Pub Date : 2024-08-21DOI: 10.1053/j.ajkd.2024.07.007
Meghan J Elliott, Tyrone G Harrison, Shannan Love, Paul E Ronksley, Nancy Verdin, Dwight Sparkes, Caitrin O'Connor, Kate Manns, Sabrina Jassemi, Brenda R Hemmelgarn, Maoliosa Donald
<p><strong>Rationale & objective: </strong>Formalized peer support is a promising approach for addressing the emotional and practical needs of people living with chronic kidney disease (CKD). We systematically identified and summarized peer support interventions studied in individuals with CKD with or without kidney replacement therapy (KRT).</p><p><strong>Sources of evidence: </strong>Search of electronic databases and grey literature sources in March 2023.</p><p><strong>Eligibility criteria: </strong>Studies of any design were eligible if they reported sufficient detail on peer support interventions and outcomes for adults with CKD with or without KRT and/or their caregivers.</p><p><strong>Charting methods: </strong>We extracted information on study and intervention characteristics and reported outcomes using established frameworks. We summarized quantitative data descriptively and qualitative data thematically. Our approach observed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews.</p><p><strong>Results: </strong>We included 77 studies describing 56 unique peer support interventions. Most reports were program evaluations (39%) or randomized controlled trials (27%) published after 2013. Two-thirds of interventions focused on in-center hemodialysis or mixed CKD populations, and three quarters were integrated within a kidney care clinic or program. Whereas most peer interactions centered on informational support, few programs offered focused support in areas such as transplant navigation or dialysis modality selection. Only one-third of outcomes were assessed against a comparator group, with results suggesting improvements in psychological health with peer support.</p><p><strong>Limitations: </strong>Heterogeneity of included studies; lack of rigorous program evaluation.</p><p><strong>Conclusions: </strong>This review suggests recent growth in peer support programming with a variety of formats and delivery methods to address the diverse needs of people living with kidney disease. Notable gaps in peer support availability for transplant and home dialysis recipients and the lack of rigorous evaluations present opportunities to expand the reach and impact of peer support in the kidney care context.</p><p><strong>Plain-language summary: </strong>Many people with kidney disease struggle with isolation, making decisions about their care, and declines in their mental well-being. Peer support is a way of providing information and emotional support to patients and their loved ones by connecting them with others who have a shared experience of kidney disease. We summarize the features of peer support programs worldwide and the settings in which they have been studied. We searched the medical literature and found 56 unique peer support programs reported in 77 studies. Most studies were from the last 10 years, targeted people receiving hemodialysis, and focused on sharing information about kidney d
{"title":"Peer Support Interventions for People With CKD: A Scoping Review.","authors":"Meghan J Elliott, Tyrone G Harrison, Shannan Love, Paul E Ronksley, Nancy Verdin, Dwight Sparkes, Caitrin O'Connor, Kate Manns, Sabrina Jassemi, Brenda R Hemmelgarn, Maoliosa Donald","doi":"10.1053/j.ajkd.2024.07.007","DOIUrl":"10.1053/j.ajkd.2024.07.007","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Formalized peer support is a promising approach for addressing the emotional and practical needs of people living with chronic kidney disease (CKD). We systematically identified and summarized peer support interventions studied in individuals with CKD with or without kidney replacement therapy (KRT).</p><p><strong>Sources of evidence: </strong>Search of electronic databases and grey literature sources in March 2023.</p><p><strong>Eligibility criteria: </strong>Studies of any design were eligible if they reported sufficient detail on peer support interventions and outcomes for adults with CKD with or without KRT and/or their caregivers.</p><p><strong>Charting methods: </strong>We extracted information on study and intervention characteristics and reported outcomes using established frameworks. We summarized quantitative data descriptively and qualitative data thematically. Our approach observed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews.</p><p><strong>Results: </strong>We included 77 studies describing 56 unique peer support interventions. Most reports were program evaluations (39%) or randomized controlled trials (27%) published after 2013. Two-thirds of interventions focused on in-center hemodialysis or mixed CKD populations, and three quarters were integrated within a kidney care clinic or program. Whereas most peer interactions centered on informational support, few programs offered focused support in areas such as transplant navigation or dialysis modality selection. Only one-third of outcomes were assessed against a comparator group, with results suggesting improvements in psychological health with peer support.</p><p><strong>Limitations: </strong>Heterogeneity of included studies; lack of rigorous program evaluation.