A pre-dialysis psychoeducational intervention increased length of survival more than usual care in patients with chronic kidney disease

2006 ◽  
Vol 9 (3) ◽  
pp. 83-83
Author(s):  
M. E (Beth) Horsburgh
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Usual Care ◽  
Psychoeducational Intervention

scholarly journals Cost-effectiveness analysis of a strategy to delay progression to dialysis and death among chronic kidney disease patients in Lima, Peru

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
E. M. Saldarriaga ◽  
J. Bravo-Zúñiga ◽  
Y. Hurtado-Roca ◽  
V. Suarez
Keyword(s):  
Chronic Kidney Disease ◽  
Cost Effectiveness ◽  
Kidney Disease ◽  
Usual Care ◽  
Lifetime Cost ◽  
Standard Of Care ◽  
Health Consequences ◽  
Lack Of Information ◽  
Payer Perspective ◽  
Life Years

Abstract Background The Renal Health Program (RHP) was implemented in 2013 as a secondary prevention strategy to reduce the incidence of patients initiating dialysis and overall mortality. A previous study found that adherent patients have 58% protection against progression to dialysis compared to non-adherent. The main objective of the study was to estimate the lifetime economic and health consequences of the RHP intervention to determine its cost-effectiveness in comparison with usual care. Methods We use a Markov model of three health stages to simulate disease progression among chronic kidney disease patients in Lima, Peru. The simulation time-horizon was 30 years to capture the lifetime cost and health consequences comparing the RHP to usual care. Costs were estimated from the payer perspective using institutional data. Health outcomes included years lived free of dialysis (YL) and quality adjusted life years (QALY). We conducted a probabilistic sensitivity analysis (PSA) to assess the robustness of our estimates against parameter uncertainty. Results We found that the RHP was dominant—cost-saving and more effective—compared to usual care. The RHP was 783USD cheaper than the standard of care and created 0.04 additional QALYs, per person. The Incremental Cost-Effectiveness Ratio (ICER) showed a cost per QALY gained of $21,660USD. In the PSA the RHP was dominant in 996 out of 1000 evaluated scenarios. Conclusions The RHP was cheaper than the standard of care and more effective due to a reduction in the incidence of patients progressing to dialysis, which is a very expensive treatment and many times inaccessible. We aim these results to help in the decision-making process of scaling-up and investment of similar strategies in Peru. Our results help to increase the evidence in Latin America where there is a lack of information in the long-term consequences of clinical-management-based prevention strategies for CKD patients.

scholarly journals Effects of exercise on kidney and physical function in patients with non-dialysis chronic kidney disease: a systematic review and meta-analysis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Keisuke Nakamura ◽  
Tomohiro Sasaki ◽  
Shuhei Yamamoto ◽  
Hiroto Hayashi ◽  
Shinji Ako ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Exercise Training ◽  
Usual Care ◽  
Physical Function ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Risk Of Mortality ◽  
Walking Capacity ◽  
Physical Functions

Abstract Patients with non-dialysis chronic kidney disease (CKD) are at greater risk of early mortality and decreased physical function with an advance in the stage of CKD. However, the effect of exercise in these patients is unclear. This meta-analysis aimed to determine the effects of physical exercise training on the risk of mortality, kidney and physical functions, and adverse events in patients with non-dialysis CKD. The meta-analysis conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and the Cochrane Handbook recommendations. On 16 August 2019, the PubMed, CINAHL, Cochrane Library databases, and Embase were electronically searched, with no restrictions for date/time, language, document type, or publication status, for eligible randomized controlled trials (RCTs) investigating the effects of exercise on mortality and kidney and physical function in patients with non-dialysis CKD. Eighteen trials (28 records), including 848 patients, were analyzed. The effects of exercise on all-cause mortality and estimated glomerular filtration rate were not significantly different from that of usual care. Exercise training improved peak/maximum oxygen consumption compared to usual care. Regular exercise improves physical and walking capacity for patients with non-dialysis CKD. Effect on leg muscle strength was unclear.

