المؤلفون: Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH), Alberta Kidney Disease Network Investigators, James, Matthew T, Tonelli, Marcello, Ghali, William A, Knudtson, Merril L, Faris, Peter, Manns, Braden J, Pannu, Neesh, Galbraith, P Diane, Hemmelgarn, Brenda R

المصدر: BMJ: British Medical Journal, 2013 Jul . 347(7918), 13-13.

الوصول الحر: https://www.jstor.org/stable/23495451Test

المؤلفون: Manns, Braden, Hemmelgarn, Brenda, Tonelli, Marcello, Au, Flora, Chiasson, T Carter, Dong, James, Klarenbach, Scott

المصدر: BMJ: British Medical Journal, 2010 Nov . 341(7781), 1036-1036.

الوصول الحر: https://www.jstor.org/stable/20800427Test

المؤلفون: Manns, Braden J., Mendelssohn, David C., Taub, Kenneth J.

المصدر: International Journal of Health Care Finance and Economics, 2007 Sep 01. 7(2/3), 149-169.

الوصول الحر: https://www.jstor.org/stable/30221727Test

المؤلفون: Liu, Ping, Quinn, Robert R., Karim, Mohammad Ehsanul, Bello, Aminu, Tam-Tham, Helen, Weaver, Robert, Ronksley, Paul E., Quan, Hude, Strippoli, Giovanni F.M., Manns, Braden, Hemmelgarn, Brenda R., Tonelli, Marcello, Ravani, Pietro

المصدر: Canadian Medical Association Journal (CMAJ); 3/11/2019, Vol. 191 Issue 10, pE274-E282, 9p, 1 Diagram, 4 Charts, 1 Graph

مصطلحات موضوعية: KIDNEY diseases, CHRONIC diseases, NEPHROLOGY, MEDICAL consultation, DISEASE progression, MORTALITY

مصطلحات جغرافية: ALBERTA

مستخلص: Background: Guidelines recommend nephrology referral for people with advanced non-dialysis-dependent chronic kidney disease, based mostly on survival benefits seen in retrospective studies of dialysis patients, which may not be generalizable to the broader population with chronic kidney disease. We aimed to examine the association between outpatient nephrology consultation and survival in adults with stage 4 chronic kidney disease.Methods: We linked population-based laboratory and administrative data from 2002 to 2014 in Alberta, Canada, on adults with stage 4 chronic kidney disease (sustained estimated glomerular filtration rate ≥ 15 to < 30 mL/min/1.73 m2 for > 90 d), who had never had kidney failure and had had no outpatient nephrology encounter in the 2 years preceding study entry. Participants who had never had an outpatient nephrology visit before renal replacement treatment were considered "unexposed." Participants who saw a nephrologist during follow-up were considered "unexposed" before the first outpatient nephrology visit and "exposed" thereafter. The primary outcome was all-cause mortality.Results: Of the 14 382 study participants (median follow-up 2.7 yr), 64% were aged ≥ 80 years, 35% saw a nephrologist and 66% died during follow-up. Nephrology consultation was associated with lower mortality (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.82-0.93). The association was strongest in people < 70 years (HR 0.78, 95% CI, 0.65-0.92), progressively weaker with increasing age, and absent in people ≥ 90 years (HR 1.05, 95% CI 0.88-1.25).Interpretation: The survival benefit of nephrology consultation in adults with stage 4 chronic kidney disease may be smaller than expected and appears to attenuate with increasing age. These findings should inform recommendations for nephrology referral considering the advanced age of the patient population meeting current referral criteria. [ABSTRACT FROM AUTHOR]

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المؤلفون: Elliott, Meghan J., Gil, Sarah, Hemmelgarn, Brenda R., Manns, Braden J., Tonelli, Marcello, Min Jun, Donald, Maoliosa

المصدر: Nephrology Dialysis Transplantation; May2017, Vol. 32 Issue 5, p838-846, 9p, 1 Diagram, 1 Chart

مصطلحات موضوعية: CHRONIC kidney failure, KIDNEY diseases, HEALTH outcome assessment, PRIMARY care, MEDICAL care costs, PATIENTS

