Epidemiology and Challenges to the Management of Advanced CKD

Hazzan, Azzour D.; Halinski, Candice; Agoritsas, Sofia; Fishbane, Steven; Devita, Maria

doi:10.1053/j.ackd.2016.04.005

Cited by 17 publications

(12 citation statements)

References 26 publications

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“…As a result, CKD presents an increasing burden to health services . Most patients with mild to moderate CKD are asymptomatic, but have a higher risk of cardiovascular disease and are at risk of developing anaemia, metabolic bone disease or progressing to end‐stage renal disease (ESRD) requiring renal replacement therapy (RRT) . Interventions recommended to reduce the risk of these endpoints include lifestyle modification, anti‐hypertensive medication (specifically inhibitors of the renin‐angiotensin‐aldosterone system), lipid modification, and achieving glycaemic control in patients with diabetes mellitus…”

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confidence: 99%

Models of care for chronic kidney disease: A systematic review

et al. 2018

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Aim Chronic kidney disease (CKD) is common and presents an increasing burden to patients and health services. However, the optimal model of care for patients with CKD is unclear. We systematically reviewed the clinical effectiveness of different models of care for the management of CKD. Methods A comprehensive search of eight databases was undertaken for articles published from 1992 to 2016. We included randomized controlled trials that assessed any model of care in the management of adults with pre‐dialysis CKD, reporting renal, cardiovascular, mortality and other outcomes. Data extraction and quality assessment was carried out independently by two authors. Results Results were summarized narratively. Nine articles (seven studies) were included. Four models of care were identified: nurse‐led, multidisciplinary specialist team, pharmacist‐led and self‐management. Nurse and pharmacist‐led care reported improved rates of prescribing of drugs relevant to CKD. Heterogeneity was high between studies and all studies were at high risk of bias. Nurse‐led care and multidisciplinary specialist care were associated with small improvements in blood pressure control. Conclusion Evidence of long term improvements in renal, cardiovascular or mortality endpoints was limited by short follow up. We found little published evidence about the effectiveness of different models of care to guide best practice for service design, although there was some evidence that models of care where health professionals deliver care according to a structured protocol or guideline may improve adherence to treatment targets.

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confidence: 99%

Models of care for chronic kidney disease: A systematic review

et al. 2018

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“…Subjects more than 65 years of age were considered elderly. To analyze ESKDassociated comorbidities, patients were categorized according to each comorbidity [4,11,21,22]. A total of 14 comorbidities (ICD-9-CM) were noted, which were as follows: diabetes, cerebrovascular accident, heart failure, heart arrhythmia, coronary atherosclerotic heart disease (CAHD), anemia, dyslipidemia, chronic obstructive pulmonary disease (COPD), peptic ulcer, atrial fibrillation, hypertension, cardiovascular diseases, ischemic heart disease (IHD), and ischemic stroke.…”

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confidence: 99%

A five-year longitudinal study of the relation between end-stage kidney disease as the outcomes

Tai

Hwang

et al. 2020

BMC Nephrol

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Background: Patients with end-stage kidney disease (ESKD) are required to undergo consecutive time-based blood and biochemical tests to determine the progression of the disease according to changes in their blood and biochemical data. This study employed a random intercept model to investigate whether time-based blood and biochemical data present any notable clinical meaning that can be used to track disease progression.Methods: This study conducted a retrospective analysis on the dialytic data of 148 patients with ESKD, who received hemodialysis between January 2005 and December 2015. The patients were all at least 20 years old, and the data used included patient demographic information and results for at least 60 blood and biochemical tests. A random intercept model was used to analyze the relationships among blood and biochemical test results, explanatory variables of patient comorbidities, and time.Results: The age range of patients was between 33 and 98 years, with an average of 66.1 years and those over 65 years old comprising 51.3% (n = 76) of the total. Furthermore, hypertension was found to be the most common comorbidity among patients (87.2%, n = 129), followed by anemia (48.6%, n = 72), diabetes (47.3%, n = 70), dyslipidemia (19.6%, n = 29), and peptic ulcer (19.6%, n = 29). Coronary atherosclerotic heart disease is a comorbidity that can serve as a strong and independent marker for prognosis in patients with ESKD. Serum creatinine level can serve as an alternative indicator because patients with ESKD and comorbid diabetes may exhibit increased creatinine levels. Conclusions:The results of a parameter estimation for longitudinal data analysis suggested that comorbidity and time were critical variables influencing blood and biochemical test results. Furthermore, WBC and HBC, HCT, albumin, protein, and creatinine levels were recognized as variables of critical significance. The results obtained in this study indicate that multimorbidity increases the treatment burden on patients, leading to polypharmacy. For this reason, comprehensive care and treatment of ESKD cannot rely solely on data from one single time point; instead, longitudinal analysis and other data that can affect patient prognosis must also be considered.