</p><p><strong>Conclusions: </strong>This review suggests recent growth in peer support programming with a variety of formats and delivery methods to address the diverse needs of people living with kidney disease. Notable gaps in peer support availability for transplant and home dialysis recipients and the lack of rigorous evaluations present opportunities to expand the reach and impact of peer support in the kidney care context.</p><p><strong>Plain-language summary: </strong>Many people with kidney disease struggle with isolation, making decisions about their care, and declines in their mental well-being. Peer support is a way of providing information and emotional support to patients and their loved ones by connecting them with others who have a shared experience of kidney disease. We summarize the features of peer support programs worldwide and the settings in which they have been studied. We searched the medical literature and found 56 unique peer support programs reported in 77 studies. Most studies were from the last 10 years, targeted people receiving hemodialysis, and focused on sharing information about kidney d","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-16DOI: 10.1053/j.ajkd.2024.06.018
Ling Tian, Byron C Jaeger, Julia J Scialla, Matthew J Budoff, Rupal C Mehta, Bernard G Jaar, Georges Saab, Mirela A Dobre, Muredach P Reilly, Daniel J Rader, Raymond R Townsend, James P Lash, Philip Greenland, Tamara Isakova, Joshua D Bundy
<p><strong>Rationale & objective: </strong>Coronary artery calcification (CAC) progresses rapidly in people with chronic kidney disease (CKD) compared with the general population. We studied the association between CAC progression and higher risks of atherosclerotic cardiovascular disease (CVD), congestive heart failure, and all-cause mortality among adults with CKD.</p><p><strong>Study design: </strong>Prospective cohort study.</p><p><strong>Setting & participants: </strong>1,310 participants in the Chronic Renal Insufficiency Cohort (CRIC) Study who had at least 1 CAC scan with no prior history of CVD and with observed or imputed data on changes in CAC over time.</p><p><strong>Exposure: </strong>Observed or imputed CAC progression, categorized as incident CAC among participants with 0 CAC on the baseline scan or progressive CAC when the baseline scan demonstrated CAC and there was an increase in CAC≥50 Agatston units per year.</p><p><strong>Outcome: </strong>Atherosclerotic CVD (myocardial infarction or stroke), congestive heart failure, and all-cause mortality.</p><p><strong>Analytical approach: </strong>Cause-specific Cox proportional hazards regression, stratified by presence of CAC at baseline.</p><p><strong>Results: </strong>A total of 545 participants without and 765 with prevalent CAC at baseline were included. During a mean 3.3 years between CAC assessments, 177 participants (32.5%) without baseline CAC developed incident CAC while 270 participants (35.3%) with baseline CAC developed a≥50 Agatston units per year increase in CAC. After multivariable adjustment, incident CAC was associated with 2.42-fold higher rate of atherosclerotic CVD (95% CI, 1.23-4.79) and 1.82-fold higher rate of all-cause mortality (95% CI, 1.03-3.22). Progressive CAC (≥50 units per year) was not associated with atherosclerotic CVD (HR, 1.42 [95% CI, 0.85-2.35]) but was associated with a 1.73-fold higher rate of all-cause mortality (95% CI, 1.31-2.28). Progressive CAC was not associated with incident heart failure.</p><p><strong>Limitations: </strong>Residual confounding and limited statistical power for some outcomes.</p><p><strong>Conclusions: </strong>Among adults with CKD stages 2-4, CAC progression over a mean 3.3 years was associated with higher risk of atherosclerotic CVD and all-cause mortality. The associations were strongest among participants without CAC at baseline.</p><p><strong>Plain-language summary: </strong>Prior research has shown that coronary artery calcification (CAC) is a marker of higher risk of heart disease and death. Less is known about how changes in CAC over time might affect risk, particularly among patients with kidney disease. In this study, participants with chronic kidney disease who developed CAC or had worsening CAC over time showed higher rates of heart attack, stroke, and death than those who did not develop CAC. These findings support the need for further research on longitudinal changes in CAC as a possible aid to establishin
