Introduction: The Kidney Disease: Improving Global Outcomes (KDIGO) 2012 guidelines recommend classifying patients by glomerular filtration rate (GFR) and albuminuria to predict chronic kidney disease (CKD) prognosis. The aim of this systematic review was to explore the epidemiological burden of CKD stratified by the KDIGO 2012 categories. Methods: MEDLINEÒ and Embase were searched for observational studies of patients with CKD with results stratified according to the KDIGO 2012 classification. Investigated outcomes were prevalence, incidence, and risk factors and complications of CKD, including mortality. Results: The review included ten observational studies with 3033 to 46,949 participants, conducted in the USA, China, France, Italy and Spain. The most frequently reported outcome was the prevalence of CKD (GFR categories G3-5), ranging from 2% to 17%. Most participants were normoalbuminuric, with 0.4-3.2% macroalbuminuric, and most fell within the KDIGO 2012 low-risk or moderate-risk groups, with 0.9-5.6% in the high-risk and 0.3-4.8% in the very high-risk groups. Although scarce, data on the prevalence of comorbidities in CKD according to the KDIGO classification suggest that they increase with albuminuria severity. Conclusions: Patients with CKD frequently have complications, but only a small proportion have severely increased albuminuria or fall within the KDIGO high-risk or very high-risk groups. These groups, however, are associated with the highest burden of disease, as comorbidities are more prevalent with increasing Electronic supplementary material The online version of this article (
Background Information on the epidemiology of uncommon EGFR mutations including exon 20 insertions amongst nonsmall-cell lung cancer (NSCLC) is lacking. Objective The objective of this pragmatic literature review (PLR) and meta-analysis was to generate robust prevalence and incidence estimates based on ranges of exon 20 insertion mutations reported in the literature. Materials and methods Searches of MEDLINE, Embase, congresses and reference lists for articles published from 2013 in key European countries of interest (
Background Achondroplasia is the most common form of skeletal dysplasia. Recent advances in therapeutic options have highlighted the need for understanding the burden and treatment landscape of the condition. This systematic literature review (SLR) aimed to identify health-related quality of life (HRQoL)/utilities, healthcare resource use (HCRU), costs, efficacy, safety and economic evaluation data in achondroplasia and to identify gaps in the research. Methods Searches of MEDLINE, Embase, the University of York Centre for Reviews and Dissemination (CRD), the Cochrane Library and grey literature were performed. Articles were screened against pre-specified eligibility criteria by two individuals and study quality was assessed using published checklists. Additional targeted searches were conducted to identify management guidelines. Results Fifty-nine unique studies were included. Results demonstrated a substantial HRQoL and HCRU/cost-related burden of achondroplasia on affected individuals and their families throughout their lifetimes, particularly in emotional wellbeing and hospitalisation costs and resource use. Vosoritide, growth hormone (GH) and limb lengthening all conferred benefits for height or growth velocity; however, the long-term effects of GH therapy were unclear, data for vosoritide were from a limited number of studies, and limb lengthening was associated with complications. Included management guidelines varied widely in their scope, with the first global effort to standardise achondroplasia management represented by the International Achondroplasia Consensus Statement published at the end of 2021. Current evidence gaps include a lack of utility and cost-effectiveness data for achondroplasia and its treatments. Conclusions This SLR provides a comprehensive overview of the current burden and treatment landscape for achondroplasia, along with areas where evidence is lacking. This review should be updated as new evidence becomes available on emerging therapies. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-023-02549-3.
