The MONitoring Dialysis Outcomes (MONDO) Initiative

Usvyat, Len; Haviv, Yosef S.; Etter, Michael; Kooman, Jeroen P.; Marcelli, Daniele; Marelli, Cristina; Power, Albert; Toffelmire, Ted; Wang, Yuedong; Kotanko, Peter

doi:10.1159/000345179

Cited by 34 publications

(33 citation statements)

References 34 publications

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“…The MONitoring Dialysis Outcomes initiative comprises HD databases from Renal Research Institute clinics in the United States; Fresenius Medical Care (FMC) clinics in Europe, Asia Pacific, and Latin America; KfH clinics in Germany; and clinics associated with the Imperial College (United Kingdom), Hadassah Medical Center (Israel), and Maastricht University Medical Center (The Netherlands) (22). Electronic medical records are assembled in a primary database after obtaining informed consent and in accordance with local privacy and data protection regulations.…”

Section: Methodsmentioning

confidence: 99%

Body Composition and Survival in Dialysis Patients

Marcelli

Usvyat

Kotanko

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives High body mass index appears protective in hemodialysis patients, but uncertainty prevails regarding which components of body composition, fat or lean body mass, are primarily associated with survival. (FTIs), which are the respective tissue masses normalized to height squared, relative to an age-and sex-matched healthy population. The relationship between LTI and FTI and all-cause mortality was studied by Kaplan-Meier analysis, multivariate Cox regression, and smoothing spline ANOVA logistic regression.Results In 37,345 hemodialysis patients, median (25th-75th percentile) LTI and FTI were 12.2 (10.3-14.5) and 9.8 (6.6-12.4) kg/m 2 , respectively. Median (25th-75th percentile) follow-up time was 266 (132-379) days; 3458 (9.2%) patients died during follow-up. Mortality was lowest with both LTI and FTI in the 10th-90th percentile (reference group) and significantly higher at the lower LTI and FTI extreme (hazard ratio [HR], 3.37; 95% confidence interval [95% CI], 2.94 to 3.87; P,0.001). Survival was best with LTI between 15 and 20 kg/m 2 and FTI between 4 and 15 kg/m 2 (probability of death during follow-up: ,5%). When taking the relation between both compartments into account, the interaction was significant (P=0.01). Higher FTI appeared protective in patients with low LTI (HR, 3.37; 95% CI, 2.94 to 3.87; P,0.001 at low LTI-low FTI, decreasing to HR, 1.79; 95% CI, 1.47 to 2.17; P,0.001 at low LTI-high FTI).Conclusions This large international study indicates best survival in patients with both LTI and FTI in the 10th-90th percentiles of a healthy population. In analyses of body composition, both lean tissue and fat tissue compartments and also their relationship should be considered.

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Section: Methodsmentioning

confidence: 99%

Body Composition and Survival in Dialysis Patients

Marcelli

Usvyat

Kotanko

et al. 2015

Clinical Journal of the American Society of Nephrology

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140

115

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“…This effort was supplemented by telephone interviews and discussions at several committee meetings. The general structure as well as some aspects of the MONDO initiative have already been described [3]. In addition, the structure and content of some of the primary electronic databases that collaborate in the MONDO initiative have been reported previously [1,7,8,9,10].…”

Section: Methodsmentioning

confidence: 99%

“…Starting from an ad hoc collaboration to address a specific scientific question [2], the MONDO (MONitoring Dialysis Outcomes) initiative was founded and subsequently developed into a consortium in which a variety of academic and nonacademic institutions from around the world work together on research projects to analyze primary clinical databases of dialysis patients [3]. …”

Section: Introductionmentioning

confidence: 99%

Monitoring Dialysis Outcomes across the World - The MONDO Global Database Consortium

Gersdorff¹,

Usvyat

Marcelli

et al. 2013

Blood Purif

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Background/Aims: Dialysis providers frequently collect detailed longitudinal and standardized patient data, providing valuable registries of routine care. However, even large organizations are restricted to certain regions, limiting their ability to separate effects of local practice from the pathophysiology shared by most dialysis patients. To overcome this limitation, the MONDO (MONitoring Dialysis Outcomes) research consortium has created a platform for the joint analysis of data from almost 200,000 dialysis patients worldwide. Methods: We examined design and operation of MONDO as well as its methodology with respect to patient inclusion, descriptive data and other study parameters. Results: MONDO partners contribute primary databases of anonymized patient data and collaboratively analyze populations across national and regional boundaries. To that end, datasets from different electronic health record systems are converted into a uniform structure. Patients are enrolled without systematic exclusions into open cohorts representing the diversity of patients. A large number of patient level treatment and outcome data is recorded frequently and can be analyzed with little delay. Detailed variable definitions are used to determine if a parameter can be studied in a subset or all databases. Conclusion: MONDO has created a large repository of validated dialysis data, expanding the opportunities for outcome studies in dialysis patients. The density of longitudinal information facilitates in particular trend analysis. Limitations include the paucity of uniform definitions and standards regarding descriptive information (e.g. comorbidities), which limits the identification of patient subsets. Through its global outreach, depth, breadth and size, MONDO advances the observational study of dialysis patients and care.

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“…Kidney disease diagnosed at a younger age is most commonly due to congenital anomalies of the kidneys and urinary tract, whereas in the older age it is most often due to glomerular disease [4]. In fact, the USRDS reports glomerular disease is the most prevalent diagnosis among AYA and diabetes is the least common [5]. …”

Section: The Adolescent/young Adult With Chronic Kidney Disease or Enmentioning

confidence: 99%

Self-Management and Transition Among Adolescents/Young Adults with Chronic or End-Stage Kidney Disease

Ferris

Cuttance²,

Javalkar

et al. 2015

Blood Purif

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Background: Adolescents/young adults (AYA) with chronic kidney disease (CKD) or end-stage kidney disease (ESKD) are at risk for poor health outcomes related to self-management. To improve their health and quality of life, AYA must build self-management (for those in the pediatric- and adult-focused setting) and/or health care transition (HCT) skills (for those in the pediatric setting). Methods: Self-management and/or HCT encompass a variety of domains that must be tailored to each individual. Annual assessments should begin between the ages of 12 and 14 and continue in the adult-focused setting until patients have achieved demonstrated self-management and/or HCT skills mastery. These assessments will guide interventions that are congruent in terms of literacy, development and culture. Facilitation of this process from the perspective of both the pediatric and the adult health-care systems is described. Conclusions: Deficiencies and barriers to self-management and/or HCT for AYA with ESKD remain. There is no consensus on the definition of successful HCT preparation, with few tools to assess transition readiness and/or self-management. It is important for health providers to promote the self-management and/or health-care transition skills of AYA with ESKD. Customization of these activities and involvement of the whole family will contribute towards better health-related quality of life and patient outcomes.

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The MONitoring Dialysis Outcomes (MONDO) Initiative

Cited by 34 publications

References 34 publications

Body Composition and Survival in Dialysis Patients

Body Composition and Survival in Dialysis Patients

Monitoring Dialysis Outcomes across the World - The MONDO Global Database Consortium

Self-Management and Transition Among Adolescents/Young Adults with Chronic or End-Stage Kidney Disease

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