, Watson, A, Wei, J, Wei, M, Weintraub, R, Weiss, J, Werdecker, A, West, J, Westerman, R, Whisnant, J, Whiteford, H, Wiens, K, Wolfe, C, Wozniak, S, Wu, A, Wu, J, Wulf Hanson, S, Xu, G, Xu, R, Yadgir, S, Yahyazadeh Jabbari, S, Yamagishi, K, Yaminfirooz, M, Yano, Y, Yaya, S, Yazdi-Feyzabadi, V, Yeheyis, T, Yilgwan, C, Yilma, M, Yip, P, Yonemoto, N, Younis, M, Younker, T, Yousefi, B, Yousefi, Z, Yousefinezhadi, T, Yousuf, A, Yu, C, Yusefzadeh, H, Moghadam, T, Zamani, M, Zamanian, M, Zandian, H, Zastrozhin, M, Zhang, Y, Zhang, Z, Zhao, J, Zhao, X, Zhao, Y, Zheng, P, Zhou, M, Ziapour, A, Zimsen, S, Lim, S, Murray, C, GBD 2019 Risk Factors Collaborator, Violante FS, Biosciences, Department of Public Health, Clinicum, Department of Neurosciences, HUS Comprehensive Cancer Center, Environmental Sciences, Sub Foundations&PhilosophyofNaturSc begr, IRAS OH Epidemiology Chemical Agents, dIRAS RA-2, Public Health, Bin Sayeed, M. S. B., Caetano Dos Santos, F. L., Camera, L. A., Elyazar, I. R. F., Ayalew Gebreslassie, A. A. A., Ginindza, T. G., Matin, B. K., Morgado-Da-Costa, J., Khaneghah, A. M., Mahesh, P. A., Toroudi, H. P., Syed, Z. Q., Salem, M. R., Skou, S. T., Tovani-Palone, M. R., Tudor Car, L. T., and Moghadam, T. Z.

Subjects
Male, Nutritional Sciences, Specific risk, Contaminación del Aire Interior, 030204 cardiovascular system & hematology, Socioeconomic Factor, systematic analysis, Global Health, Body Mass Index, Global Burden of Disease, Health Risk Behavior, Health Risk Behaviors, Disease studies, 0302 clinical medicine, Risk Factors, METABOLIC RISKS, 030212 general & internal medicine, 11 Medical and Health Sciences, Factores de Riesgo, 2. Zero hunger, education.field_of_study, Public health, Injuries, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, GBD, risck factors, attributable burden of disease, 3142 Public health care science, environmental and occupational health, 3. Good health, Relative risk, Environmental health, Health, Hypertension, Global Burden of Diseases, Injuries, Risk Factors, A990 Medicine and Dentistry not elsewhere classified, Female, Leading risk factors, Global Health Metrics, Cohort study, Human, medicine.medical_specialty, Substance-Related Disorders, Population, UNITED-STATES, Risk Assessment, DIET, ITC-HYBRID, 03 medical and health sciences, Life Expectancy, MORTALITY, DISABILITY, POLLUTION, CLUSTERS, SDG 3 - Good Health and Well-being, General & Internal Medicine, medicine, Humans, Global Burden of Disease Study, Risk factor, education, Global burden, business.industry, Risk Factor, Malnutrition, Klinisk medicin, Global Burden of Diseases, Environmental Exposure, medicine.disease, Enfermedades, purl.org/pe-repo/ocde/ford#3.02.00 [https], Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Years of potential life lost, Socioeconomic Factors, Risk factors, Disease study, Hyperglycemia, ITC-ISI-JOURNAL-ARTICLE, NA, Clinical Medicine, business, RA
Abstract

Background Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10.8 million (95% uncertainty interval [UI] 9.51-12.1) deaths (19.2% [16.9-21.3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8.71 million (8.12-9.31) deaths (15.4% [14.6-16.2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11.6% [10.3-13.1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. Interpretation Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.

Published
2020

36. Conversion of Urine Protein-Creatinine Ratio or Urine Dipstick Protein to Urine Albumin-Creatinine Ratio for Use in Chronic Kidney Disease Screening and Prognosis: An Individual Participant-Based Meta-analysis

Author

Keiichi, Sumida, Girish N, Nadkarni, Morgan E, Grams, Yingying, Sang, Shoshana H, Ballew, Josef, Coresh, Kunihiro, Matsushita, Aditya, Surapaneni, Nigel, Brunskill, Steve J, Chadban, Alex R, Chang, Massimo, Cirillo, Kenn B, Daratha, Ron T, Gansevoort, Amit X, Garg, Licia, Iacoviello, Takamasa, Kayama, Tsuneo, Konta, Csaba P, Kovesdy, James, Lash, Brian J, Lee, Rupert W, Major, Marie, Metzger, Katsuyuki, Miura, David M J, Naimark, Robert G, Nelson, Simon, Sawhney, Nikita, Stempniewicz, Mila, Tang, Raymond R, Townsend, Jamie P, Traynor, José M, Valdivielso, Jack, Wetzels, Kevan R, Polkinghorne, Hiddo J L, Heerspink, Aditya, Surapeneni, Groningen Kidney Center (GKC), Cardiovascular Centre (CVC), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Centre de recherche en épidémiologie et santé des populations (CESP), and Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay

Subjects
Male, musculoskeletal diseases, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Urology, Renal function, Urine, Urinalysis, 01 natural sciences, Sensitivity and Specificity, 03 medical and health sciences, 0302 clinical medicine, immune system diseases, Diabetes mellitus, Internal Medicine, Medicine, Albuminuria, Humans, Mass Screening, 030212 general & internal medicine, 0101 mathematics, Stage (cooking), Renal Insufficiency, Chronic, skin and connective tissue diseases, Reagent Strips, Kidney, business.industry, 010102 general mathematics, General Medicine, Dipstick, Middle Aged, medicine.disease, Prognosis, 3. Good health, Proteinuria, medicine.anatomical_structure, Creatinine, Female, medicine.symptom, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11], business, Kidney disease
Abstract

BACKGROUND: Although measuring albuminuria is the preferred method for defining and staging chronic kidney disease (CKD), total urine protein or dipstick protein is often measured instead.OBJECTIVE: To develop equations for converting urine protein-creatinine ratio (PCR) and dipstick protein to urine albumin-creatinine ratio (ACR) and to test their diagnostic accuracy in CKD screening and staging.DESIGN: Individual participant-based meta-analysis.SETTING: 12 research and 21 clinical cohorts.PARTICIPANTS: 919 383 adults with same-day measures of ACR and PCR or dipstick protein.MEASUREMENTS: Equations to convert urine PCR and dipstick protein to ACR were developed and tested for purposes of CKD screening (ACR ≥30 mg/g) and staging (stage A2: ACR of 30 to 299 mg/g; stage A3: ACR ≥300 mg/g).RESULTS: Median ACR was 14 mg/g (25th to 75th percentile of cohorts, 5 to 25 mg/g). The association between PCR and ACR was inconsistent for PCR values less than 50 mg/g. For higher PCR values, the PCR conversion equations demonstrated moderate sensitivity (91%, 75%, and 87%) and specificity (87%, 89%, and 98%) for screening (ACR >30 mg/g) and classification into stages A2 and A3, respectively. Urine dipstick categories of trace or greater, trace to +, and ++ for screening for ACR values greater than 30 mg/g and classification into stages A2 and A3, respectively, had moderate sensitivity (62%, 36%, and 78%) and high specificity (88%, 88%, and 98%). For individual risk prediction, the estimated 2-year 4-variable kidney failure risk equation using predicted ACR from PCR had discrimination similar to that of using observed ACR.LIMITATION: Diverse methods of ACR and PCR quantification were used; measurements were not always performed in the same urine sample.CONCLUSION: Urine ACR is the preferred measure of albuminuria; however, if ACR is not available, predicted ACR from PCR or urine dipstick protein may help in CKD screening, staging, and prognosis.PRIMARY FUNDING SOURCE: National Institute of Diabetes and Digestive and Kidney Diseases and National Kidney Foundation.

