288 results on '"Kevan R, Polkinghorne"'
Search Results
2. A codesigned integrated kidney and diabetes model of care improves patient activation among patients from culturally and linguistically diverse backgrounds
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Edward Zimbudzi, Clement Lo, Sanjeeva Ranasinha, Tim Usherwood, Kevan R. Polkinghorne, Gregory Fulcher, Martin Gallagher, Stephen Jan, Alan Cass, Rowan Walker, Grant Russell, Greg Johnson, Peter G. Kerr, and Sophia Zoungas
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chronic kidney disease ,culturally and linguistically diverse background ,diabetes ,integrated kidney and diabetes model of care ,patient activation ,Medicine (General) ,R5-920 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Little is known about the relationship between patients' cultural and linguistic backgrounds and patient activation, especially in people with diabetes and chronic kidney disease (CKD). We examined the association between culturally and linguistically diverse (CALD) background and patient activation and evaluated the impact of a codesigned integrated kidney and diabetes model of care on patient activation by CALD status in people with diabetes and CKD. Methods This longitudinal study recruited adults with diabetes and CKD (Stage 3a or worse) who attended a new diabetes and kidney disease service at a tertiary hospital. All completed the patient activation measure at baseline and after 12 months and had demographic and clinical data collected. Patients from CALD backgrounds included individuals who spoke a language other than English at home, while those from non‐CALD backgrounds spoke English only as their primary language. Paired t‐tests compared baseline and 12‐month patient activation scores by CALD status. Results Patients from CALD backgrounds had lower activation scores (52.1 ± 17.6) compared to those from non‐CALD backgrounds (58.5 ± 14.6) at baseline. Within‐group comparisons showed that patient activation scores for patients from CALD backgrounds significantly improved by 7 points from baseline to 12 months follow‐up (52.1 ± 17.6–59.4 ± 14.7), and no significant change was observed for those from non‐CALD backgrounds (58.5 ± 14.6–58.8 ± 13.6). Conclusions Among patients with diabetes and CKD, those from CALD backgrounds report worse activation scores. Interventions that support people from CALD backgrounds with comorbid diabetes and CKD, such as the integrated kidney and diabetes model of care, may address racial and ethnic disparities that exist in patient activation and thus improve clinical outcomes. Patient or Public Contribution Patients, caregivers and national consumer advocacy organisations (Diabetes Australia and Kidney Health Australia) codesigned a new model of care in partnership with healthcare professionals and researchers. The development of the model of care was informed by focus groups of patients and healthcare professionals and semi‐structured interviews of caregivers and healthcare professionals. Patients and caregivers also provided a rigorous evaluation of the new model of care, highlighting its strengths and weaknesses.
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- 2023
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3. Serological responses and clinical outcomes following a three‐dose primary COVID‐19 vaccine schedule in kidney transplant recipients and people on dialysis
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Dhakshayini Tharmaraj, Irene Boo, Jessie O'Hara, Shir Sun, Kevan R Polkinghorne, Claire Dendle, Stephen J Turner, Menno C vanZelm, Heidi E Drummer, Gabriela Khoury, and William R Mulley
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antibody response ,COVID‐19 vaccine ,dialysis ,immune response ,kidney transplant ,SARS‐CoV‐2 ,Immunologic diseases. Allergy ,RC581-607 - Abstract
Abstract Objectives Despite vaccination strategies, people with chronic kidney disease, particularly kidney transplant recipients (KTRs), remained at high risk of poor COVID‐19 outcomes. We assessed serological responses to the three‐dose COVID‐19 vaccine schedule in KTRs and people on dialysis, as well as seroresponse predictors and the relationship between responses and breakthrough infection. Methods Plasma from 30 KTRs and 17 people receiving dialysis was tested for anti‐Spike receptor binding domain (RBD) IgG and neutralising antibodies (NAb) to the ancestral and Omicron BA.2 variant after Doses 2 and 3 of vaccination. Results After three doses, KTRs achieved lower anti‐Spike RBD IgG levels (P 1 g per day) and lower absolute B‐cell counts predicted poor serological responses in KTRs. ChAdOx‐1 vaccine type and higher monocyte counts were negative predictors in dialysis recipients. Among ancestral NAb seroresponders, higher NAb levels positively correlated with higher Omicron neutralisation (R = 0.9, P
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- 2024
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4. Study protocol for Vascular Access outcome measure for function: a vaLidation study In hemoDialysis (VALID)
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Andrea K. Viecelli, Armando Teixeira-Pinto, Andrea Valks, Richard Baer, Roy Cherian, Pietro E. Cippà, Jonathan C. Craig, Ranil DeSilva, Allison Jaure, David W. Johnson, Charani Kiriwandeniya, Pascal Kopperschmidt, Wen-J Liu, Timmy Lee, Charmaine Lok, Krishan Madhan, Alistair R. Mallard, Veronica Oliver, Kevan R. Polkinghorne, Rob R. Quinn, Donna Reidlinger, Matthew Roberts, Bénédicte Sautenet, Lai Seong Hooi, Rob Smith, Maarten Snoeijs, Jan Tordoir, Tushar J. Vachharajani, Raymond Vanholder, Liza A. Vergara, Martin Wilkie, Bing Yang, Theodore H. Yuo, Li Zou, Carmel M. Hawley, and on behalf of the VALID Investigator Team
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Hemodialysis ,Vascular access ,Arteriovenous fistula ,Arteriovenous graft ,Central venous catheter ,Validation ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Abstract Background A functioning vascular access (VA) is crucial to providing adequate hemodialysis (HD) and considered a critically important outcome by patients and healthcare professionals. A validated, patient-important outcome measure for VA function that can be easily measured in research and practice to harvest reliable and relevant evidence for informing patient-centered HD care is lacking. Vascular Access outcome measure for function: a vaLidation study In hemoDialysis (VALID) aims to assess the accuracy and feasibility of measuring a core outcome for VA function established by the international Standardized Outcomes in Nephrology (SONG) initiative. Methods VALID is a prospective, multi-center, multinational validation study that will assess the accuracy and feasibility of measuring VA function, defined as the need for interventions to enable and maintain the use of a VA for HD. The primary objective is to determine whether VA function can be measured accurately by clinical staff as part of routine clinical practice (Assessor 1) compared to the reference standard of documented VA procedures collected by a VA expert (Assessor 2) during a 6-month follow-up period. Secondary outcomes include feasibility and acceptability of measuring VA function and the time to, rate of, and type of VA interventions. An estimated 612 participants will be recruited from approximately 10 dialysis units of different size, type (home-, in-center and satellite), governance (private versus public), and location (rural versus urban) across Australia, Canada, Europe, and Malaysia. Validity will be measured by the sensitivity and specificity of the data acquisition process. The sensitivity corresponds to the proportion of correctly identified interventions by Assessor 1, among the interventions identified by Assessor 2 (reference standard). The feasibility of measuring VA function will be assessed by the average data collection time, data completeness, feasibility questionnaires and semi-structured interviews on key feasibility aspects with the assessors. Discussion Accuracy, acceptability, and feasibility of measuring VA function as part of routine clinical practice are required to facilitate global implementation of this core outcome across all HD trials. Global use of a standardized, patient-centered outcome measure for VA function in HD research will enhance the consistency and relevance of trial evidence to guide patient-centered care. Trial registration Clinicaltrials.gov: NCT03969225. Registered on 31st May 2019.
