The finding of reduced estimated glomerular filtration rate is associated with increased mortality in a large UK population

Quinn, Michael; Cardwell, Christopher; Kee, Frank; Maxwell, Alexander P.; Savage, Gerard; McCarron, Peter; Fogarty, Damian

doi:10.1093/ndt/gfq505

Cited by 17 publications

(16 citation statements)

References 20 publications

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“…Previous work has demonstrated that patients with reduced renal function have worsening outcomes as their condition progresses 15. This study highlights that as patients enter the phase of their illness when dialysis is needed, they require additional support, often in a hospital setting.…”

Section: Discussionmentioning

confidence: 78%

“…We have a high prevalence of CKD in Northern Ireland and we have previously demonstrated this condition's significant association with increased morbidity and mortality 15. It therefore seemed likely that patients with renal disease requiring dialysis (ESRD) would represent an even greater clinical challenge leading to additional resource utilisation.…”

Section: Introductionmentioning

confidence: 99%

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Patterns of hospitalisation before and following initiation of haemodialysis: a 5 year single centre study

Quinn

Cardwell

Rainey

et al. 2011

Postgraduate Medical Journal

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BACKGROUND The utilisation of healthcare resources by prevalent haemodialysis patients has been robustly evaluated with regard to the provision of outpatient haemodialysis; however, the impact of hospitalisation among such patients is poorly defined. Minimal information is available in the UK to estimate the health and economic burden associated with the inpatient management of prevalent haemodialysis patients. The aim of this study was to assess the pattern of hospitalisation among a cohort of haemodialysis patients, before and following their initiation of haemodialysis. In addition the study sought to assess the impact of their admissions on bed occupancy in a large tertiary referral hospital in a single region in the UK. METHODS All admission episodes were reviewed and those receiving dialysis with the Belfast City Hospital Programme were identified over a 5 year period from January 2001 to December 2005. This tertiary referral centre provides dialysis services for a population of approximately 700 000 and additional specialist renal services for the remainder of Northern Ireland. The frequency and duration of hospitalisation, and contribution to bed day occupancy of haemodialysis patients, was determined and compared to other common conditions which are known to be associated with high bed occupancy. In addition, the pattern and timing of admissions in dialysis patients in relation to their dialysis initiation date was assessed. RESULTS Over the 5 year study period, 798 haemodialysis patients were admitted a total of 2882 times. These accounted for 2.5% of all admissions episodes; the median number of admissions for these patients was 3 (2-5) which compared with 1 (1-2) for non-dialysis patients. The majority of first hospitalisations (54%) were within 100 days before or after commencement of maintenance dialysis therapy. In all clinical specialties the median length of stay for haemodialysis patients was significantly longer than for patients not on haemodialysis (p=0.004). In multivariate analysis with adjustment for age, gender, and other clinically relevant diagnostic codes, maintenance haemodialysis patients stayed on average 3.75 times longer than other patient groups (ratio of geometric means 3.75, IQR 3.46-4.06). CONCLUSIONS Maintenance haemodialysis therapy is an important risk factor for prolonged hospitalisation regardless of the primary reason for admission. Such patients require admission more frequently than the general hospital population, particularly within 100 days before and after initiation of their first dialysis treatment.

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Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Patterns of hospitalisation before and following initiation of haemodialysis: a 5 year single centre study

Quinn

Cardwell

Rainey

et al. 2011

Postgraduate Medical Journal

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“…age, diabetes, ethnicity, deprivation, and other comorbidity (3,4), and in immunocompromised patients, the chance of infection may further increase these risks.…”

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confidence: 99%

Incidence, Determinants, and Outcome of Chronic Kidney Disease After Adult Heart Transplantation in the United Kingdom

et al. 2012

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“…Advanced CKD (stage 4-5), is associated with an increased relative risk (RR) of death of around 2.5-fold and a RR of kidney failure, as defined by a requirement for renal replacement therapy (RRT) of up to 50-fold compared to that of age-matched individuals with ‘normal' kidney function [28,29,30,31,32]. Matsushita et al confirmed that both CKD and albumin:creatinine ratio (ACR) predict all cause and CVD mortality in the general population [33].…”

Section: Why Use Acei/arbs In Earlier Stages Of Ckd?mentioning

confidence: 99%

Should We STOP Angiotensin Converting Enzyme Inhibitors/Angiotensin Receptor Blockers in Advanced Kidney Disease?

Ahmed

Jorna²,

Bhandari³

2016

Nephron

8,330

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Chronic kidney disease (CKD) is a worldwide public health problem associated with a high prevalence of cardiovascular disease (CVD) and impaired quality of life. Previous research for preventing loss of glomerular filtration rate (GFR) has focused on reducing blood pressure (BP) and proteinuria. Angiotensin converting enzyme inhibitors (ACEi) and angiotensin II receptor antagonists (ARB) are commonly used in patients with early CKD, but their value in advanced CKD (estimated GFR (eGFR) ≤30 ml/min/1.73 m²) is unknown. There remains a debate about the omission of ACEi/ARB in patients with advanced CKD and their use in association with CVD or heart failure. Does the potential gain in eGFR with ACEi/ARB cessation outweigh the potential adverse cardiovascular outcomes? This paper reviews the current literature that addresses this issue. Several controversies are discussed. Although lowering BP reduces cardiovascular events, evidence suggests that ACEi/ARBs are not superior to other antihypertensive agents. There are no studies assessing the benefits of ACEi/ARB therapy in cardiovascular risk reduction in advanced non-dialysis CKD. The STOP ACEi trial will strengthen the evidence base and shed light on the potential merits and dangers of ACEi/ARB use in advanced CKD on renal function and cardiovascular outcomes.

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The finding of reduced estimated glomerular filtration rate is associated with increased mortality in a large UK population

Cited by 17 publications

References 20 publications

Patterns of hospitalisation before and following initiation of haemodialysis: a 5 year single centre study

Patterns of hospitalisation before and following initiation of haemodialysis: a 5 year single centre study

Incidence, Determinants, and Outcome of Chronic Kidney Disease After Adult Heart Transplantation in the United Kingdom

Should We STOP Angiotensin Converting Enzyme Inhibitors/Angiotensin Receptor Blockers in Advanced Kidney Disease?

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