Published
2020

37. Attitudes and Practices of Australian Nephrologists Toward Implementation of Clinical Genomics

Author

Stephanie Best, Zornitza Stark, Belinda J McClaren, Peter G. Kerr, Kevan R. Polkinghorne, Catherine Quinlan, Andrew Mallett, Chirag Patel, Amy Nisselle, Kushani Jayasinghe, and Amali Mallawaarachchi

Subjects
implementation science, medicine.medical_specialty, medicine.diagnostic_test, Service delivery framework, business.industry, Genetic counseling, genetic kidney disease, 030232 urology & nephrology, Staffing, Psychological intervention, Geneticist, 030204 cardiovascular system & hematology, lcsh:Diseases of the genitourinary system. Urology, lcsh:RC870-923, genomic implementation, 03 medical and health sciences, 0302 clinical medicine, Nephrology, Family medicine, medicine, Commentary, Implementation research, Personalized medicine, business, Genetic testing
Abstract

Introduction: Genomic testing is becoming widely available as a diagnostic tool, although widespread implementation is not yet established in nephrology. Methods: An anonymous electronic survey was administered to investigate experience and confidence with genomic tests, perceived clinical utility of genomic services, preferences for service delivery models, and readiness for implementation among nephrologists. Questions were guided by a comprehensive literature review and published tools, including a validated theoretical framework for implementation of genomic medicine: Consolidated Framework for Implementation Research (CFIR). Results: Responses were received from 224 clinicians, of which 172 were eligible for analysis. Most clinicians (132 [76%]) had referred at least one patient to a genetics clinic. Despite most clinicians (136 [85%]) indicating that they believed genetic testing would be useful, only 39 (23%) indicated they felt confident to use results of genomic testing, with pediatric clinicians feeling more confident compared with adult clinicians (12 of 20 [60%] vs. 27 of 149 [18%]), P < 0.01, Fisher exact). A multidisciplinary renal genetics clinic was the preferred model among clinicians surveyed (98 of 172 [57%]). A key implementation barrier highlighted related to the hospital or organizational culture and/or environment. Specific barriers noted in quantitative and qualitative responses included inadequate staffing, learning resources, and funding. Conclusions: Our findings suggest support for genomic testing among nephrologists, with a strong preference for a multidisciplinary model (involving a nephrologist, clinical geneticist, and genetic counselor). Broad-ranging interventions are urgently required to shift the current culture and ensure successful implementation of genomics in nephrology, including reducing knowledge gaps, increased funding and resources, disease-specific guidelines, and streamlining of testing processes.

Published
2020

38. Response to COVID-19 Infection in Hemodialysis Patients: An Australian Perspective

Author

Neil Boudville, Peter G. Kerr, and Kevan R. Polkinghorne

Subjects
Government, medicine.medical_specialty, education.field_of_study, Coronavirus disease 2019 (COVID-19), Global Perspective, business.industry, medicine.medical_treatment, Social distance, Population, 030232 urology & nephrology, General Medicine, 030204 cardiovascular system & hematology, Patient advocacy, 03 medical and health sciences, 0302 clinical medicine, Family medicine, Preparedness, medicine, Hemodialysis, China, education, business
Abstract

The first reported case of coronavirus disease 2019 (COVID-19) infection in Australia (population 26 million) occurred on January 24th, 2020 in a returned traveler from Wuhan, China (1) followed by a rapid rise in new cases (Figure 1). The Australian government activated the Health Sector Emergency Response Plan for Novel Coronavirus (2) in late February, with subsequent implementation of strict social distancing measures and closure of international boarders in late March (Figure 1). We describe the response taken by the Australian and New Zealand Society of Nephrology (ANZSN) to prepare for the potential exponential increase in case load that was seen in other countries, such as Italy, the United Kingdom, and the United States. Figure 1. Daily coronavirus disease 2019 (COVID-19) infection numbers in Austraia January 24th to June 8th, 2020 showing peak cases mid to late March. Blue and red arrows illustrate timing of Australian Government and Australian and New Zealand Society of Nephrology (ANZSN) initiatives in relation to daily COVID-19 infection numbers. On March 4th, 2020, the ANZSN Council canvassed members to determine if any had commenced preparations for the COVID-19 infection. It became clear that no coordinated approach to this infection had been instigated. As such, the ANZSN Council held a members-only virtual meeting (the COVID-19 Forum) to gauge the preparedness of society members and obtain guidance on further actions. The first COVID-19 Forum was held on March 18th at a time when daily case numbers were rapidly escalating (Figure 1). It was clear at this meeting that the society and its members were not prepared for the COVID-19 infection. This directed the ANZSN Council to create a COVID-19 Working Group (WG) comprising nephrologists and renal nursing and patient advocacy experts with geographic representation across Australia and New Zealand. Specifically, the WG performed three broad functions—monitor and remain informed …

Published
2020

39. Variability and trends over time and across centres in haemodialysis weekly duration in Australia and New Zealand

Author

Yeoungjee Cho, Kevan R. Polkinghorne, Isabelle Ethier, Carolyn van Eps, Elaine M. Pascoe, Matthew A Roberts, Nicole M. Isbel, Scott B. Campbell, David W. Johnson, Carmel M. Hawley, Andrea K. Viecelli, Christopher E. Davies, David Semple, and Emily J See

Subjects
Adult, Male, medicine.medical_specialty, Younger age, Native Hawaiian or Other Pacific Islander, Time Factors, medicine.medical_treatment, Population, 030232 urology & nephrology, Patient characteristics, Hemodialysis, Home, 030204 cardiovascular system & hematology, Ambulatory Care Facilities, Nephrologists, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Renal Dialysis, Internal medicine, medicine, Prevalence, Humans, Registries, Healthcare Disparities, Practice Patterns, Physicians', Renal Insufficiency, Chronic, education, Dialysis, Aged, education.field_of_study, business.industry, Incidence, Australia, General Medicine, Middle Aged, Nephrology, Duration (music), Registry data, Female, business, Body mass index, New Zealand
Abstract

Aim Haemodialysis treatment prescription varies widely internationally. This study explored patient- and centre-level characteristics associated with weekly haemodialysis hours. Methods Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data were analysed. Characteristics associated with weekly duration were evaluated using mixed-effects linear regression models with patient- and centre-level covariates as fixed effects, and dialysis centre and state as random effects using the 2017 prevalent in-centre haemodialysis (ICHD) and home haemodialysis (HHD) cohorts. Evaluation of patterns of weekly duration over time analysed the 2000 to 2017 incident ICHD and HHD cohorts. Results Overall, 12 494 ICHD and 1493 HHD prevalent patients in 2017 were included. Median weekly treatment duration was 13.5 (interquartile range [IQR] 12-15) hours for ICHD and 16 (IQR 15-20) hours for HHD. Male sex, younger age, higher body mass index, arteriovenous fistula/graft use, Aboriginal and Torres Strait Islander ethnicity and longer dialysis vintage were associated with longer weekly duration for both ICHD and HHD. No centre characteristics were associated with duration. Variability in duration across centres was very limited in ICHD compared with HHD, with variation in HHD being associated with state. Duration did not vary significantly over time for ICHD, whereas longer weekly HHD treatments were reported between 2006 and 2012 compared with before and after this period. Conclusion This study in the Australian and New Zealand haemodialysis population showed that weekly duration was primarily associated with patient characteristics. No centre effect was demonstrated. Practice patterns seemed to differ across states/countries, with more variability in HHD than ICHD.