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- 2022
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5. GFR Variability, Survival, and Cardiovascular Events in Older AdultsPlain-Language Summary
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Michelle A. Fravel, Michael E. Ernst, Katherine L. Webb, James B. Wetmore, Rory Wolfe, Robyn L. Woods, Christopher M. Reid, Enayet Chowdhury, Anne M. Murray, and Kevan R. Polkinghorne
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Aging ,cardiovascular disease ,disability-free survival ,eGFR variability ,long-term follow-up ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Rationale & Objective: Variability in estimated glomerular filtration rate (eGFR) over time is often observed, but it is unknown whether this variation is clinically important. We investigated the association between eGFR variability and survival free of dementia or persistent physical disability (disability-free survival) and cardiovascular disease (CVD) events (myocardial infarction, stroke, hospitalization for heart failure, or CVD death). Study Design: Post hoc analysis. Setting & Participants: 12,549 participants of the ASPirin in Reducing Events in the Elderly trial. Participants were without documented dementia, major physical disability, previous CVD, and major life-limiting illness at enrollment. Predictors: eGFR variability. Outcomes: Disability-free survival and CVD events. Analytical Approach: eGFR variability was estimated using the standard deviation of eGFR measurements obtained from participants’ baseline, first, and second annual visits. Associations between tertiles of eGFR variability with disability-free survival and CVD events occurring after the eGFR variability estimation period were examined. Results: During median follow-up of 2.7 years after the second annual visit, 838 participants died, developed dementia, or acquired a persistent physical disability; 379 had a CVD event. The highest tertile of eGFR variability had an increased risk of death/dementia/disability (HR, 1.35; 95% CI, 1.14-1.59) and CVD events (HR, 1.37; 95% CI, 1.06-1.77) compared with the lowest tertile after covariate adjustment. These associations were present in patients with and without chronic kidney disease at baseline. Limitations: Limited representation of diverse demographics. Conclusions: In older, generally healthy adults, higher variability in eGFR over time predicts increased risk of future death/dementia/disability and CVD events.
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- 2023
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6. Prognostic Value of Exercise Capacity in Kidney Transplant Candidates
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Sean Tan, Yi Wen Thang, William R. Mulley, Kevan R. Polkinghorne, Satish Ramkumar, Kevin Cheng, Jasmine Chan, John Galligan, Mark Nolan, Adam J. Brown, Stuart Moir, James D. Cameron, Stephen J. Nicholls, Philip M. Mottram, and Nitesh Nerlekar
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exercise testing ,kidney transplantation ,major adverse cardiovascular events ,stress echocardiography ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Exercise stress testing for cardiovascular assessment in kidney transplant candidates has been shown to be a feasible alternative to pharmacologic methods. Exercise stress testing allows the additional assessment of exercise capacity, which may have prognostic value for long‐term cardiovascular outcomes in pre‐transplant recipients. This study aimed to evaluate the prognostic value of exercise capacity on long‐term cardiovascular outcomes in kidney transplant candidates. Methods and Results We retrospectively evaluated exercise capacity in 898 consecutive kidney transplant candidates between 2013 and 2020 who underwent symptom‐limited exercise stress echocardiography for pre‐transplant cardiovascular assessment. Exercise capacity was measured by age‐ and sex‐predicted metabolic equivalents (METs). The primary outcome was incident major adverse cardiovascular events, defined as cardiac death, non‐fatal myocardial infarction, and stroke. Cox proportional hazard multivariable modeling was performed to define major adverse cardiovascular events predictors with transplantation treated as a time‐varying covariate. A total of 429 patients (48%) achieved predicted METs. During follow‐up, 93 (10%) developed major adverse cardiovascular events and 525 (58%) underwent transplantation. Achievement of predicted METs was independently associated with reduced major adverse cardiovascular events (hazard ratio [HR] 0.49; [95% CI 0.29–0.82], P=0.007), as was transplantation (HR, 0.52; [95% CI 0.30–0.91], P=0.02). Patients achieving predicted METs on pre‐transplant exercise stress echocardiography had favorable outcomes that were independent (HR, 0.78; [95% CI 0.32–1.92], P=0.59) and of similar magnitude to subsequent transplantation (HR, 0.97; [95% CI 0.42–2.25], P=0.95). Conclusions Achievement of predicted METs on pre‐transplant exercise stress echocardiography confers excellent prognosis independent of and of similar magnitude to subsequent kidney transplantation. Future studies should assess the benefit on exercise training in this population.
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- 2022
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7. Attitudes and Practices of Australian Nephrologists Toward Implementation of Clinical Genomics
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Kushani Jayasinghe, Catherine Quinlan, Andrew J. Mallett, PhD, Peter G. Kerr, Belinda McClaren, Amy Nisselle, Amali Mallawaarachchi, Kevan R. Polkinghorne, Chirag Patel, Stephanie Best, and Zornitza Stark
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genetic kidney disease ,genomic implementation ,implementation science ,Diseases of the genitourinary system. Urology ,RC870-923 - 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.
