Nephron Clinical Practice最新文献_第8页

The reimbursement and cost of acute kidney injury: a UK hospital perspective. 急性肾损伤的报销和费用:英国医院的观点。

Nephron Clinical Practice Pub Date : 2014-01-01 Epub Date: 2014-02-08 DOI: 10.1159/000358435

Nitin V Kolhe, Mohamed T Eldehni, Nicholas M Selby, Christopher W McIntyre

{"title":"The reimbursement and cost of acute kidney injury: a UK hospital perspective.","authors":"Nitin V Kolhe, Mohamed T Eldehni, Nicholas M Selby, Christopher W McIntyre","doi":"10.1159/000358435","DOIUrl":"https://doi.org/10.1159/000358435","url":null,"abstract":"Background: Despite the great interest in acute kidney injury (AKI), there have been very few studies that examined the economic impact and costing methodologies of AKI. We aimed to examine the cost and income of AKI in hospitalised patients over a period of 1 year using the NHS costing system related to that year.Methods: A total of 627 patients discharged between January 2008 and December 2008 with AKI were identified by International Classification of Disease 10 codes (ICD-10). Basic demographic data were collected using the hospital electronic records, and the severity of AKI was classified according to the Acute Kidney Injury Network (AKIN) classification. We calculated the total income and isolated the AKI income related to AKI-specific finished consultant episodes. Then we conducted a patient level costing exercise using relative value units (RVU) to compare the cost of AKI to the actual income.Results: The total spell income for all patients was GBP 1,954,922.7; the mean total income per patient was GBP 3,752.3 (95% CI 3,594.6-3,903.9). AKIN stage 3 generated significantly higher total spell and AKI income. The estimated overall cost of treating AKI was higher than the AKI income to the Primary Care Trust (GBP 1,984,543.9 vs. 1,755,395).Conclusion: AKIN stage 3 has a significant economic impact when compared with AKIN stages 1 and 2. The move towards a patient level costing using RVU could be a more efficient way to match cost and income.","PeriodicalId":19094,"journal":{"name":"Nephron Clinical Practice","volume":"126 1","pages":"51-6"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000358435","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32103981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 18

How can we define recovery after acute kidney injury? Considerations from epidemiology and clinical trial design. 如何定义急性肾损伤后的恢复?从流行病学和临床试验设计的考虑。

Nephron Clinical Practice Pub Date : 2014-01-01 Epub Date: 2014-09-24 DOI: 10.1159/000363681

John A Kellum

引用次数: 49

Biomarkers in acute kidney injury: are we ready for prime time? 急性肾损伤的生物标志物:我们准备好了吗?

Nephron Clinical Practice Pub Date : 2014-01-01 Epub Date: 2014-09-24 DOI: 10.1159/000363206

Prasad Devarajan, Patrick Murray

引用次数: 23

The evolution of pediatric continuous renal replacement therapy. 儿童持续肾替代疗法的发展。

Nephron Clinical Practice Pub Date : 2014-01-01 Epub Date: 2014-09-24 DOI: 10.1159/000363204

Francesco Garzotto, Monica Zanella, Claudio Ronco

引用次数: 20

Limitations of standard immunosuppressive treatment in ANCA-associated vasculitis and lupus nephritis. 标准免疫抑制治疗anca相关血管炎和狼疮性肾炎的局限性。

Nephron Clinical Practice Pub Date : 2014-01-01 Epub Date: 2014-11-19 DOI: 10.1159/000368569

Vladimir Tesar, Zdenka Hruskova

引用次数: 18

Fat mass gain predicts estimated GFR decline in a relatively healthy Korean population. 在相对健康的韩国人群中，脂肪量的增加预示着GFR的估计下降。

Nephron Clinical Practice Pub Date : 2014-01-01 Epub Date: 2014-03-12 DOI: 10.1159/000360363

Young Youl Hyun, Hyang Kim, Kyu Beck Lee

{"title":"Fat mass gain predicts estimated GFR decline in a relatively healthy Korean population.","authors":"Young Youl Hyun, Hyang Kim, Kyu Beck Lee","doi":"10.1159/000360363","DOIUrl":"https://doi.org/10.1159/000360363","url":null,"abstract":"Background: Previous studies have shown that obesity is a risk factor for estimated glomerular filtration rate (eGFR) decline and chronic kidney disease (CKD). However, the relationship between fat mass directly measured by bioimpedance analysis and eGFR is not well known.Methods: We analyzed 21,859 participants without CKD at baseline who underwent two health checkups at a 5-year interval during 2002-2009. Fat mass was measured by Inbody 3.0 (Biospace, Seoul, Korea). eGFR decline was defined as eGFR <60 ml/min/1.73 m(2) at second checkup. Logistic regression analysis was used to analyze factors related to eGFR decline.Results: Participants were divided into tertiles according to their fat mass change over 5 years: lower tertile (n = 7,042; <-0.7 kg), middle tertile (n = 7,478; -0.7 to 1.2 kg) and higher tertile (n = 7,339; >1.2 kg). After 5 years, 246 cases of eGFR decline were observed. Multivariate logistic analysis revealed that age (OR 1.03, 95% CI 1.02-1.05, p < 0.001), diabetes mellitus (OR 2.04, 95% CI 1.22-3.40, p = 0.007), baseline eGFR (OR 0.80, 95% CI 0.78-0.83, p < 0.001) and higher tertile of fat mass change (OR 1.58, 95% CI 1.16-2.13, p = 0.003) were associated with eGFR decline after adjustment for sex, hypertension, dyslipidemia, cardiovascular disease, smoking status, body mass index, and high-density lipoprotein cholesterol level.Conclusions: Fat mass gain over 5 years was independently associated with eGFR decline to <60 ml/min/1.73 m(2) in a relatively healthy Korean population. This finding suggests that lifestyle changes to prevent fat mass gain could be protective against the development of CKD.","PeriodicalId":19094,"journal":{"name":"Nephron Clinical Practice","volume":"126 1","pages":"90-6"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000360363","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32188121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 8