Published
2020

40. Predictors of Arteriovenous Fistula Failure: A

Author

Yeoungjee Cho, Ashley Irish, Elaine M. Pascoe, David Voss, Loke-Meng Ong, David W. Johnson, Andrea K. Viecelli, Peter G. Kerr, Trevor A. Mori, Carmel M. Hawley, Peta-Anne Paul-Brent, Kevan R. Polkinghorne, Yong Pey See, Alan Cass, and Lai Seong Hooi

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Fistula, Arteriovenous fistula, Original Investigations, Arteriovenous Shunt, Surgical, Renal Dialysis, Internal medicine, medicine, Central Venous Catheters, Humans, cardiovascular diseases, business.industry, Vascular disease, General Medicine, Odds ratio, medicine.disease, Thrombosis, Blood pressure, Arteriovenous Fistula, Cardiology, Kidney Failure, Chronic, Female, Hemodialysis, business, Central venous catheter
Abstract

Background An autologous arteriovenous fistula (AVF) is the preferred hemodialysis vascular access but successful creation is hampered by high rates of AVF failure. This study aimed to evaluate patient and surgical factors associated with AVF failure to improve vascular access selection and outcomes. Methods This is a post-hoc analysis of all participants of FAVOURED, a multi-center, double-blind, multinational, randomized placebo-controlled trial evaluating the effect of fish oil and/or aspirin in preventing AVF failure in patients receiving hemodialysis. The primary outcome of AVF failure was a composite of fistula thrombosis and/or abandonment and/or cannulation failure at 12 months post AVF creation and secondary outcomes included individual outcome components. Patient data (demographics, comorbidities, medications and laboratory data) and surgical factors (surgical expertise, anesthetic, intraoperative heparin use) were examined using multivariable logistic regression analyzes to evaluate associations with AVF failure. Results Of 536 participants, 253 patients (47%) experienced AVF failure during the study period. The mean age was 55 ± 14.4 years, 64% were male, 45% were diabetic and 4% had peripheral vascular disease. Factors associated with AVF failure included female sex (odds ratio [OR] 1.79, 95% confidence interval [CI] 1.20-2.68), lower diastolic blood pressure (OR for higher DBP 0.85, 95% CI 0.74-0.99), presence of central venous catheter (OR 1.49, 95% CI 1.02-2.20, p=0.04) and aspirin requirement (OR 1.60, 95% CI 1.00-2.56). Conclusions Female sex, requirement for aspirin therapy, requiring hemodialysis via a central venous catheter and lower diastolic blood pressure were factors associated with higher odds of AVF failure. These associations have potential implications for vascular access planning and warrant further studies.

Published
2020

41. Home and facility haemodialysis patients: a comparison of outcomes in a matched cohort

Author

Peter G. Kerr, Kevan R. Polkinghorne, and Emily K Yeung

Subjects
Transplantation, medicine.medical_specialty, business.industry, medicine.medical_treatment, Hemodialysis, Home, Context (language use), medicine.disease, Cohort Studies, Quality of life, Nephrology, Renal Dialysis, Internal medicine, Epidemiology, medicine, Quality of Life, Humans, Kidney Failure, Chronic, Hemodialysis, business, Dialysis, Survival analysis, Kidney disease
Abstract

Background Home haemodialysis (HHD) is utilized significantly less often than facility HD globally with few exceptions, despite being associated with improved survival and better quality of life. Previously HHD was exclusively offered to younger patients with a few comorbidities. However, with the increasing burden of end-stage kidney disease (ESKD) alongside an ageing population, increasing numbers of older patients are being treated with HHD. This study aims to re-evaluate survival and related outcomes in the context of this epidemiological shift. Methods A matched cohort design was used to compare all-cause mortality, transplantation, average biochemical values and graft survival 6 months post-transplant between HHD and facility HD patients. A total of 181 HHD patients from a major hospital network were included with 413 facility HD patients from the Australia and New Zealand Dialysis and Transplant Registry matched by age, gender and cause of ESKD. Survival analysis and competing risks analysis (for transplantation) were performed. Results After adjusting for body mass index, smoking status, racial group and comorbidities, HHD was associated with a significantly reduced risk of death compared with facility HD patients [hazard ratio 0.47 (95% confidence interval 0.30–0.74)]. Transplantation rates were comparable, with high rates of graft survival at 6 months in both groups. Haemoglobin, calcium and parathyroid hormone levels did not vary significantly. However, HHD patients had significantly lower phosphate levels. Conclusions In this study, improved survival outcomes were observed in patients on home compared with facility dialysis, with comparable rates of transplantation, graft survival and biochemical control.

Published
2020

42. REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach (REDUCCTION) - design and baseline results

Author

Alan Cass, Girish S Talaulikar, Kevan R. Polkinghorne, Stephen P. McDonald, Sarah Coggan, Nicholas A Gray, Martin Gallagher, Stephen Jan, and Sradha Kotwal

Subjects
Nephrology, medicine.medical_specialty, Cross Infection, Data collection, business.industry, medicine.medical_treatment, Psychological intervention, Hemodialysis Catheter, Australia, Original Investigations, General Medicine, Dialysis catheter, Renal Dialysis, Internal medicine, Catheter-Related Infections, Health care, Emergency medicine, medicine, Central Venous Catheters, Humans, Hemodialysis, Cluster randomised controlled trial, business
Abstract

Background: Patients with hemodialysis central venous catheters (HD CVC) are susceptible to health care associated infections, particularly hemodialysis catheter related blood stream infection (HD-CRBSI), which is associated with high mortality and health care costs. There have been few systematic attempts to reduce this burden and clinical practice remains highly variable. This manuscript will summarize the challenges in preventing HD-CRBSI and describe the methodology of the REDUcing the burden of dialysis Catheter ComplicaTIOns - a National approach (REDUCCTION) trial. Methods: The REDUCCTION trial is a stepped wedge cluster randomized trial of a suite of clinical interventions aimed at reducing HD-CRBSI across Australia. It clusters the intervention at the renal service level with implementation randomly timed across three tranches. The primary outcome is the effect of this intervention upon the rate of HD-CRBSI. Patients who received a HD CVC at a participating renal service are eligible for inclusion. A customized data collection tool allows near to real-time reporting of the number of active catheters, total exposure to catheters over time and rates of HD-CRBSI in each service. The interventions are centered around the insertion, maintenance and removal of HD CVC, informed by the most current evidence at the time of design (mid-2018). Results: A total of 37 renal services are participating in the trial. Data collection is ongoing with results expected in the last quarter of 2020. The baseline phase of the study has collected provisional data on 5385 catheters in 3615 participants, representing 603,506 days of HD CVC exposure. Conclusion: The REDUCCTION trial systematically measures the use of HD CVCs at a national level in Australia, accurately determines the rate of HD-CRBSI and tests the effect of a multifaceted, evidence-based intervention upon the rate of HD-CRBSI. These results will have global relevance in nephrology and other specialties commonly using CVCs.

Published
2020

43. Health-related quality of life among patients with comorbid diabetes and kidney disease attending a codesigned integrated model of care: a longitudinal study

Author

Clement Lo, Greg Fulcher, Kevan R. Polkinghorne, Tim Usherwood, Peter G. Kerr, Martin Gallagher, Rowan G. Walker, Greg Johnson, Sophia Zoungas, Alan Cass, Edward Zimbudzi, Grant Russell, Steven Jan, Helena J. Teede, and Sanjeeva Ranasinha

Subjects
Male, medicine.medical_specialty, Longitudinal study, Endocrinology, Diabetes and Metabolism, Population, Problem list, 030209 endocrinology & metabolism, Subgroup analysis, Comorbidity, Type 2 diabetes, Diseases of the endocrine glands. Clinical endocrinology, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Surveys and Questionnaires, Internal medicine, Diabetes mellitus, Diabetes Mellitus, medicine, Humans, Longitudinal Studies, 030212 general & internal medicine, Renal Insufficiency, Chronic, Epidemiology/Health Services Research, education, Aged, Quality of Health Care, quality of Life, education.field_of_study, Delivery of Health Care, Integrated, business.industry, Incidence, Australia, Prognosis, medicine.disease, RC648-665, 3. Good health, Female, type 2 diabetes, business, chronic kidney disease, Follow-Up Studies, Kidney disease
Abstract