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- 2021
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8. Risk indices predicting graft use, graft and patient survival in solid pancreas transplantation: a systematic review
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Jonathan E. H. Ling, Timothy Coughlan, Kevan R. Polkinghorne, and John Kanellis
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Risk index ,Pancreas ,Transplantation ,Survival ,Organ acceptance ,Risk ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
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.
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- 2021
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9. Association of polygenic scores with chronic kidney disease phenotypes in a longitudinal study of older adults
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Andrew Bakshi, Julia Jefferis, Rory Wolfe, James B. Wetmore, John J. McNeil, Anne M. Murray, Kevan R. Polkinghorne, Andrew J. Mallett, and Paul Lacaze
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Nephrology - Published
- 2023
10. Comparing dialysis centre mortality outcomes across Australia and New Zealand: identifying unusually performing centres 2008–2013
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Jessica Kasza, Kevan R. Polkinghorne, Rory Wolfe, Stephen P. McDonald, and Mark R. Marshall
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Center performance ,Mortality ,Transplantation ,Standardized mortality ratio ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Comparing the mortality profiles of dialysis centres is important to ensure that high standards of care are maintained. We compare the performance of dialysis centres in Australia and New Zealand in their treatment of haemodialysis patients, accounting for the competing risks of kidney transplantation and transfer to peritoneal dialysis. Methods Observational cohort study. We included data from all adult patients (5574 patients) commencing haemodialysis at home or in a facility between 2008 and 2010 across 62 dialysis centres, from the Australia and New Zealand Dialysis and Transplant Registry. Standardised mortality ratios were calculated by estimating mortality probabilities from a pooled random effects logistic regression model, accounting for the competing risk of transplantation using an inverse probability weighting approach. Models were adjusted for patient comorbidities, sex, height, weight, late referral to a nephrologist, age, race, primary kidney disease, smoking status, and serum creatinine (μmol/l). Results Two dialysis centres were found to have relatively higher levels of risk-adjusted mortality lying outside the prediction intervals for “usual” performance. Risk adjusted mortality rates were not associated with centres’ compliance with guidelines for vascular access and biochemical and haematological targets. Conclusions We demonstrate that standardised mortality ratios are useful to identify facilities that have statistically outlying mortality risk. Our criterion for determining whether a centre has better or worse performance than expected is statistical, and thus analyses such as ours can serve only as a screening tool, and are only one aspect of assessment of “quality” of performance.
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- 2018
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11. The stability and variability of serum and plasma fibroblast growth factor-23 levels in a haemodialysis cohort
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Matthew J. Damasiewicz, Zhong X. Lu, Peter G. Kerr, and Kevan R. Polkinghorne
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FGF-23 ,CKD-MBD ,Haemodialysis ,Phosphate ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
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
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- 2018
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12. Patient reported barriers are associated with low physical and mental well-being in patients with co-morbid diabetes and chronic kidney disease
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Edward Zimbudzi, Clement Lo, Sanjeeva Ranasinha, Gregory Fulcher, Martin Gallagher, Stephen Jan, Peter G. Kerr, Helena J. Teede, Kevan R. Polkinghorne, Grant Russell, Rowan G. Walker, and Sophia Zoungas
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Chronic kidney disease ,Diabetes ,Health related quality of life ,Mental well-being ,Patient reported barriers ,Physical well-being ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
Abstract Background Little is known about how patient reported barriers to health care impact the quality of life (HRQoL) of patients with comorbid disease. We investigated patient reported barriers to health care and low physical and mental well-being among people with diabetes and chronic kidney disease (CKD). Methods Adults with diabetes and CKD (estimated Glomerular Filtration Rate
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- 2018
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13. Incorporating kidney disease measures into cardiovascular risk prediction: Development and validation in 9 million adults from 72 datasets
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Kunihiro Matsushita, Simerjot K Jassal, Yingying Sang, Shoshana H Ballew, Morgan E Grams, Aditya Surapaneni, Johan Arnlov, Nisha Bansal, Milica Bozic, Hermann Brenner, Nigel J Brunskill, Alex R Chang, Rajkumar Chinnadurai, Massimo Cirillo, Adolfo Correa, Natalie Ebert, Kai-Uwe Eckardt, Ron T Gansevoort, Orlando Gutierrez, Farzad Hadaegh, Jiang He, Shih-Jen Hwang, Tazeen H Jafar, Takamasa Kayama, Csaba P Kovesdy, Gijs W Landman, Andrew S Levey, Donald M Lloyd-Jones, Rupert W. Major, Katsuyuki Miura, Paul Muntner, Girish N Nadkarni, David MJ Naimark, Christoph Nowak, Takayoshi Ohkubo, Michelle J Pena, Kevan R Polkinghorne, Charumathi Sabanayagam, Toshimi Sairenchi, Markus P Schneider, Varda Shalev, Michael Shlipak, Marit D Solbu, Nikita Stempniewicz, James Tollitt, José M Valdivielso, Joep van der Leeuw, Angela Yee-Moon Wang, Chi-Pang Wen, Mark Woodward, Kazumasa Yamagishi, Hiroshi Yatsuya, Luxia Zhang, Elke Schaeffner, and Josef Coresh
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Chronic kidney disease ,cardiovascular disease ,risk prediction ,meta-analysis ,Medicine (General) ,R5-920 - Abstract
Background: Chronic kidney disease (CKD) measures (estimated glomerular filtration rate [eGFR] and albuminuria) are frequently assessed in clinical practice and improve the prediction of incident cardiovascular disease (CVD), yet most major clinical guidelines do not have a standardized approach for incorporating these measures into CVD risk prediction. “CKD Patch” is a validated method to calibrate and improve the predicted risk from established equations according to CKD measures. Methods: Utilizing data from 4,143,535 adults from 35 datasets, we developed several “CKD Patches” incorporating eGFR and albuminuria, to enhance prediction of risk of atherosclerotic CVD (ASCVD) by the Pooled Cohort Equation (PCE) and CVD mortality by Systematic COronary Risk Evaluation (SCORE). The risk enhancement by CKD Patch was determined by the deviation between individual CKD measures and the values expected from their traditional CVD risk factors and the hazard ratios for eGFR and albuminuria. We then validated this approach among 4,932,824 adults from 37 independent datasets, comparing the original PCE and SCORE equations (recalibrated in each dataset) to those with addition of CKD Patch. Findings: We confirmed the prediction improvement with the CKD Patch for CVD mortality beyond SCORE and ASCVD beyond PCE in validation datasets (Δc-statistic 0.027 [95% CI 0.018–0.036] and 0.010 [0.007–0.013] and categorical net reclassification improvement 0.080 [0.032–0.127] and 0.056 [0.044–0.067], respectively). The median (IQI) of the ratio of predicted risk for CVD mortality with CKD Patch vs. the original prediction with SCORE was 2.64 (1.89–3.40) in very high-risk CKD (e.g., eGFR 30–44 ml/min/1.73m2 with albuminuria ≥30 mg/g), 1.86 (1.48–2.44) in high-risk CKD (e.g., eGFR 45–59 ml/min/1.73m2 with albuminuria 30–299 mg/g), and 1.37 (1.14–1.69) in moderate risk CKD (e.g., eGFR 60–89 ml/min/1.73m2 with albuminuria 30–299 mg/g), indicating considerable risk underestimation in CKD with SCORE. The corresponding estimates for ASCVD with PCE were 1.55 (1.37–1.81), 1.24 (1.10–1.54), and 1.21 (0.98–1.46). Interpretation: The “CKD Patch” can be used to quantitatively enhance ASCVD and CVD mortality risk prediction equations recommended in major US and European guidelines according to CKD measures, when available. Funding: US National Kidney Foundation and the NIDDK.
