Reduction in natural death and renal failure from a systematic screening and treatment program in an Australian Aboriginal community

Hoy, W. E.; Wang, Zhiqiang; Baker, Philip; Kelly, Angela M.

doi:10.1046/j.1523-1755.63.s83.14.x

Cited by 64 publications

(79 citation statements)

References 15 publications

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“…Although both programs recruit individuals based on their risk factors for CKD, the KEEP concentrates their efforts on black populations, while the SeeKD considered other ethnic groups (Aboriginal, Hispanic, South Asian, Asian, and African) as being a risk factor for CKD (22). Targeting individuals from high-risk ethnic groups is not uncommon given the disproportionate burden of ESRD among different ethnic groups, and such screening programs have been established in Australia (23) and Canada (24). Further, the KEEP used a limited number of risk factors (personal history of diabetes or hypertension, or a family history of diabetes, hypertension, or kidney disease) (12,22,25) compared with the SeeKD program (diabetes, hypertension, existing kidney problems, family history of kidney disease, member of high-risk ethnic population, current vascular disease, or currently using tobacco products).…”

Section: Discussionmentioning

confidence: 99%

The See Kidney Disease Targeted Screening Program for CKD

Galbraith¹,

Ronksley²,

Barnieh

et al. 2016

CJASN

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Background and objectives The effectiveness of targeted screening for identification of CKD is largely unknown. The See Kidney Disease (SeeKD) targeted screening project aimed to determine the prevalence of unrecognized CKD in Canada.Design, setting, participants, & measurements The SeeKD project was conducted across Canada using a convenience sample approach and events to identify adults with risk factors for CKD (i.e., diabetes, hypertension, vascular disease, family history of kidney problems, etc.). Participants with at least one risk factor received a point-of-care creatinine measurement to identify unrecognized CKD (CKD-Epidemiology Collaboration eGFR ,60 ml/min per 1.73 m 2 ). Baseline information included clinical characteristics, sociodemographics, and health knowledge. Semistructured telephone interviews were conducted with each Kidney Foundation of Canada branch (regionalized locations) after the screening events to characterize local screening strategies, which were subsequently categorized as individual-targeted (specifically targeting individuals at risk of CKD) and community-targeted (event in a community location in proximity to a high-risk population). We calculated the prevalence of unrecognized CKD overall, and by screening strategy.Results Between January 2011 and February 2014, 6329 Canadians participated in SeeKD screening events. Participants were predominantly female (65.3%), middle-aged (mean, 58.5 years), and the majority (88.9%) selfreported at least one risk factor for CKD. Of participants with at least one risk factor, 92.3% (n=5194) were screened, of whom 18.8% (95% confidence interval [95% CI], 17.8 to 19.9) had unrecognized CKD; the majority (13.8%) had stage 3a CKD (eGFR=45-60 ml/min per 1.73 m 2 ). The prevalence of unrecognized CKD was higher for branches with individual versus community-targeted events (21.9% [95% CI, 20.5 to 23.4] versus 14.7% [95% CI, 13.2 to 16.2]).Conclusions Targeted screening identified a high proportion of individuals with risk factors for CKD and a high prevalence of unrecognized CKD. Future research will evaluate the ability of targeted screening to promote selfmanagement behaviors addressing priorities for people with CKD.

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Section: Discussionmentioning

confidence: 99%

The See Kidney Disease Targeted Screening Program for CKD

Galbraith¹,

Ronksley²,

Barnieh

et al. 2016

CJASN

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“…The use of historical controls to estimate treatment effect on terminal events is imperfect for several reasons (8), but trends in community-based deaths and renal failure supported the marked effect of the program. About 2 yr of treatment was required before reduction in all-cause natural death became apparent.…”

Section: Discussionmentioning

confidence: 99%

“…We now summarize the results through June 30, 2000. The endpoint data are described in more detail in a separate manuscript (8).…”