ObjectiveTo evaluate the impact of an integrated diabetes and kidney disease model of care on health-related quality of life (HRQOL) of patients with comorbid diabetes and chronic kidney disease (CKD).Research design and methodsA longitudinal study of adult patients (over 18 years) with comorbid diabetes and CKD (stage 3a or worse) who attended a new diabetes kidney disease service was conducted at a tertiary hospital. A questionnaire consisting of demographics, clinical data, and the Kidney Disease Quality of Life (KDQOL-36) was administered at baseline and after 12 months. Paired t-tests were used to compare baseline and 12-month scores. A subgroup analysis examined the effects by patient gender. Multiple regression analysis examined the factors associated with changes in scores.Results179 patients, 36% of whom were female, with baseline mean±SD age of 65.9±11.3 years, were studied. Across all subscales, HRQOL did not significantly change over time (p value for all mean differences >0.05). However, on subgroup analysis, symptom problem list and physical composite summary scores increased among women (MD=9.0, 95% CI 1.25 to 16.67; p=0.02 and MD=4.5, 95% CI 0.57 to 8.42; p=0.03 respectively) and physical composite scores decreased among men (MD=−3.35, 95% CI −6.26 to −0.44; p=0.03).ConclusionThe HRQOL of patients with comorbid diabetes and CKD attending a new codesigned, integrated diabetes and kidney disease model of care was maintained over 12 months. Given that HRQOL is known to deteriorate over time in this high-risk population, the impact of these findings on clinical outcomes warrants further investigation.

Published
2020

44. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Author

Sorin Hostiuc, Shaun Wen Huey Lee, Jorge R. Ledesma, Carsten Flohr, Masoumeh Sadeghi, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Cyrus Alinia, Mehdi Bohluli, Félix Carvalho, Yun Jin Kim, Catalina Liliana Andrei, Seyyed Meysam Mousavi, Bernhard T. Baune, Ehsan Ahmadpour, Dinh-Toi Chu, Beatrix Haddock, Gianfranco Alicandro, Vasily Vlassov, Mohammad Taghi Khodayari, Gianna Gayle Herrera Amul, Arash Tehrani-Banihashemi, Govinda Prasad Dhungana, Fereshteh Ansari, Michael K. Hole, Azeem Majeed, Iman Halvaei, Saqib Ali, Arianna Maever L. Amit, Tomas Y. Yeheyis, John S. Ji, Martin McKee, Jamileh Shadid, Leonardo Roever, Peng Jia, Ettore Beghi, Pablo M. Lavados, Young Eun Kim, Vahid Alipour, Sowmya J. Rao, Ahmad Daryani, Cathleen Keller, Ibrahim Abdollahpour, Nicole K. DeCleene, Ebrahim Babaee, Saman Esmaeilnejad, Boris Bikbov, William M. Gardner, Lydia M. Haile, Luca Ronfani, Azalea M. Thomson, Irena Ilic, Ruth W. Kimokoti, Yingxi Zhao, Guoqing Hu, Mehran Shams-Beyranvand, Ilais Moreno Velásquez, Nathaniel J. Henry, Brijesh Sathian, Daniel Kim, Peter Memiah, Mohammad Hadi Abbasi, Andrea Farioli, Zahra Kamiab, Bolajoko O. Olusanya, Matthew C. Doxey, Tommi Vasankari, Hamideh Salimzadeh, Luisa Sorio Flor, Priya Rathi, Shanshan Li, Tanvir M. Huda, Dillon O Sylte, Rosario Cárdenas, Agegnehu Bante, Helen Ippolito, Alyssa Acebedo, Jeffrey D. Stanaway, Anwar Faraj, João Pedro Silva, Amin Mousavi Khaneghah, Pushpendra Kumar, Sangram Kishor Patel, Josephine W. Ngunjiri, Holly E. Erskine, Eugene Sobngwi, Filippo Ariani, Shane D. Morrison, Mohammad Aghaali, Meghan D. Mooney, Vera Marisa Costa, Palash Chandra Banik, Rupak Desai, Ken Takahashi, Maigeng Zhou, Morteza Oladnabi, Bogdan Oancea, Daniela Ribeiro, Mohammad Farahmand, Irmina Maria Michalek, Yetunde O. John-Akinola, Khem Narayan Pokhrel, Emilie R Maddison, Syed Mohamed Aljunid, Damian G. Hoy, Hosni Salem, V. 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S., Roberts, S., Robinson, S. R., Roever, L., Rolfe, S., Ronfani, L., Roshandel, G., Roth, G. A., Rubagotti, E., Rumisha, S. F., Sabour, S., Sachdev, P. S., Saddik, B., Sadeghi, E., Sadeghi, M., Saeidi, S., Safi, S., Safiri, S., Sagar, R., Sahebkar, A., Sahraian, M. A., Sajadi, S. M., Salahshoor, M. R., Salamati, P., Salehi Zahabi, S., Salem, H., Salem, M. R. R., Salimzadeh, H., Salomon, J. A., Salz, I., Samad, Z., Samy, A. M., Sanabria, J., Santomauro, D. F., Santos, I. S., Santos, J. V., Santric-Milicevic, M. M., Saraswathy, S. Y. I., Sarmiento-Suarez, R., Sarrafzadegan, N., Sartorius, B., Sarveazad, A., Sathian, B., Sathish, T., Sattin, D., Sbarra, A. N., Schaeffer, L. E., Schiavolin, S., Schmidt, M. I., Schutte, A. E., Schwebel, D. C., Schwendicke, F., Senbeta, A. M., Senthilkumaran, S., Sepanlou, S. G., Shackelford, K. A., Shadid, J., Shahabi, S., Shaheen, A. A., Shaikh, M. A., Shalash, A. S., Shams-Beyranvand, M., Shamsizadeh, M., Shannawaz, M., Sharafi, K., Sharara, F., Sheena, B. S., Sheikhtaheri, A., Shetty, R. S., Shibuya, K., Shiferaw, W. S., Shigematsu, M., Shin, J. I., Shiri, R., Shirkoohi, R., Shrime, M. G., Shuval, K., Siabani, S., Sigfusdottir, I. D., Sigurvinsdottir, R., Silva, J. P., Simpson, K. E., Singh, A., Singh, J. A., Skiadaresi, E., Skou, S. T. S., Skryabin, V. Y., Sobngwi, E., Sokhan, A., Soltani, S., Sorensen, R. J. D., Soriano, J. B., Sorrie, M. B., Soyiri, I. N., Sreeramareddy, C. T., Stanaway, J. D., Stark, B. A., Stefan, S. C., Stein, C., Steiner, C., Steiner, T. J., Stokes, M. A., Stovner, L. J., Stubbs, J. L., Sudaryanto, A., Sufiyan, M. B., Sulo, G., Sultan, I., Sykes, B. L., Sylte, D. O., Szocska, M., Tabares-Seisdedos, R., Tabb, K. M., Tadakamadla, S. K., Taherkhani, A., Tajdini, M., Takahashi, K., Taveira, N., Teagle, W. L., Teame, H., Tehrani-Banihashemi, A., Teklehaimanot, B. F., Terrason, S., Tessema, Z. T., Thankappan, K. 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A., Yeheyis, T. Y., Yeshitila, Y. G., Yip, P., Yonemoto, N., Yoon, S. -J., Yoosefi Lebni, J., Younis, M. Z., Younker, T. P., Yousefi, Z., Yousefifard, M., Yousefinezhadi, T., Yousuf, A. Y., Yu, C., Yusefzadeh, H., Zahirian Moghadam, T., Zaki, L., Zaman, S. B., Zamani, M., Zamanian, M., Zandian, H., Zangeneh, A., Zastrozhin, M. S., Zewdie, K. A., Zhang, Y., Zhang, Z. -J., Zhao, J. T., Zhao, Y., Zheng, P., Zhou, M., Ziapour, A., Zimsen, S. R. M., Naghavi, M., Murray, C. J. L., Department of Public Health, Clinicum, Department of Neurosciences, HUS Comprehensive Cancer Center, Environmental Sciences, Public Health, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), Sálfræðideild (HR), Department of Psychology (RU), Samfélagssvið (HR), School of Social Sciences (RU), Háskólinn í Reykjavík, Reykjavik University, GBD 2019 Diseases and Injuries Collaborator, Violante FS, Department of Earth Observation Science, Faculty of Geo-Information Science and Earth Observation, and UT-I-ITC-ACQUAL