{"title":"Progression of Coronary Artery Calcification and Risk of Clinical Events in CKD: The Chronic Renal Insufficiency Cohort Study.","authors":"Ling Tian, Byron C Jaeger, Julia J Scialla, Matthew J Budoff, Rupal C Mehta, Bernard G Jaar, Georges Saab, Mirela A Dobre, Muredach P Reilly, Daniel J Rader, Raymond R Townsend, James P Lash, Philip Greenland, Tamara Isakova, Joshua D Bundy","doi":"10.1053/j.ajkd.2024.06.018","DOIUrl":"10.1053/j.ajkd.2024.06.018","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Coronary artery calcification (CAC) progresses rapidly in people with chronic kidney disease (CKD) compared with the general population. We studied the association between CAC progression and higher risks of atherosclerotic cardiovascular disease (CVD), congestive heart failure, and all-cause mortality among adults with CKD.</p><p><strong>Study design: </strong>Prospective cohort study.</p><p><strong>Setting & participants: </strong>1,310 participants in the Chronic Renal Insufficiency Cohort (CRIC) Study who had at least 1 CAC scan with no prior history of CVD and with observed or imputed data on changes in CAC over time.</p><p><strong>Exposure: </strong>Observed or imputed CAC progression, categorized as incident CAC among participants with 0 CAC on the baseline scan or progressive CAC when the baseline scan demonstrated CAC and there was an increase in CAC≥50 Agatston units per year.</p><p><strong>Outcome: </strong>Atherosclerotic CVD (myocardial infarction or stroke), congestive heart failure, and all-cause mortality.</p><p><strong>Analytical approach: </strong>Cause-specific Cox proportional hazards regression, stratified by presence of CAC at baseline.</p><p><strong>Results: </strong>A total of 545 participants without and 765 with prevalent CAC at baseline were included. During a mean 3.3 years between CAC assessments, 177 participants (32.5%) without baseline CAC developed incident CAC while 270 participants (35.3%) with baseline CAC developed a≥50 Agatston units per year increase in CAC. After multivariable adjustment, incident CAC was associated with 2.42-fold higher rate of atherosclerotic CVD (95% CI, 1.23-4.79) and 1.82-fold higher rate of all-cause mortality (95% CI, 1.03-3.22). Progressive CAC (≥50 units per year) was not associated with atherosclerotic CVD (HR, 1.42 [95% CI, 0.85-2.35]) but was associated with a 1.73-fold higher rate of all-cause mortality (95% CI, 1.31-2.28). Progressive CAC was not associated with incident heart failure.</p><p><strong>Limitations: </strong>Residual confounding and limited statistical power for some outcomes.</p><p><strong>Conclusions: </strong>Among adults with CKD stages 2-4, CAC progression over a mean 3.3 years was associated with higher risk of atherosclerotic CVD and all-cause mortality. The associations were strongest among participants without CAC at baseline.</p><p><strong>Plain-language summary: </strong>Prior research has shown that coronary artery calcification (CAC) is a marker of higher risk of heart disease and death. Less is known about how changes in CAC over time might affect risk, particularly among patients with kidney disease. In this study, participants with chronic kidney disease who developed CAC or had worsening CAC over time showed higher rates of heart attack, stroke, and death than those who did not develop CAC. These findings support the need for further research on longitudinal changes in CAC as a possible aid to establishin","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":11.3,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-16DOI: 10.1053/j.ajkd.2024.06.020
Elaine Ku, Timothy P Copeland, Charles E McCulloch, Kaleab Z Abebe, Michel Chonchol, Ronald D Perrone, Frederic F Rahbari-Oskoui, Alan S L Yu, Theodore Steinman, Arlene Chapman, Mark J Sarnak
{"title":"Effect of Dual RAAS Blockade and Intensive BP Lowering on Risk of End-Stage Kidney Disease and Death in Autosomal Dominant Polycystic Kidney Disease: Long-term Follow-up of the HALT-PKD Trials.","authors":"Elaine Ku, Timothy P Copeland, Charles E McCulloch, Kaleab Z Abebe, Michel Chonchol, Ronald D Perrone, Frederic F Rahbari-Oskoui, Alan S L Yu, Theodore Steinman, Arlene Chapman, Mark J Sarnak","doi":"10.1053/j.ajkd.2024.06.020","DOIUrl":"10.1053/j.ajkd.2024.06.020","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-16DOI: 10.1053/j.ajkd.2024.06.021
Qiyang Chen, Michael W George, Brenda McMahon, Joshua A Rosenthal, Kang Kim, Roderick J Tan
{"title":"Super-Resolution Ultrasound to Assess Kidney Vascular Changes in Humans With Kidney Disease.","authors":"Qiyang Chen, Michael W George, Brenda McMahon, Joshua A Rosenthal, Kang Kim, Roderick J Tan","doi":"10.1053/j.ajkd.2024.06.021","DOIUrl":"10.1053/j.ajkd.2024.06.021","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-09DOI: 10.1053/j.ajkd.2024.06.015
Thalia Porteny, Kristen Kennefick, Mary Lynch, Angie M Velasquez, Kelli Collins Damron, Sylvia Rosas, Jennifer Allen, Daniel E Weiner, Sean Kalloo, Katherine Rizzolo, Keren Ladin
Older Latino adults (aged 65+years) comprise the fastest growing minoritized group among the older population in the United States and experience a disproportionate burden of kidney failure as well as disparities in kidney care compared with non-Hispanic White individuals. Despite significant need and barriers uniquely faced by this population, few educational resources or decision aids are available to meet the language and cultural needs of Latino patients. Decision aids are designed to improve knowledge and empower individuals to engage in shared decision making and have been shown to improve decisional quality and goal-concordant care among older patients with chronic kidney disease (CKD). In this commentary, we examine the barriers faced by older Latino people with CKD who must make dialysis initiation decisions. We conclude that there is a need for culturally concordant decision aids tailored for older Latino patients with CKD to overcome barriers in access to care and improve patient-centered care for older Latino CKD patients.