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confidence: 99%

Secondary Prevention of Renal and Cardiovascular Disease

Hoy¹,

Wang²,

Baker³

et al. 2003

Journal of the American Society of Nephrology

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Abstract. Australian Aborigines are experiencing an epidemic of renal and cardiovascular disease. In late 1995 we introduced a treatment program into the Tiwi community, which has a three-to fivefold increase in death rates and a recent annual incidence of treated ESRD of 2760 per million. Eligible for treatment were people with hypertension, diabetics with micro or overt albuminuria, and all people with overt albuminuria. Treatment centered around use of perindopril (Coversyl, Servier), with other agents added to reach BP goals; attempts to control glucose and lipid levels; and health education. Thirty percent of the adult population, or 267 people, were enrolled, with a mean follow up of 3.39 yr. Clinical parameters were followed every 6 mo, and rates of terminal endpoints were compared with those of 327 historical controls matched for baseline disease severity, followed in the pretreatment program era. There was a dramatic reduction in BP in the treatment group, which was sustained through 3 yr of treatment. Albuminuria and GFR stabilized or improved. Rates of natural deaths were reduced by an estimated 50% (P ϭ 0.012); renal deaths were reduced by 57% (P ϭ 0.038); and nonrenal deaths by 46% (P ϭ 0.085).

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“…So the options when establishing a prevention programme are to either screen an entire population, as in the Dutch PREVEND programme and the Australian Aboriginal CDOP studies or detect a cohort of people at the highest risk of disease ( Figure 4). (19,20) The approach in SA and other countries, like Australia, has been to focus more on the high risk population groups. (21,22) We have a few options to consider before starting a programme.…”

Section: Detection and Managementmentioning

confidence: 99%

Developing and implementing programmes for early detection, management and prevention of kidney and cardiovascular disease

Katz

Mdleleni

Shezi

et al. 2017

SAHJ

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NORMAL TC-99m MIBI MYOCARDIAL PERFUSION INTRODUCTIONThere is a strong link between chronic kidney disease (CKD) and cardiovascular disease (CVD). They share common risk factors such as smoking, hypertension, diabetes, obesity and hyperlipidaemia, which are important causes of death in both developing and developed countries. Developing and implementing programmes for early detection, management and prevention of kidney and cardiovascular diseasePatients with a reduced GFR are particularly prone to CVD,and more likely to die of CVD before entering a dialysis or transplant programme.To make matters worse, the burden of CVD is increasing.(2) CVD contributed 30% of all deaths in the world in 1998, most (78%) occurring in low and middle-income countries. (3) The global burdens of diabetes and CVD are set to rise by around 50% and 150% in the developed and the developing worlds respectively. It is estimated that by 2020, in Africa alone, nearly 22.3 million people will be affected with diabetes, resulting in concomitant increases in the prevalence of chronic kidney disease (CKD) and end-stage renal disease (ESRD). (4) This means that more patients will die of strokes, heart failure and kidney failure, with the impact greatest in the developing countries like South Africa.In under-resourced health systems, the focus has to move from expensive "end of the road" interventions such as dialysis, transplantation, cardiac catheterization and stenting to early intervention and primary prevention strategies by integrating care between specialists, primary care clinicians and the community. As CVD and CKD share similar risk factors, common preventative strategies may result in benefi t for both. For instance, in Australia CKD requiring dialysis is almost epidemic among Australian Aboriginal people, and the Australian integrated Chronic Disease Outreach Programme (CDOP) (5) was instituted to reduce the number of Aboriginal Australians starting dialysis in the Northern Territory. It was an integrative approach, which focused on detecting and treating common risk factors for CKD, namely hypertension, diabetes, and/or proteinuria. The programme substantially reduced the number of people needing dialysis and the all-cause mortality ( Figure 1). The latter was due predominantly to a reduction in CVD such as heart failure and stroke. In chronic illness treatment programmes most affected people have more than one morbidity, justifying integrated, rather than disease specifi c programmes. Chronic Kidney Disease (CKD) and Cardiovascular Disease (CVD) appear to be closely linked but also share common risk factors, making prevention, early detection and management for both diseases similar. In 1998 CVD accounted for 30% of deaths worldwide and in South Africa for almost 40% in the same year. The number of these deaths due to underlying CKD remains unanswered, but it is clear that early detection and management of CKD through screening of patients at high risk, e.g. those with uncontrolled hypertension, diabetes and proteinuria or proteinur...

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Reduction in natural death and renal failure from a systematic screening and treatment program in an Australian Aboriginal community

Cited by 64 publications

References 15 publications

The See Kidney Disease Targeted Screening Program for CKD

The See Kidney Disease Targeted Screening Program for CKD

Secondary Prevention of Renal and Cardiovascular Disease

Developing and implementing programmes for early detection, management and prevention of kidney and cardiovascular disease

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