Challenges and opportunities in late-stage chronic kidney disease

Fishbane, Steven; Hazzan, Azzour D.; Halinski, Candice; Mathew, Anna

doi:10.1093/ckj/sfu128

Cited by 39 publications

(29 citation statements)

References 44 publications

(43 reference statements)

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“…Chronic Kidney Disease (CKD) affects individuals and health systems in low, middle and high income countries (1) and the global prevalence is estimated at 5 to 10%% (2). CKD is also common in Africa although very limited data is collected on prevalence.…”

Section: Introductionmentioning

confidence: 99%

Adherence of adult Chronic Kidney Disease patients with regard to their dialysis, medication, dietary and fluid restriction

Chironda¹,

Bhengu²,

Manwere³

2017

Research Journal of Health Sciences

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Objective: Chronic Kidney Disease (CKD) has become a major health problem as a result of complicated interrelationships with diabetes mellitus, hypertension and other associated diseases. Effective management of CKD depends on patient's adherence to their dialysis plan, medications, dietary and fluid restrictions. This study aimed at systematically reviewing the adherence of adult Chronic Kidney Disease (CKD) patients with regard to their dialysis, medication, dietary and fluid restriction.Methods: Key words were used for the search in various data bases: "adherence", "Chronic Kidney Disease", "dialysis", "medication", "dietary" and "fluid restriction". Online data bases namely Medline, PubMed, Ebsco Host, CINAHL, google scholar and grey literature were used to identify published research from 1993 -2016. Forty three (43) articles were identified regarding adherence of CKD patients to dialysis, medication, dietary and fluid restriction.Results: Medication non adherence ranged from 3 to 80% through self-report, structured interview and biological markers. Fluid non-adherence was 10-74%. Using self-report and biological markers, nonadherence to diet was 2-39% and 19-57% respectively. With regards to dialysis, skipping and shortening hemodialysis adherence ranged from 2.5% -19% and 20.3% -32.3 % respectively. Globally, adherence rates to CAPD are not well documented in literature. Conclusion:Non-adherence to dialysis, medication, dietary and fluid restriction is an area of concern internationally in CKD population. Furthermore, non-adherence rates are not well researched and documented in African literature. Therefore, Nephrology professionals in clinical practice are agents of improving adherence of CKD patients to ensure effective management of the disease.Keywords: Adherence and non-adherence to medication, fluid, diet and dialysis, Chronic Ambulatory Peritoneal Dialysis (CAPD), Chronic Kidney Disease (CKD) and hemodialysis. Méthodes: Les mots clés suivants ont été utilisés pour la recherche: l'observance, la maladie rénale chronique, la dialyse, la médication, la restriction alimentaire et la restriction des fluides. La recherche a identifié 47 articles qui quantifient l 'adhérence des patients CKD à la dialyse, à la médication, à la restriction alimentaire et à la restriction des fluides.Résultats: La non-adhésion aux médicaments variait de 3 à 80% grâce à l'auto-évaluation, à l'entrevue structurée et aux marqueurs biologiques. La non-adhésion fluide de 30-74% en utilisant l'auto-rapport et de 10 à 60% sur la base d'un gain de poids interdialytique inapproprié. À l'aide de marqueurs biologiques et d'auto-évaluation, la nonadhésion à l'alimentation était respectivement de 2 à 39% et de 19 à 57%. En ce qui concerne la dialyse, le saut et le raccourcissement de l'hémodialyse ont varié respectivement de 2,5% à 19% et de 20,3% à 32,3%. Globalement, les taux d'adhésion à la CAPD ne sont pas bien documentés dans la littérature. Conclusion:Des preuves documentées ont révélé une non-adhésion à la dialyse, aux m...