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- 2020
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14. Effect of Aspirin on CKD Progression in Older Adults: Secondary Analysis From the ASPREE Randomized Clinical Trial
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Kevan R. Polkinghorne, James B. Wetmore, Le Thi Phuong Thao, Rory Wolfe, Robyn L. Woods, Michael E. Ernst, Mark R. Nelson, Christopher M. Reid, Raj C. Shah, John J. McNeil, and Anne M. Murray
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Nephrology - Published
- 2022
15. Vascular Access for Hemodialysis
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Kevan R. Polkinghorne and Andrea K. Viecelli
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- 2022
16. Health-related quality of life among patients with comorbid diabetes and kidney disease attending a codesigned integrated model of care: a longitudinal study
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Tim Usherwood, Peter G Kerr, Kevan R Polkinghorne, Edward Zimbudzi, Clement Lo, Sanjeeva Ranasinha, Helena Teede, Greg Fulcher, Steven Jan, Rowan Walker, Greg Johnson, and Sophia Zoungas
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Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - 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.
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- 2020
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17. Endothelial Progenitor Cells and Vascular Health in Dialysis Patients
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Brooke M. Huuskes, Ryan J. DeBuque, Kevan R. Polkinghorne, Chrishan S. Samuel, Peter G. Kerr, and Sharon D. Ricardo
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Diseases of the genitourinary system. Urology ,RC870-923 - Published
- 2018
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18. Relationship Between Urinary Phosphate and All-Cause and Cardiovascular Mortality in a National Population-Based Longitudinal Cohort Study
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Nigel D. Toussaint, Matthew J. Damasiewicz, Stephen G. Holt, Zhong X. Lu, Dianna J. Magliano, Robert C. Atkins, Steven J. Chadban, Jonathan E. Shaw, and Kevan R. Polkinghorne
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Male ,Nutrition and Dietetics ,Australia ,Medicine (miscellaneous) ,Middle Aged ,Phosphates ,Cohort Studies ,Cardiovascular Diseases ,Risk Factors ,Nephrology ,Humans ,Female ,Longitudinal Studies ,Renal Insufficiency, Chronic ,Proportional Hazards Models - Abstract
High dietary phosphate intake may lead to adverse outcomes including cardiovascular disease (CVD). Urinary phosphate excretion, a marker of intestinal phosphate absorption, may be a more reliable marker of phosphate homeostasis in steady state than serum phosphate. Studies report good agreement between urine phosphate-to-creatinine ratio (uPiCr) and 24-hour urinary phosphate; however, whether uPiCr is associated with increased risk of CVD or mortality remains uncertain. This study aimed to assess the relationship between uPiCr and all-cause and CVD mortality.This is an observational longitudinal cohort study using data from the population-based national Australian Diabetes, Obesity and Lifestyle study (n = 10,014 participants). Non-linear association between uPiCr and all-cause and CVD mortality was assessed using fractional polynomial transformations. Cox proportional hazards regression models were used to estimate adjusted hazard ratios for all-cause and CVD mortality.Median age [interquartile range] was 50 [41-62] years, and 46% were male. Median uPiCr was 1.38 [1.02-1.79] mmol/mmol. Median follow-up time was 16.9 years with 1,735 deaths. uPiCr was associated with all-cause and CVD mortality in univariate models and when adjusted for age and gender. However, associations were not significant in multivariate models. Sensitivity analyses excluding participants with chronic kidney disease (CKD) revealed a significant J-shaped association between uPiCr and all-cause mortality. Urine phosphate alone showed an association with increased all-cause mortality in a similar J-shape relationship.Although no association between uPiCr and all-cause and CVD mortality was observed in multivariate analyses in the whole cohort, a significant relationship between uPiCr and mortality in those without CKD suggests that uPiCr may have predictive validity for future adverse outcomes in people with no CKD.