scholarly journals Home-based exercise for people living with frailty and chronic kidney disease: A mixed-methods pilot randomised controlled trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0251652
Author(s):  
Andrew C. Nixon ◽  
Theodoros M. Bampouras ◽  
Helen J. Gooch ◽  
Hannah M. L. Young ◽  
Kenneth W. Finlayson ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Mixed Methods ◽  
Randomised Controlled Trial ◽  
Kidney Disease ◽  
Usual Care ◽  
Controlled Trial ◽  
Pilot Randomised Controlled Trial ◽  
Home Based ◽  
Pilot Rct ◽  
Randomised Controlled

Background Frailty is associated with adverse health outcomes in people with chronic kidney disease (CKD). Evidence supporting targeted interventions is needed. This pilot randomised controlled trial (RCT) aimed to inform the design of a definitive RCT evaluating the effectiveness of a home-based exercise intervention for pre-frail and frail older adults with CKD. Methods Participants were recruited from nephrology outpatient clinics to this two-arm parallel group mixed-methods pilot RCT. Inclusion criteria were: ≥65 years old; CKD G3b-5; and Clinical Frailty Scale score ≥4. Participants categorised as pre-frail or frail using the Frailty Phenotype were randomised to a 12-week progressive multi-component home-based exercise programme or usual care. Primary outcome measures included eligibility, recruitment, adherence, outcome measure completion and participant attrition rate. Semi-structured interviews were conducted with participants to explore trial and intervention acceptability. Results Six hundred and sixty-five patients had an eligibility assessment with 217 (33%; 95% CI 29, 36) eligible. Thirty-five (16%; 95% CI 12, 22) participants were recruited. Six were categorised as robust and withdrawn prior to randomisation. Fifteen participants were randomised to exercise and 14 to usual care. Eleven (73%; 95% CI 45, 91) participants completed ≥2 exercise sessions/week. Retained participants completed all outcome measures (n = 21; 100%; 95% CI 81, 100). Eight (28%; 95% CI 13, 47) participants were withdrawn. Fifteen participated in interviews. Decision to participate/withdraw was influenced by perceived risk of exercise worsening symptoms. Participant perceived benefits included improved fitness, balance, strength, well-being, energy levels and confidence. Conclusions This pilot RCT demonstrates that progression to definitive RCT is possible provided recruitment and retention challenges are addressed. It has also provided preliminary evidence that home-based exercise may be beneficial for people living with frailty and CKD. Trial registration ISRCTN87708989; https://clinicaltrials.gov/.

Abstract P265: Blood Pressure Control is Better and Less Expensive in Chronic Kidney Disease When Associated Metabolic Acidosis is Treated with Fruits and Vegetables Rather Than Sodium Bicarbonate

Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Nimrit Goraya ◽  
Jan Simoni ◽  
Jessica Pruszynski ◽  
Pin Xiang ◽  
Donald Wesson
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Metabolic Acidosis ◽  
Kidney Disease ◽  
Sodium Bicarbonate ◽  
Usual Care ◽  
Blood Pressure Control ◽  
Fruits And Vegetables ◽  
Pressure Control ◽  
Hypertension Management

