Dataset Information

Harmonizing Formula Prescription Patterns in Patients With Chronic Kidney Disease: A Population-Based Cross-Sectional Study.

ABSTRACT: Objective: Harmonizing formulas are associated with beneficial renal outcomes in chronic kidney disease (CKD), but the therapeutic mechanisms are unclear. The study aims to explore the associations of intentions and independent factors with harmonizing formulas prescriptions for patients with CKD. Methods: We conducted a population-based cross-sectional study to explore factors associated with harmonizing formulas prescription. Patients who had been prescribed harmonizing formulas after CKD diagnosis was defined as the using harmonizing formulas group. Disease diagnoses when having harmonizing formula prescriptions and patient characteristics related to these prescriptions were collected. Results: In total, 24,971 patients were enrolled in this analysis, and 5,237 (21%) patients were prescribed harmonizing formulas after CKD diagnosis. The three most frequent systematic diseases and related health problems for which harmonizing formula prescriptions were issued in CKD were symptoms, signs, and ill-defined conditions (24.5%), diseases of the digestive system (20.67%), and diseases of the musculoskeletal system (12.9%). Higher likelihoods of harmonizing formula prescriptions were associated with young age (adjusted odds ratio: 0.98, 95% confidence interval: 0.97-0.98), female sex (1.79, 1.68-1.91), no diabetes (1.20, 1.06-1.36), no hypertension (1.38, 1.27-1.50), no cerebrovascular disease (1.34, 1.14-1.56), less disease severity (0.85, 0.83-0.88), using nonsteroidal anti-inflammatory drugs (NSAIDs) (1.65, 1.54-1.78), and using analgesic drugs other than NSAIDs (1.47, 1.35-1.59). Conclusion: Harmonizing formulas are commonly used for treating symptoms of the digestive and musculoskeletal systems in CKD cases. Further research on harmonizing formula effectiveness with regard to particular characteristics of CKD patients is warranted.

SUBMITTER: Lin HL

PROVIDER: S-EPMC8117089 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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Harmonizing Formula Prescription Patterns in Patients With Chronic Kidney Disease: A Population-Based Cross-Sectional Study.

Lin Hung-Lung HL Lin Ming-Yen MY Tsai Cheng-Hsun CH Wang Yi-Hsiu YH Chen Chung-Jen CJ Hwang Shang-Jyh SJ Yen Ming-Hong MH Chiu Yi-Wen YW

Frontiers in pharmacology 20210429

<b>Objective:</b> Harmonizing formulas are associated with beneficial renal outcomes in chronic kidney disease (CKD), but the therapeutic mechanisms are unclear. The study aims to explore the associations of intentions and independent factors with harmonizing formulas prescriptions for patients with CKD. <b>Methods:</b> We conducted a population-based cross-sectional study to explore factors associated with harmonizing formulas prescription. Patients who had been prescribed harmonizing formulas ...[more]

PMID: 33995002

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Project description:ObjectiveIn the general population, "healthy" dietary patterns are associated with improved health outcomes, but data on associations between observance of specific dietary patterns and kidney function in patients with chronic kidney disease (CKD) are sparse.MethodsDietary intake was evaluated using food frequency questionnaires in patients with moderately severe CKD under nephrology care enrolled into the observational multicenter German CKD study. The Dietary Approaches to Stop Hypertension (DASH) diet score, Mediterranean diet score, and German Food Pyramid Index (GFPI) were calculated and their association with estimated glomerular filtration rate (eGFR) and albuminuria was assessed by multivariable linear regression analysis, adjusted for gender, age, body mass index, energy intake, smoking status, alcohol intake, education, high-density lipoprotein-cholesterol (HDL- cholesterol), low-density lipoprotein-cholesterol (LDL-cholesterol), hypertension, and diabetes mellitus.ResultsA total of 2,813 patients (41% women; age 60.1 ± 11.6 years) were included in the analysis. High DASH diet score and GFPI were associated with lower systolic blood pressure and lower intake of antihypertensive medication, higher HDL, and lower uric acid levels. Mediterranean-style diet was associated with lower prevalence of diabetes mellitus. Higher DASH and Mediterranean diet scores were associated with higher eGFR (β-coefficient = 1.226, P < .001; β-coefficient = 0.932, P = .007, respectively). In contrast, GFPI was not associated with eGFR. For the individual components of the dietary patterns, higher intake of nuts and legumes, cereals, fish, and polyunsaturated fats was associated with higher eGFR and higher intake of dairy, composed of low- and whole-fat dairy, was associated with lower eGFR. No association was found between dietary patterns and albuminuria.ConclusionHigher observance of the DASH or Mediterranean diet, but not German food pyramid recommendations, was associated with higher eGFR among patients with CKD. Improving dietary habits may offer an opportunity to better control comorbidities and kidney function decline in patients with CKD.