Subjects
Male, Life expectancy, Disability-Adjusted Life Year, Diseases, Disease, communicable disease, systematic analysis, Global Burden of Disease, 0302 clinical medicine, 80 and over, Medicine, 10. No inequality, Child, 11 Medical and Health Sciences, injuries, Aged, 80 and over, education.field_of_study, Sjúkdómar, DEMENTIA, FALLS, General Medicine, Forvarnir, 3. Good health, Child, Preschool, Human, GBD, Population health, 03 medical and health sciences, SDG 3 - Good Health and Well-being, Humans, Global Burden of Disease Study, education, Aged, Spatial Analysis, Global burden, Disability, Prevention, DISABILITY, Infant, Spatial Analysi, Mortality rate, Global Burden of Disease, Diseases, Injuries, Systematic analysis, PREVENTION, Years of potential life lost, Risk factors, Disease study, ITC-ISI-JOURNAL-ARTICLE, RISK-FACTORS, Clinical Medicine, RA, Demography, Fötlun, Dánartíðni, Áhættuþættir, 030204 cardiovascular system & hematology, Risk Factors, Cause of Death, Global health, 030212 general & internal medicine, 1. No poverty, Disability-Adjusted Life Years, Public Health, Global Health, Social Medicine and Epidemiology, Middle Aged, 3142 Public health care science, environmental and occupational health, Adolescent, Adult, Age Distribution, Female, Infant, Newborn, Young Adult, Lýðheilsa, CLINICAL-TRIALS, Population, Settore MED/01 - Statistica Medica, diseases, ITC-HYBRID, Heilbrigðisvísindi, General & Internal Medicine, Mortality, Preschool, Disease burden, business.industry, Risk Factor, Klinisk medicin, Newborn, purl.org/pe-repo/ocde/ford#3.02.00 [https], Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Áverkar, Systematic analysis, NA, business
Abstract

