The CKD Outcomes and Practice Patterns Study (CKDopps): Rationale and Methods

Mariani, Laura; Stengel, Bénédicte; Combe, Christian; Massy, Ziad A.; Reichel, Helmut; Fliser, Danilo; Pécoits-Filho, Roberto; Lopes, Antônio Alberto; Yamagata, Kunihiro; Wada, Takashi; Wong, Michelle M.Y.; Speyer, Élodie; Port, Friedrich K.; Pisoni, Ronald L.; Robinson, Bruce M.

doi:10.1053/j.ajkd.2016.03.414

Cited by 53 publications

(45 citation statements)

References 70 publications

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“…It is unclear if these variations improved after the issuance of the most recent updated guidelines, as various concerted efforts focusing not just on CKD care but other disease conditions (such as telehealth for hypertension and diabetes control) are being implemented to improve the care delivered to the veterans (7,23). Although there are ongoing efforts to study the practice patterns for CKD care across the globe, studies addressing these issues are limited in the United States (24). Albuminuria is recognized as an independent cardiovascular risk factor and is associated with all-cause mortality among the CKD population (25).…”

Section: Discussionmentioning

confidence: 99%

Facility-Level Variations in Kidney Disease Care among Veterans with Diabetes and CKD

Navaneethan¹,

Akeroyd

Ramsey

et al. 2018

CJASN

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Background and objectives Facility-level variation has been reported among veterans receiving care for various diseases. We studied the frequency and facility-level variations of guideline-recommended practices in patients with diabetes and CKD. Design, setting, participants, & measurements Patients with diabetes and concomitant CKD (eGFR 15-59 ml/min per 1.73 m 2 , measured twice, 90 days apart) receiving care in 130 facilities across the Veterans Affairs Health Care System were included (n=281,223). We studied the proportions of patients (facility-level) receiving recommended core measures and facility-level variations of these study outcomes using median rate ratios, adjusting for various patient and provider-level factors. Median rate ratio quantifies the degree to which care may vary for similar patients receiving care at two randomly chosen facilities, with ,1 being no variation and .1.2 as substantial variation between the facilities. Study outcomes included measurement of urine albumin-to-creatinine ratio/ urine protein-to-creatinine ratio and blood hemoglobin concentration, prescription of statins and angiotensinconverting enzyme inhibitors/angiotensin receptor blockers, BP,140/90 mm Hg, and referral to a Veterans Affairs nephrologist (only for those with eGFR,30 ml/min per 1.73 m 2). Results Among those with eGFR 30-59 ml/min per 1.73 m 2 , proportion of patients receiving recommended core measures (median and interquartile range across facilities) were 37% (22%-47%) for urine albumin-to-creatinine ratio/urine protein-to-creatinine ratio, 74% (72%-79%) for hemoglobin measurement, 66% (62%-69%) for angiotensin-converting enzyme inhibitor/angiotensin receptor blocker prescription, 85% (74%-87%) for statin prescription, 47% (42%-53%) for achieving BP,140/90 mm Hg, and 13% (7%-16%) for meeting all outcome measures. Adjusted median rate ratios (95% confidence intervals) were 5.2 (4.1 to 6.4), 2.4 (2.1 to 2.6), 1.3 (1.2 to 1.3), 1.2 (1.2 to 1.3), 1.4 (1.3 to 1.4), and 4.1 (3.3 to 5.0), respectively. Median rate ratios were qualitatively similar in an analysis restricted to those with eGFR 15-29 ml/min per 1.73 m 2. Conclusions Among patients with diabetes and CKD, at facility-level, ordering of laboratory tests, and scheduling of nephrology referrals in eligible patients remains suboptimal, with substantial variations across facilities.

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Section: Discussionmentioning

confidence: 99%

Facility-Level Variations in Kidney Disease Care among Veterans with Diabetes and CKD

Navaneethan¹,

Akeroyd

Ramsey

et al. 2018

CJASN

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“…CKD is associated with reduced survival in the general population, where it is primarily due to medical aetiologies (CKD‐M) . Patients with CKD‐M typically have comorbidities that are impactful and longstanding, such as diabetes, and therefore they remain at risk of progressive decline in renal function . This can eventually lead to metabolic consequences, cardiovascular events, and increased mortality rates .…”

Section: Discussionmentioning

confidence: 99%

Analysis of survival for patients with chronic kidney disease primarily related to renal cancer surgery