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- 2022
19. Including measures of chronic kidney disease to improve cardiovascular risk prediction by SCORE2 and SCORE2-OP
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Kunihiro Matsushita, Stephen Kaptoge, Steven H J Hageman, Yingying Sang, Shoshana H Ballew, Morgan E Grams, Aditya Surapaneni, Luanluan Sun, Johan Arnlov, Milica Bozic, Hermann Brenner, Nigel J Brunskill, Alex R Chang, Rajkumar Chinnadurai, Massimo Cirillo, Adolfo Correa, Natalie Ebert, Kai-Uwe Eckardt, Ron T Gansevoort, Orlando Gutierrez, Farzad Hadaegh, Jiang He, Shih-Jen Hwang, Tazeen H Jafar, Simerjot K Jassal, Takamasa Kayama, Csaba P Kovesdy, Gijs W Landman, Andrew S Levey, Donald M Lloyd-Jones, Rupert W Major, Katsuyuki Miura, Paul Muntner, Girish N Nadkarni, Christoph Nowak, Takayoshi Ohkubo, Michelle J Pena, Kevan R Polkinghorne, Toshimi Sairenchi, Elke Schaeffner, Markus P Schneider, Varda Shalev, Michael G Shlipak, Marit D Solbu, Nikita Stempniewicz, James Tollitt, José M Valdivielso, Joep van der Leeuw, Angela Yee-Moon Wang, Chi-Pang Wen, Mark Woodward, Kazumasa Yamagishi, Hiroshi Yatsuya, Luxia Zhang, Jannick A N Dorresteijn, Emanuele Di Angelantonio, Frank L J Visseren, Lisa Pennells, and Josef Coresh
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Epidemiology ,Cardiology and Cardiovascular Medicine - Abstract
Aims The 2021 European Society of Cardiology (ESC) guideline on cardiovascular disease (CVD) prevention categorizes moderate and severe chronic kidney disease (CKD) as high and very-high CVD risk status regardless of other factors like age and does not include estimated glomerular filtration rate (eGFR) and albuminuria in its algorithms, systemic coronary risk estimation 2 (SCORE2) and systemic coronary risk estimation 2 in older persons (SCORE2-OP), to predict CVD risk. We developed and validated an ‘Add-on’ to incorporate CKD measures into these algorithms, using a validated approach. Methods In 3,054 840 participants from 34 datasets, we developed three Add-ons [eGFR only, eGFR + urinary albumin-to-creatinine ratio (ACR) (the primary Add-on), and eGFR + dipstick proteinuria] for SCORE2 and SCORE2-OP. We validated C-statistics and net reclassification improvement (NRI), accounting for competing risk of non-CVD death, in 5,997 719 participants from 34 different datasets. Results In the target population of SCORE2 and SCORE2-OP without diabetes, the CKD Add-on (eGFR only) and CKD Add-on (eGFR + ACR) improved C-statistic by 0.006 (95%CI 0.004–0.008) and 0.016 (0.010–0.023), respectively, for SCORE2 and 0.012 (0.009–0.015) and 0.024 (0.014–0.035), respectively, for SCORE2-OP. Similar results were seen when we included individuals with diabetes and tested the CKD Add-on (eGFR + dipstick). In 57 485 European participants with CKD, SCORE2 or SCORE2-OP with a CKD Add-on showed a significant NRI [e.g. 0.100 (0.062–0.138) for SCORE2] compared to the qualitative approach in the ESC guideline. Conclusion Our Add-ons with CKD measures improved CVD risk prediction beyond SCORE2 and SCORE2-OP. This approach will help clinicians and patients with CKD refine risk prediction and further personalize preventive therapies for CVD.
- Published
- 2022
20. Multifaceted Quality Improvement Interventions to Prevent Hemodialysis Catheter–Related Bloodstream Infections: A Systematic Review
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Benjamin Lazarus, Elisa Bongetti, Jonathan Ling, Martin Gallagher, Sradha Kotwal, and Kevan R. Polkinghorne
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Nephrology - Published
- 2023
21. Solid pancreas transplant outcomes with increased donor and recipient ages compared with reference ages: a systematic review
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Shi Zhou Choo, Kevan R. Polkinghorne, Jonathan E.H. Ling, and John Kanellis
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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.
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- 2022
22. Cystatin C: not just a marker of kidney function
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Sanduni Fernando and Kevan R. Polkinghorne
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Diseases of the genitourinary system. Urology ,RC870-923 - Published
- 2020
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23. 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.
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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
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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.
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- 2019
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24. The impact of an integrated diabetes and kidney service on patients, primary and specialist health professionals in Australia: A qualitative study.
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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.
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- 2019
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- View/download PDF
25. CKD Biomarkers, Cognitive Impairment, and Incident Dementia in an Older Healthy Cohort
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Anne M. Murray, Le Thi Phuong Thao, Joanne Ryan, Rory Wolfe, James B. Wetmore, Robyn L. Woods, and Kevan R. Polkinghorne
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Aged, 80 and over ,Male ,General Medicine ,Cohort Studies ,Cross-Sectional Studies ,Creatinine ,Albuminuria ,Humans ,Cognitive Dysfunction ,Dementia ,Female ,Longitudinal Studies ,Renal Insufficiency, Chronic ,Biomarkers ,Original Investigation ,Aged ,Glomerular Filtration Rate - Abstract
BACKGROUND: CKD is a risk factor for cognitive impairment (CI), but reports of individual associations of eGFR and albuminuria with CI and incident dementia in healthier, older, longitudinal populations are lacking. Our goal was to estimate these associations in a large cohort of older healthy persons. METHODS: In a longitudinal cohort study of older persons without prior cardiovascular disease, we estimated the associations between baseline eGFR (in ml/min per 1.73 m(2)) and albuminuria, measured as urine albumin-creatinine ratio (UACR; in mg/mmol) and cognitive test scores, declines in cognitive test scores, and incident dementia using adjusted linear and linear mixed models. Cox proportional hazards regression models assessed the association between baseline kidney function and incident CI no dementia (CIND) or dementia at a median of 4.7 years. RESULTS: At baseline, among 18,131 participants, median age was 74 years, eGFR was 74 (IQR, 63–84) ml/min per 1.73 m(2), UACR was 0.8 (IQR, 0.5–1.5) mg/mmol (7.1 [4.4–13.3] mg/g), and 56% were female. Baseline eGFR was not associated with performance on any cognitive tests in cross-sectional analysis, nor was incident CIND or dementia over a median follow-up of 4.7 years. However, baseline UACR ≥3 mg/mmol (≥26.6 mg/g) was significantly associated with lower baseline scores and larger declines on the Modified Mini-Mental State Exam, verbal memory and processing speed tests, and with incident CIND (hazard ratio [HR], 1.19; 95% CI, 1.07 to 1.33) and dementia (HR, 1.32; 95% CI, 1.06 to 1.66). CONCLUSION: Mild albuminuria was associated with worse baseline cognitive function, cognitive decline, and increased risk for incident CIND and dementia. Screening global cognitive tests for older persons with UACR ≥3 mg/mmol could identify those at elevated risk of cognitive decline and dementia.