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Section: Introductionmentioning

confidence: 99%

Adherence of adult Chronic Kidney Disease patients with regard to their dialysis, medication, dietary and fluid restriction

Chironda¹,

Bhengu²,

Manwere³

2017

Research Journal of Health Sciences

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“…For chronic kidney disease (CKD), a thorough assessment of the aforementioned aspects is rather straightforward although many epidemiological and economic figures have an unexpectedly large uncertainty in the relevant literature. Chronic kidney disease (listed in chapter N18 of the International Classification of Diseases-ICD10) has a very high-and almost certainly underestimated-prevalence in the general population; most recently published figures range from 5 to 7% in global evaluations [11][12][13], to roughly 8-10% for the adult population in Western countries [14,15]. More specialized studies also claim markedly higher numbers, for example, 16.8% in the National Health and Nutrition Examination Survey (NHANES) of the adult Americans [16,17].…”

Section: The Rationale For New Diagnostic Markers 21 Unmet Medical mentioning

confidence: 99%

Towards Metabolic Biomarkers for the Diagnosis and Prognosis of CKD

Lundin¹,

Weinberger²

2018

Advances in Nephropathy

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Chronic kidney disease, the gradual loss of renal function, is an increasingly recognized burden for patients and health care systems; globally, it has a high and rapidly growing prevalence, a significant mortality, and causes disproportionately high costs, particularly for hemodialysis and kidney transplantations. Yet, the available diagnostic tools are either impractical in clinical routine or have serious shortcomings preventing a well-informed disease management, although optimized treatment strategies with impressive benefits for patients have been established. Advances in bioanalytics have facilitated the identification of many genomic, proteomic, and metabolic biomarker candidates, some of which have been validated in independent cohorts. Summarizing the markers discovered so far, this chapter focuses on compounds or pathways, for which quantitative data, substantiating evidence from translational research, and a mechanistic understanding is available. Also, multiparametric marker panels have been suggested with promising diagnostic and prognostic performance in initial analyses, although the data basis from prospective trials is very limited. Large-scale studies, however, are underway and will validate certain sets of parameters and discard others. Finally, the path from clinical research to routine application is discussed, focusing on potential obstacles such as the use of mass spectrometry, and the feasibility of obtaining regulatory approval for metabolomics assays.

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“…Overall, Medicare expenditures for CKD totaled US$45.5 billion in 2011, which accounts for 18% of total Medicare dollars (U.S. Renal Data System, 2013b). Despite these substantial consequences, less attention has been paid to CKD compared to other chronic diseases (Fishbane et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

A systems thinking approach to prospective planning of interventions for chronic kidney disease care

et al. 2017

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Chronic kidney disease (CKD) is a growing health problem. Previous approaches to improve CKD care tend to focus on the linear relationships between a specific intervention and its effects on the target CKD population. The objective of this paper is to investigate how a systems thinking approach can support decision making on system-level interventions for chronic disease management. Our research team conducted a case study at an academic health-care organization. To support prospective planning of interventions at the study institution, we adopted a systems thinking approach in three phases: intervention structuring, causal loop modeling, and implementation planning. In the first phase, four potential interventions were proposed to address gaps in the current system. In the second phase, a causal loop diagram was developed to identify feedback loops and evaluate potential impacts of the interventions on patients and care providers. In the last phase, the analysis was linked to decision making on intervention implementation. Overall, this whole process based on systems thinking helped the health-care organization to holistically understand the impact of various components of their CKD care system. Furthermore, the findings from the qualitative modeling and analysis provided the leadership with insights into gaps in care and a way forward for implementing interventions more successfully and effectively.

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Challenges and opportunities in late-stage chronic kidney disease

Cited by 39 publications

References 44 publications

Adherence of adult Chronic Kidney Disease patients with regard to their dialysis, medication, dietary and fluid restriction

Adherence of adult Chronic Kidney Disease patients with regard to their dialysis, medication, dietary and fluid restriction

Towards Metabolic Biomarkers for the Diagnosis and Prognosis of CKD

A systems thinking approach to prospective planning of interventions for chronic kidney disease care

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