Publisher's version (útgefin grein), Background In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990-2010 time period, with the greatest annualised rate of decline occurring in the 0-9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10-24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10-24 years were also in the top ten in the 25-49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50-74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd., Research reported in this publication was supported by the Bill & Melinda Gates Foundation; the University of Melbourne; Queensland Department of Health, Australia; the National Health and Medical Research Council, Australia; Public Health England; the Norwegian Institute of Public Health; St Jude Children's Research Hospital; the Cardiovascular Medical Research and Education Fund; the National Institute on Ageing of the National Institutes of Health (award P30AG047845); and the National Institute of Mental Health of the National Institutes of Health (award R01MH110163). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders. The authors alone are responsible for the views expressed in this Article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated, the National Health Service (NHS), the National Institute for Health Research (NIHR), the UK Department of Health and Social Care, or Public Health England; the United States Agency for International Development (USAID), the US Government, or MEASURE Evaluation; or the European Centre for Disease Prevention and Control (ECDC). This research used data from the Chile National Health Survey 2003, 2009-10, and 2016-17. The authors are grateful to the Ministry of Health, the survey copyright owner, for allowing them to have the database. All results of the study are those of the authors and in no way committed to the Ministry. The Costa Rican Longevity and Healthy Aging Study project is a longitudinal study by the University of Costa Rica's Centro Centroamericano de Poblacion and Instituto de Investigaciones en Salud, in collaboration with the University of California at Berkeley. The original pre-1945 cohort was funded by the Wellcome Trust (grant 072406), and the 1945-55 Retirement Cohort was funded by the US National Institute on Aging (grant R01AG031716). The principal investigators are Luis Rosero-Bixby and William H Dow and co-principal investigators are Xinia Fernandez and Gilbert Brenes. The accuracy of the authors' statistical analysis and the findings they report are not the responsibility of ECDC. ECDC is not responsible for conclusions or opinions drawn from the data provided. ECDC is not responsible for the correctness of the data and for data management, data merging and data collation after provision of the data. ECDC shall not be held liable for improper or incorrect use of the data. The Health Behaviour in School-Aged Children (HBSC) study is an international study carried out in collaboration with WHO/EURO. The international coordinator of the 1997-98, 2001-02, 2005-06, and 2009-10 surveys was Candace Currie and the databank manager for the 1997-98 survey was Bente Wold, whereas for the following surveys Oddrun Samdal was the databank manager. A list of principal investigators in each country can be found on the HBSC website. Data used in this paper come from the 2009-10 Ghana Socioeconomic Panel Study Survey, which is a nationally representative survey of more than 5000 households in Ghana. The survey is a joint effort undertaken by the Institute of Statistical, Social and Economic Research (ISSER) at the University of Ghana and the Economic Growth Centre (EGC) at Yale University. It was funded by EGC. ISSER and the EGC are not responsible for the estimations reported by the analysts. The Palestinian Central Bureau of Statistics granted the researchers access to relevant data in accordance with license number SLN2014-3-170, after subjecting data to processing aiming to preserve the confidentiality of individual data in accordance with the General Statistics Law, 2000. The researchers are solely responsible for the conclusions and inferences drawn upon available data. Data for this research was provided by MEASURE Evaluation, funded by USAID. The authors thank the Russia Longitudinal Monitoring Survey, conducted by the National Research University Higher School of Economics and ZAO Demoscope together with Carolina Population Center, University of North Carolina at Chapel Hill and the Institute of Sociology, Russia Academy of Sciences for making data available. This paper uses data from the Bhutan 2014 STEPS survey, implemented by the Ministry of Health with the support of WHO; the Kuwait 2006 and 2014 STEPS surveys, implemented by the Ministry of Health with the support of WHO; the Libya 2009 STEPS survey, implemented by the Secretariat of Health and Environment with the support of WHO; the Malawi 2009 STEPS survey, implemented by Ministry of Health with the support of WHO; and the Moldova 2013 STEPS survey, implemented by the Ministry of Health, the National Bureau of Statistics, and the National Center of Public Health with the support of WHO. This paper uses data from Survey of Health, Ageing and Retirement in Europe (SHARE) Waves 1 (DOI:10.6103/SHARE. w1.700), 2 (10.6103/SHARE.w2.700), 3 (10.6103/SHARE.w3.700), 4 (10.6103/SHARE.w4.700), 5 (10.6103/SHARE.w5.700), 6 (10.6103/SHARE.w6.700), and 7 (10.6103/SHARE.w7.700); see Borsch-Supan and colleagues (2013) for methodological details. The SHARE data collection has been funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812), FP7 (SHARE-PREP: GA N degrees 211909, SHARE-LEAP: GA N degrees 227822, SHARE M4: GA N degrees 261982) and Horizon 2020 (SHARE-DEV3: GA N degrees 676536, SERISS: GA N degrees 654221) and by DG Employment, Social Affairs & Inclusion. Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the US National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C), and from various national funding sources is gratefully acknowledged. This study has been realised using the data collected by the Swiss Household Panel, which is based at the Swiss Centre of Expertise in the Social Sciences. The project is financed by the Swiss National Science Foundation. The United States Aging, Demographics, and Memory Study is a supplement to the Health and Retirement Study (HRS), which is sponsored by the National Institute of Aging (grant number NIA U01AG009740). It was conducted jointly by Duke University and the University of Michigan. The HRS is sponsored by the National Institute on Aging (grant number NIA U01AG009740) and is conducted by the University of Michigan. This paper uses data from Add Health, a program project designed by J Richard Udry, Peter S Bearman, and Kathleen Mullan Harris, and funded by a grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Special acknowledgment is due to Ronald R Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website. No direct support was received from grant P01-HD31921 for this analysis. The data reported here have been supplied by the United States Renal Data System. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US Government. Collection of data for the Mozambique National Survey on the Causes of Death 2007-08 was made possible by USAID under the terms of cooperative agreement GPO-A-00-08-000_D3-00. This manuscript is based on data collected and shared by the International Vaccine Institute (IVI) from an original study IVI conducted. L G Abreu acknowledges support from Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (Brazil; finance code 001) and Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq, a Brazilian funding agency). I N Ackerman was supported by a Victorian Health and Medical Research Fellowship awarded by the Victorian Government. O O Adetokunboh acknowledges the South African Department of Science and Innovation and the National Research Foundation. A Agrawal acknowledges the Wellcome Trust DBT India Alliance Senior Fellowship. S M Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. M Ausloos, C Herteliu, and A Pana acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. A Badawi is supported by the Public Health Agency of Canada. D A Bennett was supported by the NIHR Oxford Biomedical Research Centre. R Bourne acknowledges the Brien Holden Vision Institute, University of Heidelberg, Sightsavers, Fred Hollows Foundation, and Thea Foundation. G B Britton and I Moreno Velasquez were supported by the Sistema Nacional de Investigacion, SNI-SENACYT, Panama. R Buchbinder was supported by an Australian National Health and Medical Research Council (NHMRC) Senior Principal Research Fellowship. J J Carrero was supported by the Swedish Research Council (2019-01059). F Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/MCTES through national funds. A R Chang was supported by National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases grant K23 DK106515. V M Costa acknowledges the grant SFRH/BHD/110001/2015, received by Portuguese national funds through Fundacao para a Ciencia e Tecnologia, IP, under the Norma Transitaria DL57/2016/CP1334/CT0006. A Douiri acknowledges support and funding from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South London at King's College Hospital NHS Foundation Trust and the Royal College of Physicians, and support from the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London. B B Duncan acknowledges grants from the Foundation for the Support of Research of the State of Rio Grande do Sul (IATS and PrInt) and the Brazilian Ministry of Health. H E Erskine is the recipient of an Australian NHMRC Early Career Fellowship grant (APP1137969). A J Ferrari was supported by a NHMRC Early Career Fellowship grant (APP1121516). H E Erskine and A J Ferrari are employed by and A M Mantilla-Herrera and D F Santomauro affiliated with the Queensland Centre for Mental Health Research, which receives core funding from the Queensland Department of Health. M L Ferreira holds an NHMRC Research Fellowship. C Flohr was supported by the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust. M Freitas acknowledges financial support from the EU (European Regional Development Fund [FEDER] funds through COMPETE POCI-01-0145-FEDER-029248) and National Funds (Fundacao para a Ciencia e Tecnologia) through project PTDC/NAN-MAT/29248/2017. A L S Guimaraes acknowledges support from CNPq. C Herteliu was partially supported by a grant co-funded by FEDER through Operational Competitiveness Program (project ID P_40_382). P Hoogar acknowledges Centre for Bio Cultural Studies, Directorate of Research, Manipal Academy of Higher Education and Centre for Holistic Development and Research, Kalaghatagi. F N Hugo acknowledges the Visiting Professorship, PRINT Program, CAPES Foundation, Brazil. B-F Hwang was supported by China Medical University (CMU107-Z-04), Taichung, Taiwan. S M S Islam was funded by a National Heart Foundation Senior Research Fellowship and supported by Deakin University. R Q Ivers was supported by a research fellowship from the National Health and Medical Research Council of Australia. M Jakovljevic acknowledges the Serbian part of this GBD-related contribution was co-funded through Grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. P Jeemon was supported by a Clinical and Public Health intermediate fellowship (grant number IA/CPHI/14/1/501497) from the Wellcome Trust-Department of Biotechnology, India Alliance (2015-20). O John is a recipient of UIPA scholarship from University of New South Wales, Sydney. S V Katikireddi acknowledges funding from a NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_12017/13, MC_UU_12017/15), and the Scottish Government Chief Scientist Office (SPHSU13, SPHSU15). C Kieling is a CNPq researcher and a UK Academy of Medical Sciences Newton Advanced Fellow. Y J Kim was supported by Research Management Office, Xiamen University Malaysia (XMUMRF/2018-C2/ITCM/00010). K Krishan is supported by UGC Centre of Advanced Study awarded to the Department of Anthropology, Panjab University, Chandigarh, India. M Kumar was supported by K43 TW 010716 FIC/NIMH. B Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the BHF Centre of Research Excellence, Oxford. J V Lazarus was supported by a Spanish Ministry of Science, Innovation and Universities Miguel Servet grant (Instituto de Salud Carlos III [ISCIII]/ESF, the EU [CP18/00074]). K J Looker thanks the NIHR Health Protection Research Unit in Evaluation of Interventions at the University of Bristol, in partnership with Public Health England, for research support. S Lorkowski was funded by the German Federal Ministry of Education and Research (nutriCARD, grant agreement number 01EA1808A). R A Lyons is supported by Health Data Research UK (HDR-9006), which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, NIHR (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation, and Wellcome Trust. J J McGrath is supported by the Danish National Research Foundation (Niels Bohr Professorship), and the Queensland Health Department (via West Moreton HHS). P T N Memiah acknowledges support from CODESRIA. U O Mueller gratefully acknowledges funding by the German National Cohort Study BMBF grant number 01ER1801D. S Nomura acknowledges the Ministry of Education, Culture, Sports, Science, and Technology of Japan (18K10082). A Ortiz was supported by ISCIII PI19/00815, DTS18/00032, ISCIII-RETIC REDinREN RD016/0009 Fondos FEDER, FRIAT, Comunidad de Madrid B2017/BMD-3686 CIFRA2-CM. These funding sources had no role in the writing of the manuscript or the decision to submit it for publication. S B Patten was supported by the Cuthbertson & Fischer Chair in Pediatric Mental Health at the University of Calgary. G C Patton was supported by an aNHMRC Senior Principal Research Fellowship. M R Phillips was supported in part by the National Natural Science Foundation of China (NSFC, number 81371502 and 81761128031). A Raggi, D Sattin, and S Schiavolin were supported by grants from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4-Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). P Rathi and B Unnikrishnan acknowledge Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal. A L P Ribeiro was supported by Brazilian National Research Council, CNPq, and the Minas Gerais State Research Agency, FAPEMIG. D C Ribeiro was supported by The Sir Charles Hercus Health Research Fellowship (#18/111) Health Research Council of New Zealand. D Ribeiro acknowledges financial support from the EU (FEDER funds through the Operational Competitiveness Program; POCI-01-0145-FEDER-029253). P S Sachdev acknowledges funding from the NHMRC of Australia Program Grant. A M Samy was supported by a fellowship from the Egyptian Fulbright Mission Program. M M Santric-Milicevic acknowledges the Ministry of Education, Science and Technological Development of the Republic of Serbia (contract number 175087). R Sarmiento-Suarez received institutional support from Applied and Environmental Sciences University (Bogota, Colombia) and ISCIII (Madrid, Spain). A E Schutte received support from the South African National Research Foundation SARChI Initiative (GUN 86895) and Medical Research Council. S T S Skou is currently funded by a grant from Region Zealand (Exercise First) and a grant from the European Research Council under the EU's Horizon 2020 research and innovation program (grant agreement number 801790). J B Soriano is funded by Centro de Investigacion en Red de Enfermedades Respiratorias, ISCIII. R Tabares-Seisdedos was supported in part by the national grant PI17/00719 from ISCIII-FEDER. N Taveira was partially supported by the European & Developing Countries Clinical Trials Partnership, the EU (LIFE project, reference RIA2016MC-1615). S Tyrovolas was supported by the Foundation for Education and European Culture, the Sara Borrell postdoctoral programme (reference number CD15/00019 from ISCIII-FEDER). S B Zaman received a scholarship from the Australian Government research training programme in support of his academic career., "Peer Reviewed"