- Published
- 2022
26. A pilot study comparing the efficiency of a novel asymmetric cellulose triacetate ( <scp>ATA</scp> ) dialyser membrane ( <scp>Solacea‐190H</scp> ) to a standard high flux polysulfone dialyser membrane ( <scp>FX</scp> ‐80) in the setting of extended hours haemodialysis
- Author
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Kamya Kameshwar, Matthew J. Damasiewicz, Kevan R. Polkinghorne, and Peter G. Kerr
- Subjects
Nephrology ,General Medicine - Published
- 2022
27. Dietary habits in Australian, New Zealand and Malaysian patients with end stage kidney failure: A pre‐specified cross‐sectional study of the FAVOURED trial participants
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Marguerite, Conley, Anne, Barden, Andrea K, Viecelli, Ashley B, Irish, Alan, Cass, Carmel M, Hawley, David, Voss, Elaine M, Pascoe, Katie, Lenhoff, Kevan R, Polkinghorne, Lai-Seong, Hooi, Loke-Meng, Ong, Peta-Anne, Paul-Brent, Peter G, Kerr, and Trevor A, Mori
- Subjects
Male ,Nutrition and Dietetics ,Australia ,Medicine (miscellaneous) ,Feeding Behavior ,Diet ,Cross-Sectional Studies ,Fruit ,Vegetables ,Animals ,Humans ,Female ,Renal Insufficiency, Chronic ,New Zealand - Abstract
Dietary management plays an important role in patients with kidney failure. Current dietary habits of Australians and New Zealanders (ANZ) and Malaysians with chronic kidney disease (CKD Stage 4-5) have not been adequately investigated. We report the dietary habits of people with advanced CKD and their adherence to country-specific dietary guidelines.Participants with CKD Stage 4-5, enrolled in the Omega-3 Fatty Acids (Fish oils) and Aspirin in Vascular access Outcomes in Renal Disease (FAVOURED) trial, completed a lifestyle questionnaire at baseline on their dietary intake.Of 567 participants, 538 (ANZ, n = 386; Malaysian, n = 152; mean ± SD age 54.8 ± 14.3 years, 64% male) completed the questionnaire. Dietary fruit and vegetable intakes were higher in ANZ participants; 49% (n = 189) consumed ≥2 serves daySignificant regional variation in dietary intake for fruit, vegetables and animal protein is described that likely reflects cultural and economic differences. Barriers to meeting recommended dietary intakes require further investigation.
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- 2022
28. Impact of haemodialysis hours on outcomes in older patients
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Emily K. Yeung, Leanne Brown, Lukas Kairaitis, Rathika Krishnasamy, Casey Light, Emily See, David Semple, Kevan R. Polkinghorne, Nigel D. Toussaint, Robert MacGinley, and Matthew A. Roberts
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Nephrology ,General Medicine - Abstract
Previous studies report an association between longer haemodialysis treatment sessions and improved survival. Worldwide, there is a trend to increasing age among prevalent patients receiving haemodialysis. This analysis aimed to determine whether the mortality benefit of longer haemodialysis treatment sessions diminishes with increasing age.This was a retrospective cohort study of people who first commenced thrice-weekly haemodialysis aged ≥65 years, reported to the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry from 2005 to 2015, included from 90 days after dialysis start. The primary outcome was all-cause mortality. Cox regression analysis was performed with haemodialysis session duration the exposure of interest.Of 8224 people who commenced haemodialysis as their first treatment for kidney failure aged ≥65 years during this period, 4727 patients died. Longer dialysis hours per session was associated with a decreased risk of death in unadjusted analyses [hazard ratio, HR, for ≥5 h versus 4 to4.5 h: 0.81 (0.75-0.88, p .001)]. Patients having longer dialysis sessions were younger but had greater co-morbidity. In an adjusted model including age and other variables, the survival benefit of longer hours was only partially attenuated [HR for previous comparison: 0.75 (0.69-0.82, p .001)], and no interaction between age and hours was demonstrated (p = .89).The apparent survival benefit associated with longer haemodialysis session length appears to be preserved in patients 65 years or older. In practice, the benefit of longer dialysis hours should be carefully weighed against other factors in this patient group.
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- 2022
29. Long-Term Blood Pressure Variability and Kidney Function in Participants of the ASPREE Trial
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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
30. Donor Predictors of Donor Pancreas Retrieval and Subsequent Solid Pancreas Transplantation in Australia and New Zealand from 2007 to 2016
- Author
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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
31. The association of frailty with chronic kidney disease in older adults using the ASPirin in reducing events in the elderly cohort
- Author
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Rowan G, Walker, Rory, Wolfe, Elisa, Bongetti, Kevan R, Polkinghorne, Robyn L, Woods, Joanne, Ryan, Sara, Espinoza, Anne, Murray, Michael E, Ernst, and John J, Mcneil
- Subjects
Nephrology ,General Medicine - Abstract
Frailty and chronic kidney disease (CKD) both increase with age and are prevalent in older adults. However, studies in older adults examining the relationship between frailty and milder impairments of kidney function are relatively sparse. We examined the cross-sectional association of baseline estimated glomerular filtration rate (eGFR), albuminuria and CKD ([eGFR60 ml/min/1.73 m
- Published
- 2022
32. Projecting the incidence and costs of major cardiovascular and kidney complications of type 2 diabetes with widespread SGLT2i and GLP-1 RA use: a cost-effectiveness analysis
- Author
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Jedidiah I, Morton, Clara, Marquina, Jonathan E, Shaw, Danny, Liew, Kevan R, Polkinghorne, Zanfina, Ademi, and Dianna J, Magliano
- Abstract
Whether sodium-glucose co-transporter 2 inhibitors (SGLT2is) or glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are cost-effective based solely on their cardiovascular and kidney benefits is unknown. We projected the health and economic outcomes due to myocardial infarction (MI), stroke, heart failure (HF) and end-stage kidney disease (ESKD) among people with type 2 diabetes, with and without CVD, under scenarios of widespread use of these drugs.We designed a microsimulation model using real-world data that captured CVD and ESKD morbidity and mortality from 2020 to 2040. The populations and transition probabilities were derived by linking the Australian Diabetes Registry (1.1 million people with type 2 diabetes) to hospital admissions databases, the National Death Index and the ESKD Registry using data from 2010 to 2019. We modelled four interventions: increase in use of SGLT2is or GLP-1 RAs to 75% of the total population with type 2 diabetes, and increase in use of SGLT2is or GLP-1 RAs to 75% of the secondary prevention population (i.e. people with type 2 diabetes and prior CVD). All interventions were compared with current use of SGLT2is (20% of the total population) and GLP-1 RAs (5% of the total population). Outcomes of interest included quality-adjusted life years (QALYs), total costs (from the Australian public healthcare perspective) and the incremental cost-effectiveness ratio (ICER). We applied 5% annual discounting for health economic outcomes. The willingness-to-pay threshold was set at AU$28,000 per QALY gained.The numbers of QALYs gained from 2020 to 2040 with increased SGLT2i and GLP-1 RA use in the total population (n=1.1 million in 2020; n=1.5 million in 2040) were 176,446 and 200,932, respectively, compared with current use. Net cost differences were AU$4.2 billion for SGLT2is and AU$20.2 billion for GLP-1 RAs, and the ICERs were AU$23,717 and AU$100,705 per QALY gained, respectively. In the secondary prevention population, the ICERs were AU$8878 for SGLT2is and AU$79,742 for GLP-1 RAs.At current prices, use of SGLT2is, but not GLP-1 RAs, would be cost-effective when considering only their cardiovascular and kidney disease benefits for people with type 2 diabetes.
