What are the factors that determine treatment choices in patients with kidney failure: a retrospective cohort study using data linkage of routinely collected data in Wales

Chess, James; Roberts, Gareth; McLaughlin, Leah; Williams, Gail; Noyes, Jane

doi:10.1136/bmjopen-2023-082386

Cited by 3 publications

(1 citation statement)

References 28 publications

(58 reference statements)

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“…Even individuals with mild or early-stage CKD had about twice the likelihood of frailty compared to those without CKD, with a higher incidence of frailty observed in those with more severe CKD stages [ 37 ]. A more recent retrospective cohort study of 1,707 CKD patients revealed that half of the patients ranged from frail to severely frail [ 38 ]. Meta-analyses have further highlighted the prevalence of frailty in CKD patients, with estimates around 38.1% and 34.5% across various studies [ 39 , 40 ], though some reports have indicated a prevalence as high as 73% [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Elucidating the causal nexus and immune mediation between frailty and chronic kidney disease: integrative multi-omics analysis

Zheng,

Cheng,

Wang

et al. 2024

Renal Failure

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Background Empirical research has consistently documented the concurrent manifestation of frailty and chronic kidney disease (CKD). However, the existence of a reverse causal association or the influence of confounding variables on these correlations remains ambiguous. Methods Our analysis of 7,078 participants from National Health and Nutrition Examination Survey(NHANES) (1999–2018) applied weighted logistic regression and Mendelian Randomization (MR) to investigate the correlation between the frailty index (FI) and renal function. The multivariate MR analysis was specifically adjusted for type 2 diabetes and hypertension. Further analysis explored 3282 plasma proteins to link FI to CKD. A two-step network MR highlighted immune cells’ mediating roles in the FI-CKD relationship Result Genetically inferred FI and various renal function markers are significantly correlated, as supported by NHANES analyses. Multivariate MR analysis revealed a direct causal association between the FI and CKD. Additionally, our investigation into plasma proteins identified Tmprss11D and MICB correlated with FI and CKD, respectively. A two-step network MR to reveal 15 immune cell types, notably Central Memory CD4+ T cells and Lymphocytes, as crucial mediators between FI and CKD. Conclusion Our work establishes a causal connection between frailty and CKD, mediated by specific immune cell profiles. These findings highlight the importance of immune mechanisms in the frailty-CKD interplay and suggest that targeting shared risk factors and immune pathways could improve management strategies for these conditions. Our research contributes to a more nuanced understanding of frailty and CKD, offering new avenues for intervention and patient care in an aging population.

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Section: Discussionmentioning

confidence: 99%

Elucidating the causal nexus and immune mediation between frailty and chronic kidney disease: integrative multi-omics analysis

Zheng,

Cheng,

Wang

et al. 2024

Renal Failure

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Staying home when peritoneal dialysis ends: the integrated home dialysis approach

Pecce,

Belhumeur,

Nadeau-Fredette

2024

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of review Home dialysis has been promoted for several years for patients starting dialysis. Although incident use of peritoneal dialysis (PD) and home hemodialysis (HHD) is increasing in several regions, patients on home dialysis remain at high risk of transfer to facility-hemodialysis (HD). The integrated home dialysis model, where patient start dialysis on PD and eventually transition to HHD when PD cannot be optimally continued has gain interest from dialysis stakeholders. Recent findings Transfers from PD to HHD are infrequently used among patients ending PD, representing between 2% and 6% of transfers to HD in registry studies. Nonetheless, this approach is associated with several clinical benefits as well as favorable cost-effectiveness. Summary In this review, we will present data pertaining to home dialysis and the integrated home dialysis model, with broad discussion of the implementation challenges, including identifying patients who could most benefit from this approach, timely planning of the transitions and challenges relating to unexpected PD endings.

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Treatment response amplitude and timing in chronic inflammatory demyelinating polyneuropathy with routine care: Study of a UK cohort

Rajabally,

Min,

Nazeer

et al. 2024

Euro J of Neurology

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Background and purposeThe amplitude, timing, and determinants of improvement with available treatments are uncertain in chronic inflammatory demyelinating polyneuropathy (CIDP). Our primary objective was to quantify categorized outcomes with routine care.MethodsWe retrospectively studied treatment response within 36 months from initiation in 112 consecutive subjects with CIDP. Response was classified into a proposed new "CIDP treatment‐response category" (CT‐RC), based on achieved endpoints. Determinants of the CT‐RC, of timing of maximum improvement, and of treatment discontinuation were ascertained.ResultsThe CT‐RC demonstrated high concurrent validity with current outcome measures. Thirty‐six subjects (32.1%) achieved a “complete response,” 37 (33%) a “good partial response,” 10 (8.9%) a “moderate partial response,” and 15 (13.4%) a “poor partial response.” Fourteen subjects (12.5%) were “nonresponsive.” The CT‐RC was independently predicted only by age. Mean time to maximum improvement was 12.1 months (range = 1–36) and was not associated with any pretreatment covariate. Treatment discontinuation occurred in 24 of 62 (38.2%) partial responders and was only associated with shorter pretreatment disease duration. Nonresponders were older and received a similar number of treatments compared to responders.ConclusionsCT‐RC classification indicates persistent disability in >60% of treatment responders in CIDP. Timing of maximum improvement is variable, frequently delayed, and unpredictable. Treatment withdrawal without deterioration is achievable in approximately 40% of subjects and may be more likely with prompt treatment. Treatment withdrawal in partial responders and limited escalation in nonresponders suggest implication of physician‐ and patient‐related factors in suboptimal response. More effective treatments/treatment methods and better understanding of other factors influencing response are needed in CIDP.

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What are the factors that determine treatment choices in patients with kidney failure: a retrospective cohort study using data linkage of routinely collected data in Wales

Cited by 3 publications

References 28 publications

Elucidating the causal nexus and immune mediation between frailty and chronic kidney disease: integrative multi-omics analysis

Elucidating the causal nexus and immune mediation between frailty and chronic kidney disease: integrative multi-omics analysis

Staying home when peritoneal dialysis ends: the integrated home dialysis approach

Treatment response amplitude and timing in chronic inflammatory demyelinating polyneuropathy with routine care: Study of a UK cohort

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