Suk-Ouichai

Dong

et al. 2017

BJU International

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Objectives To evaluate predictors of long‐term survival for patients with chronic kidney disease primarily due to surgery (CKD‐S). Patients with CKD‐S have generally good survival that approximates patients who do not have CKD even after renal cancer surgery (RCS), yet there may be heterogeneity within this cohort. Patients and Methods From 1997 to 2008, 4 246 patients underwent RCS at our centre. The median (interquartile range [IQR]) follow‐up was 9.4 (7.3–11.0) years. New baseline glomerular filtration rate (GFR) was defined as highest GFR between nadir and 6 weeks after RCS. We retrospectively evaluated three cohorts: no‐CKD (new baseline GFR of ≥60 mL/min/1.73 m2); CKD‐S (new baseline GFR of <60 mL/min/1.73 m2 but preoperative GFR of ≥60 mL/min/1.73 m2); and CKD due to medical aetiologies who then require RCS (CKD‐M/S, preoperative and new baseline GFR both <60 mL/min/1.73 m2). Analysis focused primarily on non‐renal cancer‐related survival (NRCRS) for the CKD‐S cohort. Kaplan–Meier analysis assessed the longitudinal impact of new baseline GFR (45–60 mL/min/1.73 m2 vs <45 mL/min/1.73 m2) and Cox regression evaluated relative impact of preoperative GFR, new baseline GFR, and relevant demographics/comorbidities. Results Of the 4 246 patients who underwent RCS, 931 had CKD‐S and 1 113 had CKD‐M/S, whilst 2 202 had no‐CKD even after RCS. Partial/radical nephrectomy (PN/RN) was performed in 54%/46% of the patients, respectively. For CKD‐S, 641 patients had a new baseline GFR of 45–60 mL/min/1.73 m2 and 290 had a new baseline GFR of <45 mL/min/1.73 m2. Kaplan–Meier analysis showed significantly reduced NRCRS for patients with CKD‐S with a GFR of <45 mL/min/1.73 m2 compared to those with no‐CKD or CKD‐S with a GFR of 45–60 mL/min/1.73 m2 (both P ≤ 0.004), and competing risk analysis confirmed this (P < 0.001). Age, gender, heart disease, and new baseline GFR were all associated independently with NRCRS for patients with CKD‐S (all P ≤ 0.02). Conclusion Our data suggest that CKD‐S is heterogeneous, and patients with a reduced new baseline GFR have compromised survival, particularly if <45 mL/min/1.73 m2. Our findings may have implications regarding choice of PN/RN in patients at risk of developing CKD‐S.

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“…CKDopps study design details and objectives have previously been published. 18 CKDopps was approved by national and/or local ethics committees, as required by local ethics regulations, with informed patient consent obtained, as required.…”

Section: Patient Samplementioning

confidence: 99%

Associations of Hemoglobin Levels With Health-Related Quality of Life, Physical Activity, and Clinical Outcomes in Persons With Stage 3-5 Nondialysis CKD

Hoshino

Muenz

Zee

et al. 2020

Journal of Renal Nutrition

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, MS, † and on behalf of CKDopps Investigators* Objective: Conflicting findings and knowledge gaps exist regarding links between anemia, physical activity, health-related quality of life (HRQOL), chronic kidney disease (CKD) progression, and mortality in moderate-to-advanced CKD. Using the CKD Outcomes and Practice Patterns Study, we report associations of hemoglobin (Hgb) with HRQOL and physical activity, and associations of Hgb and physical activity with CKD progression and mortality in stage 3-5 nondialysis (ND)-CKD patients. Design and Methods: Prospectively collected data were analyzed from 2,121 ND-CKD stage 3-5 patients, aged $18 years, at 43 nephrologist-run US and Brazil CKD Outcomes and Practice Patterns Study-participating clinics. Cross-sectional associations were assessed of Hgb levels with HRQOL and physical activity levels (from validated Kidney Disease Quality of Life Instrument and Rapid Assessment of Physical Activity surveys). CKD progression (first of $40% estimated glomerular filtration rate [eGFR] decline, eGFR,10 mL/min/1.73 m 2 , or end-stage kidney disease) and all-cause mortality with Hgb and physical activity levels were also evaluated. Linear, logistic, and Cox regression analyses were adjusted for country, demographics, smoking, eGFR, serum albumin, very high proteinuria, and 13 comorbidities. Results: HRQOL was worse, with severe anemia (Hgb,10 g/dL), but also evident for mild/moderate anemia (Hgb 10-12 g/dL), relative to Hgb.12 g/dL. Odds of being highly physically active were substantially greater at Hgb.10.5 g/dL. Lower Hgb was strongly associated with greater CKD progression and mortality, even after extensive adjustment. Physical inactivity was strongly associated with greater mortality and weakly associated with CKD progression. Possible residual confounding is a limitation. Conclusion: This multicenter international study provides real-world observational evidence for greater HRQOL, physical activity, lower CKD progression, and greater survival in ND-CKD patients with Hgb levels .12 g/dL, exceeding current treatment guideline recommendations. These findings help inform future studies aimed at understanding the impact of new anemia therapies and physical activity regimens on improving particular dimensions of ND-CKD patient well-being and clinical outcomes.

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The CKD Outcomes and Practice Patterns Study (CKDopps): Rationale and Methods

Cited by 53 publications

References 70 publications

Facility-Level Variations in Kidney Disease Care among Veterans with Diabetes and CKD

Facility-Level Variations in Kidney Disease Care among Veterans with Diabetes and CKD

Analysis of survival for patients with chronic kidney disease primarily related to renal cancer surgery

Associations of Hemoglobin Levels With Health-Related Quality of Life, Physical Activity, and Clinical Outcomes in Persons With Stage 3-5 Nondialysis CKD

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