Background: Both sodium bicarbonate (NaHCO 3 ) and base-producing fruits and vegetables (F+V) improve metabolic acidosis in chronic kidney disease (CKD) and appear to provide similar levels of kidney protection. Because F+V themselves reduce blood pressure, we examined if treatment of metabolic acidosis in CKD with F+V was associated with improved blood pressure control, using fewer anti-hypertensive drugs, and thereby with lower cost of hypertension management. Methods: We randomized 108 subjects with CKD stage 3 eGFR (30-59 ml/min) and metabolic acidosis as follows: F+V (n=36) added to reduce dietary potential renal acid load (PRAL) 50%, oral NaHCO 3 (HCO 3 , n=36) to reduce PRAL 50%, or no alkali (Usual Care, n=36). All were treated toward systolic blood pressure (SBP) <130 mmHg with regimens including ACE inhibition and followed 5 years. Results: Entry SBP and initial doses of 5 formulary anti-hypertensive drugs most commonly used for blood pressure control in CKD were not different among the 3 groups. At 5 years, SBP was lower in F+V (125±5 mm Hg) than both HCO 3 and Usual Care (135±5 and 134±5 mm Hg, respectively, p<0.01 vs. F+V for each). Daily doses for the following drugs at year 5 were lower in F+V than HCO 3 and Usual Care: Enalapril (8.3±2.4 vs. 11.1±3.6 and 11.7±4.8, mg/day, respectively, p<0.01), Diltiazem (1.7±7.0 vs. 145.8±36.0 and 153.3±35.7, mg/day, p<0.01), Clonidine (0.14±0.20 vs. 0.65±0.15 and 0.63±0.16, mg/day, p<0.01), Atenolol (0 vs. 6.25±15.1 and 6.25±15.1 mg/day, p<0.02) but there was no difference among groups in the year 5 dose of hydrochlorthiazide (16.1±9.9 vs. 21.9±16.2 and 21.5±16.3 mg/day, p=0.27). Five-year drug cost of hypertension management was less in F+V ($79,760) than both HCO 3 ($155,372) and Usual Care ($152,305). Conclusions: Treating metabolic acidosis in CKD patients with F+V but not NaHCO 3 was associated with lower SBP, use of fewer and lower doses of anti-hypertensive drugs, and lower group cost of hypertension management. The data support that clinicians consider these adjunctive benefits of F+V on hypertension management when recommending treatment strategies for metabolic acidosis in CKD.

scholarly journals Nephrologist Follow-Up versus Usual Care after an Acute Kidney Injury Hospitalization (FUSION)

2021 ◽  
pp. CJN.17331120
Author(s):  
Samuel Silver ◽  
Neill Adhikari ◽  
Chaim Bell ◽  
Christopher Chan ◽  
Ziv Harel ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Clinical Outcome ◽  
Usual Care ◽  
Controlled Trial ◽  
Kidney Injury ◽  
Healthcare Team ◽  
Cardiovascular Risk Reduction

Background and Objectives: Survivors of acute kidney injury (AKI) are at higher risk of chronic kidney disease and death, but few patients see a nephrologist following hospital discharge. Our objectives during this 2-year vanguard phase were to determine the feasibility of randomizing survivors of AKI to early follow-up with a nephrologist or usual care, as well as to collect data on care processes and outcomes. Design, Setting, Participants, and Measurements: We performed a randomized controlled trial in patients hospitalized with Kidney Disease Improving Global Outcomes (KDIGO) stage 2-3 AKI at 4 hospitals in Toronto, Canada. We randomized patients to early nephrologist follow-up (standardized basket of care that emphasized blood pressure control, cardiovascular risk reduction, and medication safety) or usual care from July 2015 to June 2017. Feasibility outcomes included the proportion of eligible patients enrolled, seen by a nephrologist, and followed to 1-year. The primary clinical outcome was a major adverse kidney event at 1-year, defined as death, maintenance dialysis, or incident/progressive chronic kidney disease. Results: We screened 3687 participants from July 2015 to June 2017, of whom 269 were eligible. We randomized 71 (26%) patients (34 to nephrology follow-up and 37 to usual care). The primary reason stated for declining enrollment included hospitalization-related fatigue (n=65), reluctance to add more doctors to the healthcare team (n=59), and long travel times (n=40). Nephrologist visits occurred in 24/34 (71%) intervention participants compared to 3/37 (8%) randomized to usual care. The primary clinical outcome occurred in 15/34 (44%) patients in the nephrologist follow-up arm and 16/37 (43%) patients in the usual care arm (relative risk=1.02, 95% CI 0.60-1.73). Conclusions: Major adverse kidney events are common in AKI survivors, but we found that the in-person model of follow-up posed a variety of barriers that was not acceptable to many patients. (ClinicalTrials.gov, NCT02483039).

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