Project description:BackgroundTo date, comprehensive data on the distribution of chronic kidney disease (CKD), the most prevalent comorbidity in diabetes, among Chinese adults with diabetes is lacking. Additionally, research gaps exist in understanding the association between CKD and cardiovascular health (CVH), an integrated indicator of lifestyle and metabolic control, within a nationwide sample of Chinese adults with diabetes.MethodsA nationally community-based cross-sectional survey was conducted in 2018-2020. 58,560 residents diagnosed with diabetes aged 18-74 years nationwide were invited to participate, and 52,000 participants with complete CKD data were included in this study. CKD was identified by the presence of albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g) and/or decreased estimated glomerular filtration rate (eGFR, <60 mL/min/1.73 m2). The latter was calculated using the CKD-EPI equation incorporating serum cystatin C and creatinine. CVH was evaluated using the "life's essential 8" (LE8) score, which ranged from 0 to 100 and included 8 components: diet, sleep duration, physical activity, nicotine exposure, hemoglobin A1c, blood pressure, non-high-density lipoprotein cholesterol, and body mass index. The total LE8 scores were categorized into low (0-49), middle (50-79), and high (80-100) according to the American Heart Association. The associations of albuminuria and decreased eGFR with potential associated factors, including CVH, socioeconomic status, clinical characteristics, sub-regional divisions, comorbidities, treatments, and metabolic controls, were evaluated using survey logistic regression.FindingsThe weighted prevalence rates (95% CI) of CKD, albuminuria, and decreased eGFR were 32.6% (31.3%-33.8%), 30.8% (29.6%-32.1%), and 5.5% (5.1%-5.9%), respectively. Among those with CKD, 25.7% had diabetic retinopathy (DR) and 22.3% had cardiovascular disease (CVD). The weighted prevalence rates of albuminuria and decreased eGFR were consistently higher among southern residents, rural residents, and individuals with more severe DR and a history of CVD than their counterparts (all p < 0.05). After adjustment for age, sex, sub-regional division, setting, educational level, annual household income, family history of diabetes, diabetes duration, glucose-lowering treatment, any DR, CVD, and drinking status, the logistic models showed that the odds ratios (ORs) (95% CI) for albuminuria and decreased eGFR were 0.46 (0.42-0.51) and 0.61 (0.55-0.67) for the participants with moderate scores, and 0.14 (0.10-0.21) and 0.28 (0.19-0.41) for those with high scores, compared with those with low total LE8 scores. Furthermore, the restricted cubic spline curves depicted that the disparities in the odds of having albuminuria or decreased eGFR among subpopulations grouped by sex, age, setting, and geographical region, significantly decreased and even disappeared in some cases as the LE8 scores increased.InterpretationChinese adults with diabetes are heavily burdened by CKD. Optimized CVH is central to reducing CKD risk across different subpopulations.FundingNational Key Clinical Specialty, the Chinese Academy of Engineering.

Project description:ObjectivesThe objectives were to characterise the haematological profile of screen-detected chronic kidney disease (CKD) participants and to correlate the complete blood count measures with the commonly advocated kidney function estimators.MethodsThe current cross-sectional study used data, collected between February 2015 and November 2016, of 1564 adults of mixed-ancestry, who participated in the Cape Town Vascular and Metabolic Health study. Kidney function was estimated using the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. CKD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, and anaemia as haemoglobin level <13.5 g/dL (men) and <12 g/dL (women).ResultsBased on the MDRD and CKD-EPI equations, the crude prevalence of CKD was 6% and 3%. Irrespective of the equation used, median red blood cell (RBC) indices were consistently lower in those with CKD compared with those without CKD (all p<0.0001). Despite not showing any significant difference in total white blood cell (WBC) count between the two groups, the number of lymphocytes were lower (p=0.0001 and p<0.0001 for MDRD and CKD-EPI, respectively) and neutrophil count (both p<0.0297) and the ratio of lymphocytes to neutrophil (both p<0.0001) higher in the CKD group compared with those without CKD; with the remaining WBC indices similar in the two groups. The platelet count was similar in both groups. Of the screen-detected CKD participants, 45.5% (MDRD) and 57.8% (CKD-EPI) were anaemic, with the prevalence increasing with increasing severity of CKD, from 37.2% (stage 3) to 82.4% (stages 4-5). Furthermore, CKD-EPI-estimated kidney function, but not MDRD, was positively associated with RBC indices.ConclusionThough it remains unclear whether common kidney function estimators provide accurate estimates of CKD in Africans, the correlation of their estimates with deteriorating RBC profile, suggests that advocated estimators, to some extent approximate kidney function in African populations.