- Published
- 2022
33. Long-Term Graft and Patient Outcomes Following Kidney Transplantation in End-Stage Kidney Disease Secondary to Hyperoxaluria
- Author
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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
34. A comparison of arteriovenous fistula failure between Malaysian and Australian and New Zealand participants enrolled in the FAVOURED trial
- Author
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Rebecca Hudson, Elaine M Pascoe, Yong Pey See, Yeoungjee Cho, Kevan R Polkinghorne, Peta-Anne Paul-Brent, Lai-Seong Hooi, Loke-Meng Ong, Trevor A Mori, Sunil V Badve, Alan Cass, Peter G Kerr, David Voss, Carmel M Hawley, David W Johnson, Ashley B Irish, and Andrea K Viecelli
- Subjects
Nephrology ,Surgery - Abstract
Aim: To describe and compare de novo arteriovenous fistula (AVF) failure rates between Australia and New Zealand (ANZ), and Malaysia. Background: AVFs are preferred for haemodialysis access but are limited by high rates of early failure. Methods: A post hoc analysis of 353 participants from ANZ and Malaysia included in the FAVOURED randomised-controlled trial undergoing de novo AVF surgery was performed. Composite AVF failure (thrombosis, abandonment, cannulation failure) and its individual components were compared between ANZ ( n = 209) and Malaysian ( n = 144) participants using logistic regression adjusted for patient- and potentially modifiable clinical factors. Results: Participants’ mean age was 55 ± 14.3 years and 64% were male. Compared with ANZ participants, Malaysian participants were younger with lower body mass index, higher prevalence of diabetes mellitus and lower prevalence of cardiovascular disease. AVF failure was less frequent in the Malaysian cohort (38% vs 54%; adjusted odds ratio (OR) 0.53, 95% confidence interval (CI) 0.31–0.93). This difference was driven by lower odds of cannulation failure (29% vs 47%, OR 0.45, 95% CI 0.25–0.80), while the odds of AVF thrombosis (17% vs 20%, OR 1.24, 95% CI 0.62–2.48) and abandonment (25% vs 23%, OR 1.17, 95% CI 0.62–2.16) were similar. Conclusions: The risk of AVF failure was significantly lower in Malaysia compared to ANZ and driven by a lower risk of cannulation failure. Differences in practice patterns, including patient selection, surgical techniques, anaesthesia or cannulation techniques may account for regional outcome differences and warrant further investigation.
- Published
- 2022
35. 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
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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
36. A pilot study comparing the efficiency of a novel asymmetric cellulose triacetate (ATA) dialyser membrane (Solacea-190H) to a standard high flux polysulfone dialyser membrane (FX-80) in the setting of extended hours haemodialysis
- Author
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Kamya, Kameshwar, Matthew J, Damasiewicz, Kevan R, Polkinghorne, and Peter G, Kerr
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Inflammation ,Fluorocarbons ,Interleukin-6 ,Polymers ,Membranes, Artificial ,Pilot Projects ,Phosphates ,Renal Dialysis ,Albumins ,Creatinine ,Dialysis Solutions ,Humans ,Urea ,Sulfones ,Cellulose ,Furans ,beta 2-Microglobulin - Abstract
To compare small, middle and large-middle molecule clearance; and expression of markers of inflammation, between Solacea-190H (asymmetric cellulose triacetate [ATA]) and FX-80 dialysers in long-hour haemodialysis patients.This pilot, randomized cross-over trial recruited 10 home haemodialysis patients. The total study duration was 8 weeks, using each dialyser for 4 weeks. Removal of small (urea, phosphate, creatinine and indoxyl sulfate [IS]), middle and large-middle molecules (beta-2 microglobulin [β2M], albumin), markers of inflammation (interleukin-6 [IL-6], malondialdehyde-modified low density lipoprotein [MDA-LDL] and alpha-1 microglobulin [α1M]), was evaluated in serum and dialysate samples.Reduction ratios [RR] were calculated for variables at the fourth week of each dialyzer sequence and results expressed as difference in mean RR between dialyzers. There was no difference in clearance of small molecules, with difference in mean RR for urea -2.43 (95% CI -6.44, 1.57; p = .19), creatinine -1.82 (95% CI -5.50, 1.85; p = .28) and phosphate -2.61 (95% CI -12.45, 7.23; p = .55); clearance of middle and large-middle molecules with difference in mean RR (range) for β2M 2.2 (95% CI -3.2, 7.7; p = .35), IS 1.8 (95% CI -9.5, 13; p = .72) and albumin -0.6 (95% CI -5.5, 4.2; p = .77). There was lack of induction of markers of inflammation, including IL-6 15.2 (95% CI -31.9, 62.2; p = .47), MDA-LDL -8.1 (95% CI -22.1, 5.8; p = .21) and α1M -3.50 (95% CI -29.2, 22.2; p = .76). Dialysate removal results were concurrent.This study showed no difference in clearance of small, middle and large-middle molecules, nor expression of markers of inflammation between dialysers.