{"title":"The Need for Culturally Tailored CKD Education in Older Latino Patients and Their Families.","authors":"Thalia Porteny, Kristen Kennefick, Mary Lynch, Angie M Velasquez, Kelli Collins Damron, Sylvia Rosas, Jennifer Allen, Daniel E Weiner, Sean Kalloo, Katherine Rizzolo, Keren Ladin","doi":"10.1053/j.ajkd.2024.06.015","DOIUrl":"10.1053/j.ajkd.2024.06.015","url":null,"abstract":"<p><p>Older Latino adults (aged 65+years) comprise the fastest growing minoritized group among the older population in the United States and experience a disproportionate burden of kidney failure as well as disparities in kidney care compared with non-Hispanic White individuals. Despite significant need and barriers uniquely faced by this population, few educational resources or decision aids are available to meet the language and cultural needs of Latino patients. Decision aids are designed to improve knowledge and empower individuals to engage in shared decision making and have been shown to improve decisional quality and goal-concordant care among older patients with chronic kidney disease (CKD). In this commentary, we examine the barriers faced by older Latino people with CKD who must make dialysis initiation decisions. We conclude that there is a need for culturally concordant decision aids tailored for older Latino patients with CKD to overcome barriers in access to care and improve patient-centered care for older Latino CKD patients.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141911354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-09DOI: 10.1053/j.ajkd.2024.06.017
Keith P McCullough, Hal Morgenstern, Hugh C Rayner, Friedrich K Port, Michel Y Jadoul, Tadao Akizawa, Ronald L Pisoni, William H Herman, Bruce M Robinson
<p><strong>Rationale & objective: </strong>Case-mix adjusted hemodialysis mortality has decreased since 1998. Many factors that influence mortality may have contributed to this trend, and these associations may differ by continental region. We studied changes in hemodialysis facility practices over time and their potential role in mediating changes in patient survival.</p><p><strong>Study design: </strong>Observational prospective cohort study.</p><p><strong>Setting & participants: </strong>Adult hemodialysis patients treated in 500 hemodialysis facilities participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS) between 1999 and 2015 in the United States, Japan, and 4 European countries: Germany, Italy, Spain, and the United Kingdom.</p><p><strong>Predictors: </strong>Four practice measures at each facility: the percentages of patients with Kt/V≥1.2, interdialytic weight gain [IDWG]<5.7%, phosphorus<6mg/dL, and using arteriovenous fistulas (AVFs).</p><p><strong>Outcome: </strong>Patient survival.</p><p><strong>Analytical approach: </strong>Mediation analyses, adjusted for case mix, were conducted using 3-year study phase as the exposure and facility practice measures as potential mediators.</p><p><strong>Results: </strong>In Europe, we observed a 13% improvement in overall case-mix adjusted survival per decade. Trends in facility practice measures, especially Kt/V and phosphorus, explained 10% improvement in case-mix survival per decade, representing 77% (10% explained of 13% improvement) of the observed improvement. In Japan, 73% of the observed 12%/decade improvement in case-mix adjusted survival could be attributed to facility practices, especially Kt/V and IDWG. In the United States, 56% of the observed 47%/decade improvement in case-mix adjusted survival could be attributed to facility practices, especially AVF use and phosphorus control.</p><p><strong>Limitations: </strong>Unmeasured changes in the characteristics of the patient population over this period may confound the observed associations.</p><p><strong>Conclusions: </strong>The improvements in adjusted hemodialysis patient survival in Europe, Japan, and the United States from 1999 to 2015 can be largely explained by improvements in specific facility practices. Future changes in patient survival may be responsive to further evolution in the implementation of common clinical practices.</p><p><strong>Plain-language summary: </strong>Case-mix adjusted survival of patients treated with hemodialysis has improved over the last 2 decades in the United States, Japan, and Europe. Some of this improvement can be explained by region-specific changes in 4 dialysis practices, namely increases in the proportions of patients achieving (1) Kt/V≥1.2, (2) serum phosphorus levels<6mg/dL, (3) interdialytic weight gain<5.7% of body weight, and/or (4) use of arteriovenous fistulas as vascular access, with the magnitude varying according to region-specific trends in these practices. These
