The Stockholm CREAtinine Measurements (SCREAM) project: Fostering improvements in chronic kidney disease care

Carrero, Juan Jesús; Elinder, Carl Gustaf

doi:10.1111/joim.13418

Cited by 51 publications

(33 citation statements)

References 78 publications

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“…This study used data from the Stockholm CREAtinine Measurements (SCREAM) project, a healthcare utilization cohort that includes all residents in the region of Stockholm accessing any form of healthcare during 2006–2019 23 . Laboratory tests were linked to a variety of health registers, including the Stockholm regional healthcare data warehouse (VAL), the Swedish Prescribed Drug Register (PDR) and the Swedish Renal Register (SRR), for complete information on demographics, clinical diagnoses, healthcare utilization, prescribed drugs, and validated kidney replacement therapy endpoints.…”

Section: Methodsmentioning

confidence: 99%

“…residents in the region of Stockholm accessing any form of healthcare during 2006-2019. 23 Laboratory tests were linked to a variety of health registers, including the Stockholm regional healthcare data warehouse (VAL), the Swedish Prescribed Drug Register (PDR) and the Swedish Renal Register (SRR), for complete information on demographics, clinical diagnoses, healthcare utilization, prescribed drugs, and validated kidney replacement therapy endpoints. The PDR provides information on all dispensed prescriptions to the entire Swedish population since July 2005, including drug identity (classified by Anatomical Therapeutic Chemical [ATC] codes), dosage, date of dispensing, and the prescriber's profession and practice.…”

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confidence: 99%

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Kidney function and prescribed dose in middle‐aged and older patients starting selective serotonin reuptake inhibitors

Zhu

Lisinski

Lagerberg

et al. 2022

Pharmacoepidemiology and Drug

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Purpose: To avoid adverse drug reactions, dose reductions are recommended when prescribing selective serotonin reuptake inhibitors (SSRIs) to patients with impaired kidney function. The extent of this practice in routine clinical care is however unknown. We aimed to evaluate the starting and maintenance SSRI doses prescribed to patients stratified by levels of kidney function in real-world practice.Methods: Using data from the Stockholm CREAtinine Measurements (SCREAM) project, we identified 101 409 new users of antidepressants (including 52 286 SSRI users) in the region of Stockholm during 2006-2019, who were ≥50 years of age and had a recent creatinine test taken in order to estimate glomerular filtration rate (eGFR). SSRI dose reduction was defined as a prescribed SSRI dose of ≤0.5 defined daily doses, according to current recommendations. We examined the associations between eGFR and reductions in initial dose and maintenance dose of SSRIs using logistic regression models.Results: Overall, reductions in initial and maintenance dose were observed among 54.1% and 34.1% of new SSRI users. Nevertheless, about 40% of individuals with an eGFR <30 ml/min/1.73 m 2 were prescribed an SSRI without dose reduction. After adjusting for age and other covariates, lower eGFR was associated with moderately higher odds of dose reduction, for both initial and maintenance dose. Compared to individuals with an eGFR of 90-104 ml/min/1.73 m 2 , the adjusted odds ratios for those with an eGFR <30 ml/min/1.73 m 2 were 1.18 (95% CI: 1.03, 1.36) for initial dose reduction, and 1.49 (1.29, 1.72) for maintenance dose reduction. Stratified analyses showed stronger associations between lower eGFR and SSRI dose reduction among individuals aged 50-64 years and in those receiving prescriptions from psychiatric care.Conclusions: Lower kidney function was moderately associated with a reduced SSRI dose, independently of age. Prescribing SSRIs to middle-aged and older patients should not only consider patients' age but also their kidney function.

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Kidney function and prescribed dose in middle‐aged and older patients starting selective serotonin reuptake inhibitors

Zhu

Lisinski

Lagerberg

et al. 2022

Pharmacoepidemiology and Drug

View full text Add to dashboard Cite

show abstract

“…We used two databases with anonymised health and administrative data: the Stockholm Creatinine Measurements project (SCREAM) covers the entire region of Stockholm, Sweden (approximately 2.9 million people during the study period) [12], and the Secure Anonymised Information Linkage Databank (SAIL) covers 79% of the population of Wales (approximately 3.4 million people during the study period) [13]. In both cohorts, primary care, secondary care, prescribing and mortality data were linked.…”

Section: Study Populationsmentioning

confidence: 99%

The presence and impact of multimorbidity clusters on adverse outcomes across the spectrum of kidney function

