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1دورية أكاديمية
المؤلفون: Udayaraj, Udaya, Ben-Shlomo, Yoav, Roderick, Paul, Casula, Anna, Dudley, Chris, Collett, Dave, Ansell, David, Tomson, Charles, Caskey, Fergus
الوصف: Background. Socioeconomic disparities and their contribution to the ethnic differences in living kidney donor transplantation have not been adequately studied. Methods. A total of 12,282 patients aged 18 to 69 years starting renal replacement therapy (January 1, 1997, to December 31, 2004) in the United Kingdom were included. Logistic regression models were used to examine probability of living donor transplantation within 3 years of renal replacement therapy. The effect of area deprivation (Townsend index) was studied among whites only adjusted for patient characteristics and the effect of ethnic origin (South Asians and blacks compared with whites) was then examined among all patients adjusting for area deprivation. Results. Among whites, increasing social deprivation was associated with lower odds of living donor transplantation. In the fully adjusted model, odds ratio (OR) for the most deprived quintile was 0.40 (95% confidence interval [CI] 0.33, 0.49; P trend<0.0001) compared with the least deprived. These gradients were more pronounced among centers performing more live donor transplants (P value for interaction <0.0001). South Asians and blacks had lower odds of living donor transplantation compared with whites, but there was an interaction with age (P<0.0001), so that this disparity was observed only in those younger than 50 years (blacks: OR, 0.31; 95% CI, 0.18, 0.54; South Asians: OR, 0.55; 95% CI, 0.34, 0.90; P value <0.0001). Conclusions. Socially deprived and younger ethnic minority patients have lower probability of living kidney donor transplantation. The extent to which these inequalities reflect modifiable societal healthcare system barriers and donor/recipient factors requires further study.
العلاقة: Udayaraj, Udaya, Ben-Shlomo, Yoav, Roderick, Paul, Casula, Anna, Dudley, Chris, Collett, Dave, Ansell, David, Tomson, Charles and Caskey, Fergus (2012) Social deprivation, ethnicity, and uptake of living kidney donor transplantation in the United Kingdom. Transplantation, 93 (6), 610-616. (doi:10.1097/TP.0b013e318245593f ). (PMID:22245879 )
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2دورية أكاديمية
المؤلفون: Udayaraj, Udaya P., Ben-Sholmo, Yoav, Roderick, Paul, Steenkamp, Retha, Ansell, David, Tomson, Charles R.V.
الوصف: Background and objectives: the role of socioeconomic status (SES) and its contribution to ethnic differences in standards attainment among dialysis patients is not known. Design, setting, participants, & measurements: we examined associations between area- level SES (Townsend index) and ethnicity (white, black, South Asian) and standards attainment in 14,117 incident dialysis patients (1997–2004) in the UK. Results: deprived patients were less likely to achieve hemoglobin (Hb) ? 10g/dl (trend P < 0.001) but not after controlling for patient and center characteristics (trend P = 0.1). There was no association with hemodialysis dose and parathyroid hormone (PTH) standard but deprived patients had better attainment of phosphate (PO4) <5.6 mg/dl, calcium (Ca) and Calcium-phosphate (CaPO4) standard (e.g., most deprived versus least deprived adjusted odds ratio [OR] 1.25, 95% confidence intervals [CI] 1.12, 1.38). There was no association with SES using a lower limit for PO4 (3.5 – 5.5 mg/dl). Compared with Whites, Blacks had lower attainment of Hb (adjusted OR 0.57, 95% CI 0.45, 0.71) and PTH standards (adjusted OR 0.27, 95% CI 0.22, 0.33) but better attainment of PO4 and CaPO4, while South Asians experienced better or comparable outcomes for most standards except Ca and PTH. Conclusions: there was no evidence of socioeconomic inequity in standards attainment or a consistent pattern of inequity by ethnic group. The lower attainment of some standards in ethnic minorities may reflect biologic differences rather than ethnicity-related inequity of care
العلاقة: Udayaraj, Udaya P., Ben-Sholmo, Yoav, Roderick, Paul, Steenkamp, Retha, Ansell, David and Tomson, Charles R.V. (2009) Ethnicity, socioeconomic status, and attainment of clinical practice guideline standards in dialysis patients in the United Kingdom. Clinical Journal of the American Society of Nephrology, 4 (5), 979-987. (doi:10.2215/CJN.06311208 ).