Published
2020

45. The stability and variability of serum and plasma fibroblast growth factor-23 levels in a haemodialysis cohort

Author

Peter G. Kerr, Matthew J Damasiewicz, Kevan R. Polkinghorne, and Zhong X. Lu

Subjects
Male, Nephrology, medicine.medical_specialty, 030232 urology & nephrology, Subgroup analysis, Phosphate, 030204 cardiovascular system & hematology, lcsh:RC870-923, Gastroenterology, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Renal Dialysis, Internal medicine, medicine, CKD-MBD, Humans, Prospective Studies, Prospective cohort study, Aged, FGF-23, Protein Stability, business.industry, Repeated measures design, medicine.disease, lcsh:Diseases of the genitourinary system. Urology, Fibroblast Growth Factors, Fibroblast Growth Factor-23, Haemodialysis, Specimen collection, Cohort, Kidney Failure, Chronic, Female, business, Biomarkers, Research Article, Kidney disease, Cohort study
Abstract

Background Serum fibroblast growth factor 23 (FGF-23) levels are markedly elevated in haemodialysis patients and have been linked to mortality outcomes. Small studies in health and chronic kidney disease, have demonstrated marked intra- and inter-individual variability in measured FGF-23 levels, and variable degradation in serum as compared to plasma samples. In end-stage kidney disease (ESKD), the intra- and inter-individual variability of FGF-23 levels, and the optimal collection methods remain poorly characterized. In this study we assessed the variability of FGF-23 levels in a cohort of stable haemodialysis patients. Secondly, in a subset of patients, we assessed the effects of different collection methods on measured FGF-23 levels. Methods To assess the variability of FGF-23, pre-dialysis blood samples were collected over 3 consecutive weeks from 75 haemodialysis patients. The effects of different specimen collection methods were examined in a subset of patients (n = 23), with pre-dialysis blood collected into different tubes: plain (serum), EDTA (plasma) and EDTA with the addition of a protease inhibitor (EDTA-PI). All analyses were performed in the main cohort and repeated in each subgroup. Variability over a 3-week period was assessed using repeated measures ANOVA and random effects linear regression models. Intra-class correlation coefficients were calculated to assess agreement, and coefficients of variation were calculated to assess intra- and inter-individual variability. Results Over the 3-week study period the mean FGF-23 levels were not significantly different in the serum (p = 0.26), EDTA (p = 0.62) and EDTA-PI (p = 0.55) groups. FGF-23 levels demonstrated marked intra- and inter-individual variability with a CV of 36 and 203.2%, respectively. In the subgroup analysis, the mean serum FGF-23 levels were significantly lower than the EDTA (p

Published
2018

46. Type 2 diabetes in patients with end‐stage kidney disease: influence on cardiovascular disease‐related mortality risk

Author

Neil Boudville, Wai H. Lim, Matthew A Roberts, Kevan R. Polkinghorne, Germaine Wong, David W. Johnson, Charmaine E. Lok, and Carmel M. Hawley

Subjects
Adult, Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, 030209 endocrinology & metabolism, Type 2 diabetes, 030204 cardiovascular system & hematology, Nephropathy, Diabetic nephropathy, 03 medical and health sciences, 0302 clinical medicine, Renal Dialysis, Internal medicine, Diabetes mellitus, medicine, Humans, Diabetic Nephropathies, Registries, Dialysis, Aged, Retrospective Studies, business.industry, Age Factors, Australia, Type 2 Diabetes Mellitus, General Medicine, Middle Aged, medicine.disease, Survival Analysis, Diabetes Mellitus, Type 2, Cardiovascular Diseases, Kidney Failure, Chronic, Female, Urologic disease, business, New Zealand, Kidney disease
Abstract

Objectives: To examine the association between type 2 diabetes mellitus, with and without diabetic nephropathy, and cardiovascular disease-related mortality in dialysis-dependent patients with end-stage kidney disease (ESKD); to determine whether this association is affected by the age of the patient.Design, setting, participants: Prospective population cohort analysis of Australia and New Zealand Dialysis and Transplant Registry data for all patients with incident ESKD who commenced dialysis in Australia or New Zealand during 1980-2014.Outcome measures: Primary outcome: cardiovascular diseaserelated mortality; secondary outcome: all-cause mortality.Results: Of 56 552 patients followed for a median 2.5 years (total, 193 549 person-years), 15 829 (28.0%) had type 2 diabetes and diabetic nephropathy; 4993 (8.8%) had type 2 diabetes and non-diabetic nephropathy. Cardiovascular diseaserelated mortality during the first 10 years of dialysis was significantly higher for patients with diabetes/diabetic nephropathy (277 deaths per 1000 patients; 95% CI, 270-284) or diabetes/non-diabetic nephropathy (220 deaths per 1000 patients; 95% CI, 208-231) than for patients without type 2 diabetes (136 deaths per 1000 patients; 95% CI, 133-140). The risk of cardiovascular disease-related mortality was greater for patients with diabetes/diabetic nephropathy (adjusted hazard ratio [aHR], 1.63; 95% CI, 1.56-1.72) or diabetes/non-diabetic nephropathy (aHR, 1.31; 95% CI, 1.23-1.41) than for patients without diabetes. The excess risk associated with having diabetes was greater for younger than for older patients.Conclusions: Mortality risk is higher for patients with incident ESKD commencing dialysis who also have type 2 diabetes than for patients without diabetes, particularly among patients under 50 years of age, and the risk was more pronounced in patients for whom ESKD was attributed to diabetic nephropathy.

Published
2018

47. Patient survival on haemodiafiltration and haemodialysis: a cohort study using the Australia and New Zealand Dialysis and Transplant Registry

Author

Vincent W. Lee, Patrick J. Kelly, Emily J See, John W M Agar, James Hedley, Kannaiyan S Rabindranath, Kathy Mac, Kamal Sud, Kevan R. Polkinghorne, Angela C Webster, David W. Johnson, and Carmel M. Hawley

Subjects
Adult, Male, medicine.medical_specialty, Time Factors, Adolescent, medicine.medical_treatment, 030232 urology & nephrology, Comorbidity, Hemodiafiltration, 030204 cardiovascular system & hematology, Lower risk, Peritoneal dialysis, Cohort Studies, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Renal Dialysis, Interquartile range, Internal medicine, Humans, Medicine, Registries, Dialysis, Aged, Proportional Hazards Models, Transplantation, business.industry, Hazard ratio, Australia, Middle Aged, Kidney Transplantation, Nephrology, Kidney Failure, Chronic, Female, Hemodialysis, business, Peritoneal Dialysis, New Zealand, Cohort study
Abstract

Background: It is unclear if haemodiafiltration improves patient survival compared with standard haemodialysis. Observational studies have tended to show benefit with haemodiafiltration, while meta-analyses have not provided definitive proof of superiority. Methods: Using data from the Australia and New Zealand Dialysis and Transplant Registry, this binational inception cohort study compared all adult patients who commenced haemodialysis in Australia and New Zealand between 2000 and 2014. The primary outcome was all-cause mortality. Cardiovascular mortality was the secondary outcome. Outcomes were measured from the first haemodialysis treatment and were examined using multivariable Cox regression analyses. Patients were censored at permanent discontinuation of haemodialysis or at 31 December 2014. Analyses were stratified by country. Results: The study included 26 961 patients (4110 haemodiafiltration, 22 851 standard haemodialysis; 22 774 Australia, 4187 New Zealand) with a median follow-up of 5.31 (interquartile range 2.87-8.36) years. Median age was 62 years, 61% were male, 71% were Caucasian. Compared with standard haemodialysis, haemodiafiltration was associated with a significantly lower risk of all-cause mortality [adjusted hazard ratio (HR) for Australia 0.79, 95% confidence interval (95% CI) 0.72-0.87; adjusted HR for New Zealand 0.88, 95% CI 0.78-1.00]. In Australian patients, there was also an association between haemodiafiltration and reduced cardiovascular mortality (adjusted HR 0.78, 95% CI 0.64-0.95). Conclusion: Haemodiafiltration was associated with superior survival across patient subgroups of age, sex and comorbidity.