مستخلص: Background: Chronic kidney disease (CKD) affects ~10% of the adult population. The majority of patients with CKD are managed by primary care physicians, and despite the availability of effective treatment options, the use of evidence-based interventions for CKD in this setting remains suboptimal. Clinical pathways have been identified as effective tools to guide primary care physicians in providing evidence-based care. We aimed to describe the availability, characteristics and credibility of clinical pathways for adult CKD using a scoping review methodology. Methods: We searched Medline, Embase, CINAHL and targeted Internet sites from inception to 31 October 2014 to identify studies and resources that identified adult CKD clinical pathways for primary care settings. Study selection and data extraction were independently performed by two reviewers. Results: From 487 citations, 41 items were eligible for review: 7 published articles and 34 grey literature resources published between 2001 and 2014. Of the 41 clinical pathways, 32, 24 and 22% were from the UK, USA and Canada, respectively. The majority (66%, n = 31) of clinical pathways were static in nature (did not have an online interactive feature). The majority (76%) of articles/resources reported using one or more clinical practice guidelines as a resource to guide the clinical pathway content. Few articles described a dissemination and evaluation plan for the clinical pathway, but most reported the targeted end-users. Conclusions: Our scoping review synthesized available literature on CKD clinical pathways in the primary care setting. We found that existing clinical pathways are diverse in their design, content and implementation. These results can be used by researchers developing or testing new or existing clinical pathways and by practitioners and health system stakeholders who aim to implement CKD clinical pathways in clinical practice. [ABSTRACT FROM AUTHOR]

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المؤلفون: Elliott, Meghan J., Straus, Sharon E., Pannu, Neesh, Ahmed, Sofia B., Laupacis, Andreas, Chong, George C., Hillier, David R., Huffman, Kate T., Lei, Andrew C., Villanueva, Berlene V., Young, Donna M., Tam-Tham, Helen, Donald, Maoliosa, Lillie, Erin, Manns, Braden J., Hemmelgarn, Brenda R.

المصدر: BMC Medical Informatics & Decision Making; 8/24/2016, Vol. 16, p1-12, 12p, 1 Diagram, 3 Charts, 1 Graph

مصطلحات موضوعية: RANDOMIZED controlled trials, KIDNEY diseases, STAKEHOLDER theory, PATIENTS, GLOMERULAR filtration rate, MEDICAL care

مستخلص: Background: Few studies have evaluated stakeholder engagement in chronic kidney disease (CKD) research prioritization. In this two-arm, parallel group randomized controlled trial, we sought to compare an in-person nominal group technique (NGT) approach with an online wiki-inspired alternative to determining the top 10 CKD research priorities, and to evaluate stakeholder engagement and satisfaction with each process.Methods: Eligible participants included adults ≥18 years with access to a computer and Internet, high health literacy, and from one of the following stakeholder groups: patients with CKD not on dialysis, their caregivers, health care providers who care for patients with CKD, or CKD-related health policymakers. Fifty-six participants were randomized to a wiki-inspired modified NGT that occurred over 3 weeks vs. a 1-day in-person NGT workshop, informed by James Lind Alliance methodology, to determine the top 10 CKD-related research priorities. The primary outcome was the pairwise agreement between the two groups' final top 10 ranked priorities, evaluated using Spearman's correlation coefficient. Secondary outcomes included participant engagement and satisfaction and wiki tool usability.Results: Spearman's rho for correlation between the two lists was 0.139 (95 % confidence interval -0.543 to 0.703, p = 0.71), suggesting low correlation between the top 10 lists across the two groups. Both groups ranked the same item as the top research priority, with 5 of the top 10 priorities ranked by the wiki group within the top 10 for the in-person group. In comparison to the in-person group, participants from the wiki group were less likely to report: satisfaction with the format (73.7 vs.100 %, p = 0.011); ability to express their views (57.9 vs 96.0 %, p = 0.0003); and perception that they contributed meaningfully to the process (68.4 vs 84.0 %, p = 0.004).Conclusions: A CKD research prioritization approach using an online wiki-like tool identified low correlation in rankings compared with an in-person approach, with less satisfaction and perceptions of active engagement. Modifications to the wiki-inspired tool are required before it can be considered a potential alternative to an in-person workshop for engaging patients in determining research priorities.Trial Registration: ( ISRCTN18248625 ). [ABSTRACT FROM AUTHOR]