Project description:BackgroundsDyspepsia is a condition that affects 25% of the U.S. population, and, when associated with pyrosis, its prevalence reaches 40%. Patients with chronic renal insufficiency not only present higher circulating levels of gastrin and gastric dysmotilty, but also make use of a great amount of drugs for the treatment of their comorbidities. This situation increases the chances of developing gastrointestinal symptoms. The aim of the current study is to evaluate the dyspeptic disease profile in patients undergoing hemodialysis, comparing them with chronic renal disease patients in conservative treatment and non-renal injury patients.MethodsThis is a cross sectional study performed at the Gastroenterology department at Faculdade de Medicina do ABC in São Paulo, Brazil. Three groups were set aside according to the renal function levels calculated using the simplified MDRD formula. They answered three questionnaires that evaluated the presence of dyspepsia, functional dyspepsia and gastroesophageal reflux disease (GERD) associated with the performance of high digestive endoscopy.ResultsA significant difference between the groups was observed concerning the renal function evaluated by the rates of creatinine clearance, creatinine and urea (p < 0.001). The rate of dyspepsia in the control group was higher than in patients with renal function alterations (p = 0.014). There was no difference between groups when it came to the presence of functional dyspepsia and GERD. However, there was a higher use of proton pump inhibitors in the hemodialysis group than in the other groups (p < 0.001).ConclusionIn the proposed model, there was no positive correlation between the worsening of the renal function and the presence of dyspepsia, functional dyspepsia and GERD. The longitudinal evaluation of hemodialysis patients is hampered by the high mortality rates in this group. There was a higher use of proton pump inhibitors, and it is believed that the dyspeptic symptoms are not acid-related.

Project description:Rationale & objectiveConservative kidney management (CKM) is a viable treatment option for many patients with chronic kidney disease. However, CKM practices and resources in the United States are not well described. We undertook this study to gain a better understanding of factors influencing uptake of CKM by describing: (1) characteristics of patients who choose CKM, (2) provider practice patterns relevant to CKM, and (3) CKM resources available to providers.Study designCross-sectional study.Setting & participantsThis study is a cross-sectional analysis of data from US nephrology clinics enrolled in the chronic kidney disease Outcomes and Practice Patterns Study (CKDopps) collected between 2014 and 2020. Data for this study includes chart-abstracted characteristics of patients with an estimated glomerular filtration rate ≤30mL/min/1.73m2 (n=1018) and available information on whether a decision had been made to pursue CKM at the time of kidney failure, patient (n=407) reports of discussions about forgoing dialysis, and provider (n=26) responses about CKM delivery and available resources in their health systems.Analytical approachDescriptive statistics were used to report patient demographics, clinical information, provider demographics, and clinic characteristics.ResultsAmong data from 1018 patients, 68 (7%) were recorded as planning for CKM. These patients were older, had more comorbidities, and were more likely to require assistance with transfers. Of the 407 patient surveys, 18% reported a conversation about forgoing dialysis with their nephrologist. A majority of providers felt comfortable discussing CKM; however, no clinics had a dedicated clinic or protocol for CKM.LimitationsInconsistent survey terminology and unlinked patient and provider responses.ConclusionsFew patients reported discussion of forgoing dialysis with their providers and even fewer anticipated a choice of CKM on reaching kidney failure. Most providers were comfortable discussing CKM, but practiced in clinics that lacked dedicated resources. Further research is needed to improve the implementation of a CKM pathway.Plain-language summaryFor older comorbid adults with kidney failure, conservative kidney management (CKM) can be an appropriate treatment choice. CKM is a holistic approach with treatment goals of maximizing quality of life and preventing progression of chronic kidney disease (CKD) without initiation of dialysis. We investigated US CKM practices and found that among 1018 people with CKD, only 7% were planning for CKM. Of 407 surveyed patients, 18% reported a conversation with their provider about forgoing dialysis. In contrast, most providers felt comfortable discussing CKM; however, none reported working in an environment with a dedicated CKM clinic or protocol. Our data show the need for further CKM education in the United States as well as dedicated resources for its delivery.

Dataset Information

Harmonizing Formula Prescription Patterns in Patients With Chronic Kidney Disease: A Population-Based Cross-Sectional Study.

Publications

Harmonizing Formula Prescription Patterns in Patients With Chronic Kidney Disease: A Population-Based Cross-Sectional Study.

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