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- 2022
37. Willingness to Participate in a Randomized Trial Comparing Catheters to Fistulas for Vascular Access in Incident Hemodialysis Patients: An International Survey of Nephrologists
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Krishna Poinen, Matthew J. Oliver, Pietro Ravani, Sabine N. Van der Veer, Kitty J. Jager, Wim Van Biesen, Kevan R. Polkinghorne, Aviva Rosenfeld, Adriane M. Lewin, Mandeep Dulai, and Robert R. Quinn
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Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Background: Current guidelines favor fistulas over catheters as vascular access. Yet, the observational literature comparing fistulas to catheters has important limitations and biases that may be difficult to overcome in the absence of randomization. However, it is not clear if physicians would be willing to participate in a clinical trial comparing fistulas to catheters. Objectives: We also sought to elicit participants' opinions on willingness to participate in a future trial regarding catheters and fistulas. Design: We created a three-part survey consisting of 19 questions. We collected demographic information, respondents' knowledge of the vascular access literature, appropriateness of current guideline recommendations, and their willingness to participate in a future trial. Setting: Participants were recruited from Canada, Europe, Australia, and New Zealand. Participants: Participants include physicians and trainees who are involved in the care of end-stage renal disease patients requiring vascular access. Measurements: Descriptive statistics were used to describe baseline characteristics of respondents according to geographic location. We used logistic regression to model willingness to participate in a future trial. Methods: We surveyed nephrologists from Canada, Europe, Australia, and New Zealand to assess their willingness to participate in a randomized trial comparing fistulas to catheters in incident hemodialysis patients. Results: Our results show that in Canada, 86 % of respondents were willing to participate in a trial (32 % in all patients; 54 % only in patients at high risk of primary failure). In Europe and Australia/New Zealand, the willingness to participate in a trial that included all patients was lower (28 % in Europe; 25 % in Australia/New Zealand), as was a trial that included patients at high risk of primary failure (38 % in Europe; 39 % in Australia/New Zealand). Nephrologists who have been in practice for a few years, saw a larger volume of patients, or self-identified as experts in vascular access literature were more likely to participate in a trial. (Continued on next page) Limitations: Survey distribution was limited to vascular access experts in participating European countries and ultimately led to a discrepancy in numbers of European to non-European respondents overall. Canadian views are likely over-represented in the overall outcomes. Conclusions: Our survey results suggest that nephrologists believe there is equipoise surrounding the optimal vascular access strategy and that a randomized controlled study should be undertaken, but restricted to those individuals with a high risk of primary fistula failure.
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- 2016
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38. A Randomized Trial on the Effect of Phosphate Reduction on Vascular End Points in CKD (IMPROVE-CKD)
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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
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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.
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- 2020
39. Volume management in haemodialysis patients
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Kevan R. Polkinghorne and Emily J See
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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.
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- 2020
40. The impact of comorbid chronic kidney disease and diabetes on health-related quality-of-life: a 12-year community cohort study
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Melanie L R Wyld, Steve Chadban, Kevan R. Polkinghorne, Dianna J. Magliano, Leyla Aouad, and Rachael L. Morton
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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.
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- 2020
41. Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference
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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
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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.
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- 2020
42. Patient-led identification and prioritization of exercise interventions for fatigue on dialysis: a workshop report
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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.
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- 2020
43. Global Dialysis Perspective: Australia
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Matthew J Damasiewicz and Kevan R. Polkinghorne
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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, …
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- 2020
44. Risk factors for major adverse kidney events in the first year after acute kidney injury
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Nigel D Toussaint, Emily J See, Kevan R. Polkinghorne, R.J. Robbins, Rinaldo Bellomo, Michael Bailey, and David W. Johnson
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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.
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- 2019
45. Taking a broader view of the health care needs of people with chronic kidney disease
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Kevan R Polkinghorne and Peter G Kerr
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Renal Dialysis ,Humans ,General Medicine ,Renal Insufficiency, Chronic ,Delivery of Health Care - Published
- 2021
46. Kidney transplant recipients’ attitudes toward COVID‐19 vaccination and barriers and enablers to vaccine acceptance
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Claire Dendle, Dhakshayini Tharmaraj, Kevan R. Polkinghorne, and William R. Mulley
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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
47. The association of attained age, age at diagnosis, and duration of type 2 diabetes with the long-term risk for major diabetes-related complications
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Jedidiah I, Morton, Peter A, Lazzarini, Kevan R, Polkinghorne, Bendix, Carstensen, Dianna J, Magliano, and Jonathan E, Shaw
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Diabetes Complications ,Stroke ,Endocrinology ,Diabetes Mellitus, Type 2 ,Risk Factors ,Endocrinology, Diabetes and Metabolism ,Australia ,Myocardial Infarction ,Internal Medicine ,Humans ,General Medicine ,Child - Abstract
We evaluated the associations of age and duration of type 2 diabetes with major diabetes-related complications.We included 1.1 million people with type 2 diabetes from the Australian diabetes registry, followed from 2010 to 2019. We estimated the incidence of hospitalization or death from myocardial infarction (MI), stroke, and heart failure (HF), and hospitalisation for lower extremity amputation (LEA); end-stage kidney disease (ESKD; kidney replacement therapy or death from ESKD); and all-cause mortality. Poisson regression was used to model incidence by attained age, age at diabetes diagnosis, and duration of diabetes.Risk for complications increased exponentially with diabetes duration. Effects of attained age differed for each complication: age was a strong risk factor for MI, stroke, HF, and mortality, while diabetes duration, not age, was the predominant determinant of LEA and ESKD. At a given age, a 10-year longer diabetes duration was associated with a 1.1-1.5-fold increased risk of stroke and mortality, a 1.5-2.0-fold increased risk of MI and HF, and a 2-4-fold increased risk of LEA and ESKD.Duration of diabetes is a stronger risk factor for ESKD and LEA than it is for cardiovascular disease or mortality.
- Published
- 2022
48. Socio-economic disparity, access to care and patient-relevant outcomes after kidney allograft failure
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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
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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
49. A co-designed integrated kidney and diabetes model of care improves mortality, glycaemic control and self-care
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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
50. Associations of Chronic Kidney Disease Markers with Cognitive Function: A 12-Year Follow-Up Study
- Author
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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
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