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المؤلفون: Tong, Allison, Samuel, Susan, Zappitelli, Michael, Dart, Allison, Furth, Susan, Eddy, Allison, Groothoff, Jaap, Webb, Nicholas J. A., Hui-Kim Yap, Bockenhauer, Detlef, Sinha, Aditi, Alexander, Stephen I., Goldstein, Stuart L., Gipson, Debbie S., Hanson, Camilla S., Evangelidis, Nicole, Crowe, Sally, Harris, Tess, Hemmelgarn, Brenda R., Manns, Braden

المصدر: Trials; 8/12/2016, Vol. 17, p1-11, 11p, 2 Diagrams

مصطلحات موضوعية: PEDIATRIC nephrology, KIDNEY diseases, JUVENILE diseases, QUALITY of life, NEPHROLOGY

مستخلص: Background: Children with chronic kidney disease (CKD), requiring dialysis or kidney transplantation, have a mortality rate of up to 30-fold higher than the general aged-matched population, and severely impaired quality of life. Symptoms such as fatigue and pain are prevalent and debilitating. Children with CKD are at risk of cognitive impairment, and poorer educational, vocational, and psychosocial outcomes compared with their well peers, which have consequences through to adulthood. Treatment regimens for children with CKD are long-term, complex, and highly intrusive. While many trials have been conducted to improve outcomes in children with CKD, the outcomes measured and reported are often not relevant to patients and clinicians, and are highly variable. These problems can diminish the value of trials as a means to improve the lives of children with CKD. The Standardised Outcomes in Nephrology-Children and Adolescents (SONG-Kids) study aims to develop a core outcome set for trials in children and adolescents with any stage of CKD that is based on the shared priorities of all stakeholders.Methods/design: SONG-Kids involves five phases: a systematic review to identify outcomes (both domains and measures) that have been reported in randomised controlled trials involving children aged up to 21 years with CKD; focus groups (using nominal group technique) with adolescent patients and caregivers of paediatric patients (all ages) to identify outcomes that are relevant and important to patients and their family and the reasons for their choices; semistructured key informant interviews with health professionals involved in the care of children with CKD to ascertain their views on establishing core outcomes in paediatric nephrology; an international three-round online Delphi survey with patients, caregivers, clinicians, researchers, policy-makers, and members from industry to develop consensus on important outcome domains; and a stakeholder workshop to review and finalise the set of core outcome domains for trials in children with CKD (including nondialysis-dependent, dialysis, and kidney transplantation).Discussion: Establishing a core outcome set to be reported in all trials conducted in children with any stage of CKD will enhance the relevance, transparency, and impact of research to improve the lives of children and adolescents with CKD. [ABSTRACT FROM AUTHOR]

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المؤلفون: Samuel, Susan M., Palacios-Derlingher, Luz, Tonelli, Marcello, Manns, Braden, Crowshoe, Lynden, Ahmed, Soia B., Min Jun, Saad, Nathalie, Hemmelgarn, Brenda R.

المصدر: Canadian Medical Association Journal (CMAJ); 2/4/2014, Vol. 186 Issue 2, pE86-E94, 9p, 4 Charts

مصطلحات موضوعية: CHRONIC kidney failure, KIDNEY diseases, ALBUMINURIA, KIDNEY failure, CREATININE, FIRST Nations of Canada, HEALTH

مستخلص: Background: Despite a low prevalence of chronic kidney disease (estimated glomerular filtration rate [GFR] < 60 mL/min per 1.73 m²), First Nations people have high rates of kidney failure requiring chronic dialysis or kidney transplantation. We sought to examine whether the presence and severity of albuminuria contributes to the progression of chronic kidney disease to kidney failure among First Nations people. Methods: We identified all adult residents of Alberta (age = 18 yr) for whom an outpatient serum creatinine measurement was available from May 1, 2002, to Mar . 31, 2008. We determined albuminuria using urine dipsticks and categorized results as normal (i.e., no albuminuria), mild, heavy or unmeasured. Our primary outcome was progression to kidney failure (defined as the need for chronic dialysis or kidney transplantation, or a sustained doubling of serum creatinine levels). We calculated rates of progression to kidney failure by First Nations status, by estimated GFR and by albuminuria category. We determined the relative hazard of progression to kidney failure for First Nations compared with non-First Nations participants by level of albuminuria and estimated GFR. Results: Of the 1 816 824 participants we identified, 48 669 (2.7%) were First Nations. First Nations people were less likely to have normal albuminuria compared with non-First Nations people (38.7% v. 56.4%). Rates of progression to kidney failure were consistently 2- to 3-fold higher among First Nations people than among non-First Nations people, across all levels of albuminuria and estimated GFRs. Compared with non-First Nations people, First Nations people with an estimated GFR of 15.0-29.9 mL/min per 1.73 m had the highest risk of progression to kidney failure, with similar hazard ratios for those with normal and heavy albuminuria. Interpretation: Albuminuria confers a similar risk of progression to kidney failure for First Nations and non-First Nations people. [ABSTRACT FROM AUTHOR]