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3دورية أكاديمية
المؤلفون: Udayaraj, Udaya P, Steenkamp, Retha, Caskey, Fergus J, Rogers, Chris, Nitsch, Dorothea, Ansell, David, Tomson, Charles RV
مصطلحات موضوعية: demo
الوصف: BACKGROUND: The association of baseline blood pressure (BP) and mortality in incident peritoneal dialysis patients has not been adequately studied. STUDY DESIGN: Cohort study. SETTING & PARTICIPANTS: 2,770 patients on PD therapy at 180 days from start of renal replacement therapy in England and Wales between 1997 and 2004. PREDICTORS: Systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP) measured in the first 6 months of renal replacement therapy and other baseline demographic and laboratory variables. OUTCOMES: All-cause mortality was studied using time-stratified Cox regression models (to account for nonproportionality) dividing follow-up time into 4 intervals: year 1 (days 180 to 365), years 2 to 3, years 4 to 5, and years 6+. Interactions between BP components and transplant waitlist and diabetes status were explored. RESULTS: Median follow-up was 3.7 years (range, 0.1 to 9.9 years), and 1,104 deaths were observed. In fully adjusted analyses, greater SBP, DBP, MAP, and PP were associated with decreased mortality in the first year, but greater SBP and PP were associated with increased late mortality (in years 6+). However, in the subgroup of patients placed on the transplant waitlist within 6 months of starting renal replacement therapy, greater SBP, DBP, MAP, and PP were not associated with decreased mortality in the first year. LIMITATIONS: Exclusion of 3,086 patients because of missing BP data. No data were available for cardiac function or antihypertensive medication. CONCLUSIONS: Although greater SBP, DBP, MAP, and PP appear protective against early mortality in the overall cohort, this effect is not seen in patients registered on the national transplant waiting list within 6 months of starting renal replacement therapy.
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4دورية أكاديمية
المؤلفون: Udayaraj, Udaya P, Steenkamp, Retha, Caskey, Fergus J, Rogers, Chris, Nitsch, Dorothea, Ansell, David, Tomson, Charles RV
الوصف: BACKGROUND: The association of baseline blood pressure (BP) and mortality in incident peritoneal dialysis patients has not been adequately studied. STUDY DESIGN: Cohort study. SETTING & PARTICIPANTS: 2,770 patients on PD therapy at 180 days from start of renal replacement therapy in England and Wales between 1997 and 2004. PREDICTORS: Systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP) measured in the first 6 months of renal replacement therapy and other baseline demographic and laboratory variables. OUTCOMES: All-cause mortality was studied using time-stratified Cox regression models (to account for nonproportionality) dividing follow-up time into 4 intervals: year 1 (days 180 to 365), years 2 to 3, years 4 to 5, and years 6+. Interactions between BP components and transplant waitlist and diabetes status were explored. RESULTS: Median follow-up was 3.7 years (range, 0.1 to 9.9 years), and 1,104 deaths were observed. In fully adjusted analyses, greater SBP, DBP, MAP, and PP were associated with decreased mortality in the first year, but greater SBP and PP were associated with increased late mortality (in years 6+). However, in the subgroup of patients placed on the transplant waitlist within 6 months of starting renal replacement therapy, greater SBP, DBP, MAP, and PP were not associated with decreased mortality in the first year. LIMITATIONS: Exclusion of 3,086 patients because of missing BP data. No data were available for cardiac function or antihypertensive medication. CONCLUSIONS: Although greater SBP, DBP, MAP, and PP appear protective against early mortality in the overall cohort, this effect is not seen in patients registered on the national transplant waiting list within 6 months of starting renal replacement therapy.
العلاقة: Udayaraj, Udaya P; Steenkamp, Retha; Caskey, Fergus J; Rogers, Chris ; Nitsch, Dorothea ; Ansell, David; Tomson, Charles RV; (2009) Blood pressure and mortality risk on peritoneal dialysis. American journal of kidney diseases, 53 (1). pp. 70-78. ISSN 0272-6386 DOI: https://doi.org/10.1053/j.ajkd.2008.08.030Test