{"title":"Explaining International Trends in Mortality on Hemodialysis Through Changes in Hemodialysis Practices in the Dialysis Outcomes and Practice Patterns Study (DOPPS).","authors":"Keith P McCullough, Hal Morgenstern, Hugh C Rayner, Friedrich K Port, Michel Y Jadoul, Tadao Akizawa, Ronald L Pisoni, William H Herman, Bruce M Robinson","doi":"10.1053/j.ajkd.2024.06.017","DOIUrl":"10.1053/j.ajkd.2024.06.017","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Case-mix adjusted hemodialysis mortality has decreased since 1998. Many factors that influence mortality may have contributed to this trend, and these associations may differ by continental region. We studied changes in hemodialysis facility practices over time and their potential role in mediating changes in patient survival.</p><p><strong>Study design: </strong>Observational prospective cohort study.</p><p><strong>Setting & participants: </strong>Adult hemodialysis patients treated in 500 hemodialysis facilities participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS) between 1999 and 2015 in the United States, Japan, and 4 European countries: Germany, Italy, Spain, and the United Kingdom.</p><p><strong>Predictors: </strong>Four practice measures at each facility: the percentages of patients with Kt/V≥1.2, interdialytic weight gain [IDWG]<5.7%, phosphorus<6mg/dL, and using arteriovenous fistulas (AVFs).</p><p><strong>Outcome: </strong>Patient survival.</p><p><strong>Analytical approach: </strong>Mediation analyses, adjusted for case mix, were conducted using 3-year study phase as the exposure and facility practice measures as potential mediators.</p><p><strong>Results: </strong>In Europe, we observed a 13% improvement in overall case-mix adjusted survival per decade. Trends in facility practice measures, especially Kt/V and phosphorus, explained 10% improvement in case-mix survival per decade, representing 77% (10% explained of 13% improvement) of the observed improvement. In Japan, 73% of the observed 12%/decade improvement in case-mix adjusted survival could be attributed to facility practices, especially Kt/V and IDWG. In the United States, 56% of the observed 47%/decade improvement in case-mix adjusted survival could be attributed to facility practices, especially AVF use and phosphorus control.</p><p><strong>Limitations: </strong>Unmeasured changes in the characteristics of the patient population over this period may confound the observed associations.</p><p><strong>Conclusions: </strong>The improvements in adjusted hemodialysis patient survival in Europe, Japan, and the United States from 1999 to 2015 can be largely explained by improvements in specific facility practices. Future changes in patient survival may be responsive to further evolution in the implementation of common clinical practices.</p><p><strong>Plain-language summary: </strong>Case-mix adjusted survival of patients treated with hemodialysis has improved over the last 2 decades in the United States, Japan, and Europe. Some of this improvement can be explained by region-specific changes in 4 dialysis practices, namely increases in the proportions of patients achieving (1) Kt/V≥1.2, (2) serum phosphorus levels<6mg/dL, (3) interdialytic weight gain<5.7% of body weight, and/or (4) use of arteriovenous fistulas as vascular access, with the magnitude varying according to region-specific trends in these practices. These ","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141911352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-09DOI: 10.1053/j.ajkd.2024.06.016
Justin G Wu, Chandana Guha, Anastasia Hughes, Luca G Torrisi, Jonathan C Craig, Aditi Sinha, Allison Dart, Allison A Eddy, Detlef Bockenhauer, Hui-Kim Yap, Jaap Groothoff, Stephen I Alexander, Susan L Furth, Susan Samuel, Simon A Carter, Amanda Walker, Joshua Kausman, Allison Jaure