BackgroundWomen with axial spondyloarthritis (axSpA) are often affected by the disease during their reproductive years,1 but reports on disease activity and pregnancy outcomes in these patients (pts) are sparse. In women with ankylosing spondylitis (AS), also currently termed as radiographic axSpA, a higher risk of disease activity flares and prevalence of adverse pregnancy outcomes have been reported vs healthy controls; however, in non-radiographic (nr)-axSpA pts, such data are virtually non-existent.2,3 ObjectivesTo review the available evidence on the relationship between axSpA disease activity and pregnancy, including foetal outcomes.MethodsA systematic literature review was conducted in October 2017 by searching EMBASE, MEDLINE®, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects. Publications were systematically screened for English language articles on observational studies of axSpA pts reporting pregnancy outcomes or disease activity during pregnancy. Studies utilising agents contraindicated in pregnancy were excluded. Supplementary searches of selected, 2016–17 conference proceedings and bibliographies of relevant review articles were also conducted.Results2216 publications were reviewed, with 20 publications on 15 unique studies meeting the inclusion criteria. When utilising the verified disease activity measurement instruments, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) or Ankylosing Spondylitis Disease Activity Score C-Reactive Protein (ASDAS-CRP), 5 studies (3 prospective, 2 retrospective) reported active disease (as described by individual studies; table 1) both during pregnancy and postpartum in most pts. Pregnancy outcomes in axSpA pts were compared with healthy controls in 6 studies (3 retrospective, 2 prospective, 1 case-control), the 3 largest of which (including 1 prospective) revealed higher risk or odds of preterm births in axSpA pts. Higher rates or risk of low birth weight/small-for-gestational-age neonates were shown in pts vs controls in 2/5 studies reporting such outcomes. Stillbirths, miscarriages or foetal loss/abortion were found to occur at similar rates in both populations.ConclusionsRobust, prospective data on disease activity during pregnancies of women with axSpA are limited. Within the samples reported here, available data suggest that there may be a small increase in pre-term births; no signal for increased pregnancy loss was detected. Further research is needed to investigate relationships between maternal disease activity and pregnancy outcomes in axSpA.Abstract THU0242 – Table 1Maternal disease activity and pregnancy outcomes in axSpA patientsReferences[1] van den Brandt S. Arthritis Res Ther2017;19(1):64.[2] Jethwa H. Arthritis Rheumatol2016;68(suppl 10).[3] Jakobsson GL. Ann Rheum Dis2016;75(10):1838–42.AcknowledgementsThis study was funded by UCB Pharma. Editorial services were provided by Costello Medical.Disclosure of InterestA. Moltó Grant/research support from: MSD, AbbVie, Pfizer, UCB Pharma, Consultant ...
burden among HIV positive patients admitted into general medical ward in district hospitals without nephrology services is unknown. Objective: Evaluate renal function in HIV positive patients admitted for non-renal conditions in a general medical ward of district hospitals in Yaounde, Cameroon. Methods: We conducted a cross sectional study over 3 months (January to April 2018) in the general medical wards of the five main secondary hospitals of Yaounde (political Capital of Cameroon). We excluded patients receiving high doses of cotrimoxazole ($ 2880g/ day), major limb amputees and patients with transurethral catheter. HIV infection was classified according to the OMS classification. Glomerular filtration rate was estimated using the MDRD equation. Kidney failure (KF) was defined as an eGFR < 60 ml/min/1.73m2 and classified as mild (60 < eGFR # 30), severe (30 < eGFR # 15) and very severe (eGFR < 15). Results: We included 102 patients with 53% (n¼52%) females. Mean age was 44.1 AE 12.2 years and 70 (67%) reported complimentary and alternate medicine (CAM) use. Hypertension (9%), diabetes (8%) and hepatitis B (10%) or Hepatitis C (4%) were infrequent. In all 84.5% (n¼86) of patients were in OMS stage 3 and 4, and 71.5% (n¼73) were on combined antiretroviral therapy (c-ART) with about two-thirds receiving tenofovir (n¼61). Main reasons for admission were tuberculosis (31.5%), gastro-enteritis (18.6%) and malaria (17%). In all 26.5% (n¼27) had proteinuria and the median eGFR was 88 [25 th-75 th IQ 45-122] ml/min/1.73m2 A total of 37.2% (n¼ 38) had kidney failure with mild KF in 53% (n¼20), severe KF in 29% (n¼11) and very severe KF in 18% (n¼7). CAM use (82.5% Vs 62.5%, p¼0.02) and proteinuria (55% Vs 9%, p<0.001) were more common in KF patients. Only proteinuria was associated with KF [adjusted OR ¼9.14 CI (3.16-28.13); p<0.001]. Conclusions: Kidney failure is very frequent among HIV positive patients admitted for non-renal condition in general medical ward. Evaluation of renal function needs to be systematic especially in patients using CAM and with proteinuria.
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