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المؤلفون: Ronksley, Paul E., Tonelli, Marcello, Quan, Hude, Manns, Braden J., James, Matthew T., Clement, Fiona M., Samuel, Susan, Quinn, Robert R., Ravani, Pietro, Brar, Sony S., Hemmelgarn, Brenda R.

المصدر: Nephrology Dialysis Transplantation; May2012, Vol. 27 Issue 5, p1826-1831, 6p

مصطلحات موضوعية: KIDNEY diseases, GLOMERULAR filtration rate, BLOOD proteins, CREATININE, HOSPITAL care, MEDICAL statistics

مستخلص: Background. Administrative data are commonly used for surveillance of chronic medical conditions. The purpose of this study was to determine the validity of an algorithm derived from administrative data for identifying chronic kidney disease (CKD) compared to the reference standard of estimated glomerular filtration rate (eGFR). Methods. We identified adults from the province of Alberta with at least two outpatient serum creatinine measurements within a 1-year time period. Validity indices were estimated for CKD using up to 3 years of administrative data (physician billing claims and hospital discharge abstracts) for various case–definition combinations. For each algorithm, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated against two reference standard definitions of CKD (two eGFR measurements <60 mL/min/1.73m2 or mean eGFR < 30 mL/min/1.73m2). Results. A total of 321 293 eligible subjects were identified. Irrespective of the algorithm, sensitivities for defining CKD (eGFR < 60 mL/min/1.73m2) using administrative codes were low. A case–definition algorithm employing two physician claims or one hospitalization within a 2-year period had sensitivity of 19.4%, specificity of 97.2%, PPV of 60.1% and NPV of 84.8% for detecting CKD. Estimates of sensitivity were higher when <30 mL/min/1.73m2 was used as the reference standard, although PPVs were lower and consistently less than 50%. Conclusion. These results, using eGFR as a reference standard, suggest that administrative data have insufficient sensitivity and PPV for CKD surveillance, although they may be useful when highly specific algorithms are required for research purposes. [ABSTRACT FROM PUBLISHER]

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المؤلفون: Ahmed, Sofia B., Ronksley, Paul E., Hemmelgarn, Brenda R., Tsai, Willis H., Manns, Braden J., Tonelli, Marcello, Klarenbach, Scott W., Chin, Rick, Clement, Fiona M., Hanly, Patrick J.

المصدر: PLoS ONE; 2011, Vol. 6 Issue 4, p1-6, 6p

مصطلحات موضوعية: MEDICAL research, SLEEP apnea syndromes, KIDNEY diseases, HYPOXEMIA, DIAGNOSIS, KIDNEY glomerulus, GLOMERULAR filtration rate, CONFIDENCE intervals, APNEA, PATIENTS

مستخلص: Background: Although obstructive sleep apnea (OSA) is more common in patients with kidney disease, whether nocturnal hypoxia affects kidney function is unknown. Methods: We studied all adult subjects referred for diagnostic testing of sleep apnea between July 2005 and December 31 2007 who had serial measurement of their kidney function. Nocturnal hypoxia was defined as oxygen saturation (SaO2) below 90% for ⩾12% of the nocturnal monitoring time. The primary outcome, accelerated loss of kidney function, was defined as a decline in estimated glomerular filtration rate (eGFR) ⩾4 ml/min/1.73 m² per year. Results: 858 participants were included and followed for a mean study period of 2.1 years. Overall 374 (44%) had nocturnal hypoxia, and 49 (5.7%) had accelerated loss of kidney function. Compared to controls without hypoxia, patients with nocturnal hypoxia had a significant increase in the adjusted risk of accelerated kidney function loss (odds ratio (OR) 2.89, 95% confidence interval [CI] 1.25, 6.67). Conclusion: Nocturnal hypoxia was independently associated with an increased risk of accelerated kidney function loss. Further studies are required to determine whether treatment and correction of nocturnal hypoxia reduces loss of kidney function. [ABSTRACT FROM AUTHOR]

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