<p><strong>Rationale & objective: </strong>Growth failure is a common problem among children with chronic kidney disease (CKD). Reduced height is associated with psychosocial burden, social stigma, and impaired quality of life. This study describes the aspects of growth impairment that are most impactful from the perspectives of children with CKD, their parents, and health professionals.</p><p><strong>Study design: </strong>Qualitative study.</p><p><strong>Settings & participants: </strong>120 children with CKD (aged 8-21 years), 250 parents, and 445 health professionals from 53 countries who participated in 16 focus groups, 2 consensus workshops, and a Delphi survey.</p><p><strong>Analytical approach: </strong>A thematic analysis of all qualitative data concerning growth from the Standardized Outcomes in Nephrology-Children and Adolescents (SONG-Kids) initiative.</p><p><strong>Results: </strong>We identified 5 themes: diminishing psychological well-being (compared to and judged by peers, tired of explaining to others, damaging self-esteem), constrained life participation and enjoyment (deprived of normal school experiences, excluded from sports or competing at a disadvantage, impaired quality of life in adulthood); grappling with impacts of symptoms and treatment (difficulty understanding short stature and accessing help, lack of appetite, uncertainty regarding bone pains, medication side effects, burden of growth hormone treatment); facilitating timely interventions and optimizing outcomes (early indicator of disease, assessing management, maximizing transplant outcomes, minimizing morbidity); and keeping growth and health priorities in perspective (quality of life and survival of utmost priority, achieved adequate height).</p><p><strong>Limitations: </strong>Only English-speaking participants were included.</p><p><strong>Conclusions: </strong>Impaired growth may diminish psychological well-being, self-esteem, and participation in daily activities for children with CKD. Balancing different treatments that can affect growth complicates decision making. These findings may inform the psychosocial support needed by children with CKD and their caregivers to address concerns about growth.</p><p><strong>Plain-language summary: </strong>Children with chronic kidney disease (CKD) are often much shorter than their peers and may experience poorer mental health and quality of life. To understand the specific important issues on how growth impairment affects these children, we collected qualitative data from the Standardized Outcomes in Nephrology-Children and Adolescents (SONG-Kids) initiative and analyzed perspectives on growth from patients, parents, and health professionals. These data revealed impaired psychological health, reduced enjoyment during school and sports, difficulty dealing with medication side effects and growth hormone treatment, and concerns related to tracking health status and kidney transplant outcomes. These findings may inform the p
{"title":"Patient, Parental, and Health Professional Perspectives on Growth in Children With CKD.","authors":"Justin G Wu, Chandana Guha, Anastasia Hughes, Luca G Torrisi, Jonathan C Craig, Aditi Sinha, Allison Dart, Allison A Eddy, Detlef Bockenhauer, Hui-Kim Yap, Jaap Groothoff, Stephen I Alexander, Susan L Furth, Susan Samuel, Simon A Carter, Amanda Walker, Joshua Kausman, Allison Jaure","doi":"10.1053/j.ajkd.2024.06.016","DOIUrl":"10.1053/j.ajkd.2024.06.016","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Growth failure is a common problem among children with chronic kidney disease (CKD). Reduced height is associated with psychosocial burden, social stigma, and impaired quality of life. This study describes the aspects of growth impairment that are most impactful from the perspectives of children with CKD, their parents, and health professionals.</p><p><strong>Study design: </strong>Qualitative study.</p><p><strong>Settings & participants: </strong>120 children with CKD (aged 8-21 years), 250 parents, and 445 health professionals from 53 countries who participated in 16 focus groups, 2 consensus workshops, and a Delphi survey.</p><p><strong>Analytical approach: </strong>A thematic analysis of all qualitative data concerning growth from the Standardized Outcomes in Nephrology-Children and Adolescents (SONG-Kids) initiative.</p><p><strong>Results: </strong>We identified 5 themes: diminishing psychological well-being (compared to and judged by peers, tired of explaining to others, damaging self-esteem), constrained life participation and enjoyment (deprived of normal school experiences, excluded from sports or competing at a disadvantage, impaired quality of life in adulthood); grappling with impacts of symptoms and treatment (difficulty understanding short stature and accessing help, lack of appetite, uncertainty regarding bone pains, medication side effects, burden of growth hormone treatment); facilitating timely interventions and optimizing outcomes (early indicator of disease, assessing management, maximizing transplant outcomes, minimizing morbidity); and keeping growth and health priorities in perspective (quality of life and survival of utmost priority, achieved adequate height).