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“…Pre-ESRD nephrology education using an interdisciplinary approach results in more patients beginning dialysis at home, and also leads to a greater percentage of patients with a permanent access when in-center hemodialysis is chosen [4] . The interdisciplinary CKD clinic In this issue of the American Journal of Nephrology , Nee et al [1] demonstrate that patients who initiated dialysis while receiving care through the Military Health System (MHS) had a superior 1-year survival than those who initiated dialysis outside of the MHS.…”

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confidence: 99%

“…Simply, it may be better to approximate clinical reality, particularly in this patient-centered care era. The progression of CKD is heterogeneous, and interventions may need to be modified based on patient characteristics and patient-related goals [4] . Quality measures will need to embrace patientcentered care.…”

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The Interdisciplinary Chronic Kidney Disease Clinic: End of the Beginning, Not Beginning of the End

Yee

Campbell²

2017

Am J Nephrol

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AVF placement, was also associated with the mortality benefit. This finding adds to the recent studies by Quinn et al. [2] and Brown et al. [3] that propose a more nuanced view of the optimal care of patients with chronic kidney disease (CKD) stages 4 and 5. In these studies, patients who underwent an ultimately non-successful AVF placement and initiated dialysis with a hemodialysis catheter had improved mortality compared to those who had initiated dialysis with a catheter and had yet not undergone AVF construction. These findings imply that it is not solely the vascular access itself but also the prosecution of pre-ESRD nephrology care for greater than 12 months that provides an equal portion of the survival advantage following the onset of dialysis.The results of Quinn et al. [2] and Brown et al.[3] augment and complement the growing body of literature that demonstrates the benefits of pre-ESRD nephrology care, particularly in the form of an interdisciplinary CKD clinic. Pre-ESRD nephrology education using an interdisciplinary approach results in more patients beginning dialysis at home, and also leads to a greater percentage of patients with a permanent access when in-center hemodialysis is chosen [4] . The interdisciplinary CKD clinic In this issue of the American Journal of Nephrology , Nee et al. [1] demonstrate that patients who initiated dialysis while receiving care through the Military Health System (MHS) had a superior 1-year survival than those who initiated dialysis outside of the MHS. MHS patients were also more likely to receive pre-end-stage renal disease (ESRD) nephrology care (defined as nephrology care, dietary education, and use of erythropoiesis-stimulating agents [ESAs]) and have a functioning arteriovenous fistula (AVF) at the commencement of dialysis compared to non-MHS patients. AVF placement and pre-ESRD nephrology care provided much of the survival advantage. Pre-ESRD nephrology care of greater than 12 months' duration had a survival impact comparable to that of a functioning AVF. The authors concluded that pre-ESRD nephrology care and vascular access placement led to less mortality.The results derived from these data in some ways are not surprising. Dialysis initiation with an AVF has long been associated with decreased mortality for incident hemodialysis patients, and access placement has been a defining goal of pre-ESRD nephrology care. The interesting twist is that pre-ESRD nephrology care itself, not just the

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Epidemiology and Challenges to the Management of Advanced CKD

Cited by 17 publications

References 26 publications

Models of care for chronic kidney disease: A systematic review

Models of care for chronic kidney disease: A systematic review

A five-year longitudinal study of the relation between end-stage kidney disease as the outcomes

The Interdisciplinary Chronic Kidney Disease Clinic: End of the Beginning, Not Beginning of the End

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