Sullivan

Carrero

Jani

et al. 2022

BMC Med

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Background Multimorbidity (the presence of two or more chronic conditions) is common amongst people with chronic kidney disease, but it is unclear which conditions cluster together and if this changes as kidney function declines. We explored which clusters of conditions are associated with different estimated glomerular filtration rates (eGFRs) and studied associations between these clusters and adverse outcomes. Methods Two population-based cohort studies were used: the Stockholm Creatinine Measurements project (SCREAM, Sweden, 2006–2018) and the Secure Anonymised Information Linkage Databank (SAIL, Wales, 2006–2021). We studied participants in SCREAM (404,681 adults) and SAIL (533,362) whose eGFR declined lower than thresholds (90, 75, 60, 45, 30 and 15 mL/min/1.73m2). Clusters based on 27 chronic conditions were identified. We described the most common chronic condition(s) in each cluster and studied their association with adverse outcomes using Cox proportional hazards models (all-cause mortality (ACM) and major adverse cardiovascular events (MACE)). Results Chronic conditions became more common and clustered differently across lower eGFR categories. At eGFR 90, 75, and 60 mL/min/1.73m2, most participants were in large clusters with no prominent conditions. At eGFR 15 and 30 mL/min/1.73m2, clusters involving cardiovascular conditions were larger and were at the highest risk of adverse outcomes. At eGFR 30 mL/min/1.73m2, in the heart failure, peripheral vascular disease and diabetes cluster in SCREAM, ACM hazard ratio (HR) is 2.66 (95% confidence interval (CI) 2.31–3.07) and MACE HR is 4.18 (CI 3.65–4.78); in the heart failure and atrial fibrillation cluster in SAIL, ACM HR is 2.23 (CI 2.04 to 2.44) and MACE HR is 3.43 (CI 3.22–3.64). Chronic pain and depression were common and associated with adverse outcomes when combined with physical conditions. At eGFR 30 mL/min/1.73m2, in the chronic pain, heart failure and myocardial infarction cluster in SCREAM, ACM HR is 2.00 (CI 1.62–2.46) and MACE HR is 4.09 (CI 3.39–4.93); in the depression, chronic pain and stroke cluster in SAIL, ACM HR is 1.38 (CI 1.18–1.61) and MACE HR is 1.58 (CI 1.42–1.76). Conclusions Patterns of multimorbidity and corresponding risk of adverse outcomes varied with declining eGFR. While diabetes and cardiovascular disease are known high-risk conditions, chronic pain and depression emerged as important conditions and associated with adverse outcomes when combined with physical conditions.

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“…We used data from the Stockholm Creatinine Measurements database, a health care use database of residents in Stockholm, Sweden. 13 In brief, the Stockholm Creatinine Measurements captures the complete health care use (including primary health care) and a wide range of routine laboratory test results among individuals who had plasma/serum creatinine or albuminuria measured at least once in the Stockholm region during 2006 to 2019. It has previously been estimated that around 98% of patients with CVD in the region are covered by the Stockholm Creatinine Measurements.…”

Section: Methodsmentioning

confidence: 99%

“…It has previously been estimated that around 98% of patients with CVD in the region are covered by the Stockholm Creatinine Measurements. 13 Using the unique personal identification number of each inhabitant in Sweden, these data were linked to various regional and national administrative databases providing information on health care use, including International Classification of Diseases, Tenth Revision ( ICD‐10 ) codes for all hospital admissions, causes of death, and dispensed prescription drugs. All diagnoses were coded according to the ICD‐10 .…”

Section: Methodsmentioning

confidence: 99%

Intensity of and Adherence to Lipid‐Lowering Therapy as Predictors of Major Adverse Cardiovascular Outcomes in Patients With Coronary Heart Disease

Mazhar

Hjemdahl

Clase

et al. 2022

JAHA

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Background The effectiveness of lipid‐lowering therapy (LLT) is affected by both intensity and adherence. This study evaluated the associations of LLT intensity, adherence, and the combination of these 2 aspects of LLT management with the risk of major adverse cardiovascular events (MACE) in people with coronary heart disease. Methods and Results This is an observational study of all adults who suffered a myocardial infarction or had coronary revascularization during 2012 to 2018 and initiated LLT in Stockholm, Sweden. Study exposures were LLT adherence (proportion of days covered), LLT intensity (expected reduction of low‐density lipoprotein cholesterol), and the combined measure of adherence and intensity. At each LLT fill, adherence and intensity during the previous 12 months were calculated. The primary outcomes were MACE (nonfatal myocardial infarction or stroke and death); secondary outcomes were low‐density lipoprotein cholesterol goal attainment and individual components of MACE. We studied 20 490 patients aged 68±11 years, 75% men, mean follow‐up 2.6±1.1 years. Every 10% increase in 1‐year adherence, intensity, or adherence‐adjusted intensity was associated with a lower risk of MACE (hazard ratio [HR], 0.94 [95% CI, 0.93–0.96]; HR, 0.92 [95% CI, 0.88–0.96]; and HR, 0.91 [95% CI, 0.89–0.94], respectively) and higher odds of attaining low‐density lipoprotein cholesterol goals (odds ratio [OR],1.12 [95% CI, 1.10–1.15]; OR, 1.42 [95% CI, 1.34–1.51], and OR, 1.16 [95% CI, 1.19–1.24], respectively). Among patients with good adherence (≥80%), the risk of MACE was similar with low‐moderate and high‐intensity LLT despite differences in the low‐density lipoprotein cholesterol goal attainment with the treatment intensities. Discontinuation ≥1 year increased the risk markedly (HR,1.66 [95% CI, 1.23–2.22]). Conclusions In routine care, good adherence to LLT was associated with the greatest benefit for patients with coronary heart disease. Strategies that improve adherence and use of intensive therapies could substantially reduce cardiovascular risk.

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The Stockholm CREAtinine Measurements (SCREAM) project: Fostering improvements in chronic kidney disease care

Abstract: Carrero JJ, Elinder CG. The Stockholm CREAtinine Measurements (SCREAM) project: Fostering improvements in chronic kidney disease care.

Cited by 51 publications

References 78 publications

Kidney function and prescribed dose in middle‐aged and older patients starting selective serotonin reuptake inhibitors

Kidney function and prescribed dose in middle‐aged and older patients starting selective serotonin reuptake inhibitors

The presence and impact of multimorbidity clusters on adverse outcomes across the spectrum of kidney function

Intensity of and Adherence to Lipid‐Lowering Therapy as Predictors of Major Adverse Cardiovascular Outcomes in Patients With Coronary Heart Disease

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