Published
2018

48. Risk Predictors and Causes of Technique Failure Within the First Year of Peritoneal Dialysis: An Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) Study

Author

Elaine M. Pascoe, Sunil V. Badve, Neil Boudville, Emily J See, Monique Borlace, Kevan R. Polkinghorne, Yeoungjee Cho, Kamal Sud, Philip A. Clayton, David W. Johnson, and Carmel M. Hawley

Subjects
Nephrology, medicine.medical_specialty, business.industry, medicine.medical_treatment, 030232 urology & nephrology, medicine.disease, Peritoneal dialysis, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Ambulatory, Emergency medicine, medicine, 030212 general & internal medicine, Renal replacement therapy, Hemodialysis, business, Dialysis, Kidney transplantation, Cohort study
Abstract

Background Concern regarding technique failure is a major barrier to increased uptake of peritoneal dialysis (PD), and the first year of therapy is a particularly vulnerable time. Study Design A cohort study using competing-risk regression analyses to identify the key risk factors and risk periods for early transfer to hemodialysis therapy or death in incident PD patients. Setting & Participants All adult patients who initiated PD therapy in Australia and New Zealand in 2000 through 2014. Predictors Patient demographics and comorbid conditions, duration of prior renal replacement therapy, timing of referral, PD modality, dialysis era, and center size. Outcomes Technique failure within the first year, defined as transfer to hemodialysis therapy for more than 30 days or death. Results Of 16,748 patients included in the study, 4,389 developed early technique failure. Factors associated with increased risk included age older than 70 years, diabetes or vascular disease, prior renal replacement therapy, late referral to a nephrology service, or management in a smaller center. Asian or other race and use of continuous ambulatory PD were associated with reduced risk, as was initiation of PD therapy in 2010 through 2014. Although the risk for technique failure due to death or infection was constant during the first year, mechanical and other causes accounted for a greater number of cases within the initial 9 months of treatment. Limitations Potential for residual confounding due to limited data for residual kidney function, dialysis prescription, and socioeconomic factors. Conclusions Several modifiable and nonmodifiable factors are associated with early technique failure in PD. Targeted interventions should be considered in high-risk patients to avoid the consequences of an unplanned transfer to hemodialysis therapy or death.

Published
2018

49. Models of care for co-morbid diabetes and chronic kidney disease

Author

Rowan G. Walker, Grant Russell, Edward Zimbudzi, Clement Lo, Peter G. Kerr, Stephen Jan, Sophia Zoungas, Alan Cass, Tim Mathew, Martin Gallagher, Greg Johnson, Greg Fulcher, Kevan R. Polkinghorne, Tim Usherwood, and Helena J. Teede

Subjects
Research design, Program evaluation, education.field_of_study, medicine.medical_specialty, business.industry, Population, 030232 urology & nephrology, Psychological intervention, General Medicine, medicine.disease, Focus group, Comorbidity, 03 medical and health sciences, 0302 clinical medicine, Nephrology, Diabetes mellitus, Family medicine, Medicine, 030212 general & internal medicine, education, business, Kidney disease
Abstract

Diabetes and chronic kidney disease (CKD) are two of the most prevalent co-morbid chronic diseases in Australia. The increasing complexity of multi-morbidity, and current gaps in health-care delivery for people with co-morbid diabetes and CKD, emphasize the need for better models of care for this population. Previously, proposed published models of care for co-morbid diabetes and CKD have not been co-designed with stake-holders or formally evaluated. Particular components of health-care shown to be effective in this population are interventions that: are structured, intensive and multifaceted (treating diabetes and multiple cardiovascular risk factors); involve multiple medical disciplines; improve self-management by the patient; and upskill primary health-care. Here we present an integrated patient-centred model of health-care delivery incorporating these components and co-designed with key stake-holders including specialist health professionals, general practitioners and Diabetes and Kidney Health Australia. The development of the model of care was informed by focus groups of patients and health-professionals; and semi-structured interviews of care-givers and health professionals. Other distinctives of this model of care are routine screening for psychological morbidity; patient-support through a phone advice line; and focused primary health-care support in the management of diabetes and CKD. Additionally, the model of care integrates with the patient-centred health-care home currently being rolled out by the Australian Department of Health. This model of care will be evaluated after implementation across two tertiary health services and their primary care catchment areas.

Published
2018

50. Omega-3 Polyunsaturated Fatty Acid Supplementation to Prevent Arteriovenous Fistula and Graft Failure: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Author

Giovanni F.M. Strippoli, Charmaine E. Lok, David W. Johnson, Andrea K. Viecelli, Elaine M. Pascoe, Carmel M. Hawley, Ashley Irish, Kevan R. Polkinghorne, Suetonia C. Palmer, and Trevor A. Mori

Subjects
Graft Rejection, medicine.medical_specialty, medicine.medical_treatment, Population, 030232 urology & nephrology, Arteriovenous fistula, law.invention, 03 medical and health sciences, Arteriovenous Shunt, Surgical, 0302 clinical medicine, Randomized controlled trial, Renal Dialysis, law, Internal medicine, Fatty Acids, Omega-3, medicine, Humans, 030212 general & internal medicine, education, Dialysis, Randomized Controlled Trials as Topic, education.field_of_study, business.industry, medicine.disease, Confidence interval, Nephrology, Meta-analysis, Relative risk, Dietary Supplements, Hemodialysis, business
Abstract

Background Arteriovenous access failure frequently occurs in people on hemodialysis and is associated with morbidity, mortality and large healthcare expenditures. Omega-3 polyunsaturated fatty acids (omega-3 PUFA) may improve access outcomes via pleiotropic effects on access maturation and function, but may cause bleeding complications. Study Design Systematic review with meta-analysis. Setting & Population Adults requiring hemodialysis via arteriovenous fistula or graft. Selection Criteria Trials evaluating omega-3 PUFA for arteriovenous access outcomes identified by searches in CENTRAL, MEDLINE, and Embase to 24 January 2017. Intervention Omega-3 PUFA. Outcomes Primary patency loss, dialysis suitability failure, access abandonment, interventions to maintain patency or assist maturation, bleeding, gastrointestinal side-effects, all-cause and cardiovascular mortality, hospitalization, and treatment adherence. Treatment effects were summarized as relative risks (RR) and 95% confidence intervals (CI). Evidence was assessed using GRADE. Results Five eligible trials (833 participants) with a median follow-up of 12 months compared peri-operative omega-3 PUFA supplementation with placebo. One trial (n=567) evaluated treatment for fistulae and four (n=266) for grafts. Omega-3 PUFA supplementation prevented primary patency loss with moderate certainty (761 participants, RR 0.81, CI 0.68-0.98). Low quality evidence suggested, that omega-3 PUFA may have had little or no effect on dialysis suitability failure (536 participants, RR 0.95, CI 0.73-1.23), access abandonment (732 participants, RR 0.78, CI 0.59-1.03), need for interventions (732 participants, RR 0.82, CI 0.64-1.04), or all-cause mortality (799 participants, RR 0.99, CI 0.51-1.92). Bleeding risk (793 participants, RR 1.40, CI 0.78-2.49) or gastrointestinal side-effects (816 participants, RR 1.22, CI 0.64-2.34) from treatment were uncertain. There was no evidence of different treatment effects for grafts and fistulae. Limitations Small number and methodological limitations of included trials. Conclusions Omega-3 PUFA supplementation probably protects against primary loss of arteriovenous access patency, but may have little or no effect on dialysis suitability failure, access interventions or access abandonment. Potential treatment harms are uncertain.

Published
2018

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