</p><p><strong>Limitations: </strong>Only English-speaking participants were included.</p><p><strong>Conclusions: </strong>Impaired growth may diminish psychological well-being, self-esteem, and participation in daily activities for children with CKD. Balancing different treatments that can affect growth complicates decision making. These findings may inform the psychosocial support needed by children with CKD and their caregivers to address concerns about growth.</p><p><strong>Plain-language summary: </strong>Children with chronic kidney disease (CKD) are often much shorter than their peers and may experience poorer mental health and quality of life. To understand the specific important issues on how growth impairment affects these children, we collected qualitative data from the Standardized Outcomes in Nephrology-Children and Adolescents (SONG-Kids) initiative and analyzed perspectives on growth from patients, parents, and health professionals. These data revealed impaired psychological health, reduced enjoyment during school and sports, difficulty dealing with medication side effects and growth hormone treatment, and concerns related to tracking health status and kidney transplant outcomes. These findings may inform the p","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141911353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-06DOI: 10.1053/j.ajkd.2024.06.012
Gabriel Cojuc-Konigsberg, Alberto Guijosa, Alberto Moscona-Nissan, Alberto Nordmann-Gomes, Vianca Anabel Canaviri-Flores, Alan Braverman-Poyastro, Regina de la Fuente-Ramírez, Denisse Tinajero-Sánchez, Alejandra de Las Fuentes Cepeda, Andrés Noyola-Pérez, Rafael Lozano, Ricardo Correa-Rotter, Juan C Ramírez-Sandoval
<p><strong>Rationale & objective: </strong>Almost 80% of individuals with chronic kidney disease (CKD) reside in low- and middle-income countries (LMICs) and are potentially underrepresented in randomized controlled clinical trials (RCTs). We assessed the global distribution of RCTs comparing pharmacological treatments for CKD over the past 2 decades, as well as the magnitude and evolution of participation by LMICs.</p><p><strong>Study design: </strong>Systematic review.</p><p><strong>Setting & study populations: </strong>RCTs evaluating pharmacological interventions in adults with CKD.</p><p><strong>Selection criteria for studies: </strong>RCTs published between 2003-2023 and indexed in MEDLINE.</p><p><strong>Data extraction: </strong>Each trial was reviewed and extracted independently by 2 investigators with disagreements settled by consensus or a third reviewer.</p><p><strong>Analytical approach: </strong>RCT participation of World Bank-defined income groups and geographic regions were described, and the representation indices (RI) according to RCT participants and estimated CKD prevalences were calculated. RCTs were also categorized as global, regional, or national in scope.</p><p><strong>Results: </strong>Among 7,760 identified studies, we included 1,366 RCTs conducted in 84 countries with 301,158 participants. National, regional, and global RCTs represented 85.4%, 3.5%, and 11.1% of studies, respectively. LMICs were included in 34.7% of RCTs. No RCTs included participants from low-income countries, and lower-middle-income countries participated in 13.2%. Of participants from RCTs with available information, 25.4% (n=64,843 of 255,237) were from LMICs. According to the RI, 6 LMICs were overrepresented (>1.25), 7 were adequately represented (0.75-1.25), and 26 were underrepresented (<0.75). Most global CKD RCTs (80.2%) included LMICs; however, LMIC participants constituted only 32.9% of the global trial population. We observed a positive trend in LMIC inclusion over time, rising from 22.9% (n=71of 310) in 2003-2007 to 45.5% (n=140of 308) in 2018-2023.</p><p><strong>Limitations: </strong>The use of an income-group dichotomy, exclusion of nonrandomized studies of intervention, and studies identified in 1 database.</p><p><strong>Conclusions: </strong>Despite an increase in participation over the past 2 decades, individuals with CKD from LMICs remain significantly underrepresented in RCTs. These findings suggest that increased efforts are warranted to increase LMIC representation in pharmacological CKD RCTs.</p><p><strong>Plain-language summary: </strong>Chronic kidney disease (CKD) substantially affects people from low- and middle-income countries (LMICs). However, the participation of these countries in randomized controlled trials (RCTs) remains uncertain. To assess the global distribution and representation of these countries in kidney disease research, we reviewed 1,366 CKD drug RCTs published from 2003-2023, conducted in 84 countries involv
{"title":"Representation of Low- and Middle-Income Countries in CKD Drug Trials: A Systematic Review.","authors":"Gabriel Cojuc-Konigsberg, Alberto Guijosa, Alberto Moscona-Nissan, Alberto Nordmann-Gomes, Vianca Anabel Canaviri-Flores, Alan Braverman-Poyastro, Regina de la Fuente-Ramírez, Denisse Tinajero-Sánchez, Alejandra de Las Fuentes Cepeda, Andrés Noyola-Pérez, Rafael Lozano, Ricardo Correa-Rotter, Juan C Ramírez-Sandoval","doi":"10.1053/j.ajkd.2024.06.012","DOIUrl":"10.1053/j.ajkd.2024.06.012","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Almost 80% of individuals with chronic kidney disease (CKD) reside in low- and middle-income countries (LMICs) and are potentially underrepresented in randomized controlled clinical trials (RCTs). We assessed the global distribution of RCTs comparing pharmacological treatments for CKD over the past 2 decades, as well as the magnitude and evolution of participation by LMICs.</p><p><strong>Study design: </strong>Systematic review.</p><p><strong>Setting & study populations: </strong>RCTs evaluating pharmacological interventions in adults with CKD.</p><p><strong>Selection criteria for studies: </strong>RCTs published between 2003-2023 and indexed in MEDLINE.</p><p><strong>Data extraction: </strong>Each trial was reviewed and extracted independently by 2 investigators with disagreements settled by consensus or a third reviewer.</p><p><strong>Analytical approach: </strong>RCT participation of World Bank-defined income groups and geographic regions were described, and the representation indices (RI) according to RCT participants and estimated CKD prevalences were calculated. RCTs were also categorized as global, regional, or national in scope.</p><p><strong>Results: </strong>Among 7,760 identified studies, we included 1,366 RCTs conducted in 84 countries with 301,158 participants. National, regional, and global RCTs represented 85.4%, 3.5%, and 11.1% of studies, respectively. LMICs were included in 34.7% of RCTs. No RCTs included participants from low-income countries, and lower-middle-income countries participated in 13.2%. Of participants from RCTs with available information, 25.4% (n=64,843 of 255,237) were from LMICs. According to the RI, 6 LMICs were overrepresented (>1.25), 7 were adequately represented (0.75-1.25), and 26 were underrepresented (<0.75). Most global CKD RCTs (80.2%) included LMICs; however, LMIC participants constituted only 32.9% of the global trial population. We observed a positive trend in LMIC inclusion over time, rising from 22.9% (n=71of 310) in 2003-2007 to 45.5% (n=140of 308) in 2018-2023.</p><p><strong>Limitations: </strong>The use of an income-group dichotomy, exclusion of nonrandomized studies of intervention, and studies identified in 1 database.</p><p><strong>Conclusions: </strong>Despite an increase in participation over the past 2 decades, individuals with CKD from LMICs remain significantly underrepresented in RCTs. These findings suggest that increased efforts are warranted to increase LMIC representation in pharmacological CKD RCTs.</p><p><strong>Plain-language summary: </strong>Chronic kidney disease (CKD) substantially affects people from low- and middle-income countries (LMICs). However, the participation of these countries in randomized controlled trials (RCTs) remains uncertain. To assess the global distribution and representation of these countries in kidney disease research, we reviewed 1,366 CKD drug RCTs published from 2003-2023, conducted in 84 countries involv","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-02DOI: 10.1053/j.ajkd.2024.06.010
Jia Xin Huang , Jessica Ashley J. Williams , Raymond K. Hsu
{"title":"Continuous Kidney Replacement Therapy in Pediatric Intensive Care Unit: Little People, Big Gaps","authors":"Jia Xin Huang , Jessica Ashley J. Williams , Raymond K. Hsu","doi":"10.1053/j.ajkd.2024.06.010","DOIUrl":"10.1053/j.ajkd.2024.06.010","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"84 4","pages":"Pages 393-396"},"PeriodicalIF":9.4,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0272638624008667/pdfft?md5=1d95a5d332c21b81869dda366d94e0cc&pid=1-s2.0-S0272638624008667-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141873898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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