Update on rituximab: an established treatment for all immune-mediated kidney diseases? 利妥昔单抗的最新进展:一种治疗所有免疫介导肾病的既定疗法?

Nephron Clinical Practice Pub Date : 2014-01-01 Epub Date: 2014-03-26 DOI: 10.1159/000358887

Rhys Evans, Alan D Salama

{"title":"Update on rituximab: an established treatment for all immune-mediated kidney diseases?","authors":"Rhys Evans, Alan D Salama","doi":"10.1159/000358887","DOIUrl":"https://doi.org/10.1159/000358887","url":null,"abstract":"Rituximab, a monoclonal antibody directed against the CD20 antigen, found on certain B-cell subsets, results in significant B-cell depletion and has been increasingly used in immune-mediated renal disease and transplantation. Although originally applied to what were considered antibody-mediated diseases, it has become clear that auto- and alloreactive B cells contribute in many ways to immune dysfunction, and the benefit of B-cell depletion extends beyond reduction in auto- or alloantibody levels. Most positive data regarding the benefit of rituximab in immune-mediated kidney disease have come from uncontrolled cohort studies, with the only positive controlled clinical trials demonstrating efficacy for the treatment of systemic vasculitis. While negative trials may have potentially missed clinical effects due to trial design, there may be significant differences in responses in different diseases or lack of efficacy due to therapeutic overlap when used with certain drug combinations. Rituximab is a novel treatment that provides a clear alternative for patients in different clinical situations, and allows for customization of therapy. However, much remains to be understood as to how best to use it in a cost-effective manner, when not to use it, and what the long-term impact of therapy may be.","PeriodicalId":19094,"journal":{"name":"Nephron Clinical Practice","volume":"126 3","pages":"97-109"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000358887","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32223349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 8

The effects of acute kidney injury on long-term renal function and proteinuria in a general hospitalised population. 急性肾损伤对普通住院人群长期肾功能和蛋白尿的影响

Nephron Clinical Practice Pub Date : 2014-01-01 Epub Date: 2014-11-28 DOI: 10.1159/000368243

Kerry L Horne, Rebecca Packington, John Monaghan, Timothy Reilly, Christopher W McIntyre, Nicholas M Selby

{"title":"The effects of acute kidney injury on long-term renal function and proteinuria in a general hospitalised population.","authors":"Kerry L Horne, Rebecca Packington, John Monaghan, Timothy Reilly, Christopher W McIntyre, Nicholas M Selby","doi":"10.1159/000368243","DOIUrl":"https://doi.org/10.1159/000368243","url":null,"abstract":"Background: Acute kidney injury (AKI) is common in hospitalised patients and is associated with adverse long-term consequences. There is an urgent need to understand these sequelae in general hospitalised patients utilising a prospective cohort-based approach. We aimed to test the feasibility of study methodology prior to commencing a large-scale study and investigate the effects of AKI on chronic kidney disease (CKD) progression and proteinuria.Methods: Pilot study testing novel methodology for remote patient recruitment within a prospective case-control design. 300 cases (hospitalised patients with AKI) and controls (hospitalised patients without AKI) were matched 1:1 for age and baseline estimated glomerular filtration rate (eGFR). 70% of cases had AKI stage 1, 16% AKI stage 2 and 14% AKI stage 3. Renal function and proteinuria were measured 3 and 12 months after hospital admission.Results: The study met pre-defined recruitment, withdrawal and matching criteria. Renal function was worse in the AKI group at 3 (eGFR 61 ± 20 vs. 74 ± 23 ml/min/1.73 m(2), p < 0.001) and 12 months (eGFR 64 ± 23 vs. 75 ± 25 ml/min/1.73 m(2), p < 0.001). More cases than controls had CKD progression at 3 months (14 vs. 0.7%, p < 0.001). This difference persisted to 12 months, but there was no significant change between 3 and 12 months. Proteinuria and albuminuria were more prevalent in the AKI group and associated with CKD progression.Conclusions: We describe a method of remote patient recruitment which could be employed more widely for prospective observational studies. Even mild AKI is associated with long-term renal dysfunction. Further investigation using this methodology is now underway.","PeriodicalId":19094,"journal":{"name":"Nephron Clinical Practice","volume":"128 1-2","pages":"192-200"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000368243","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32877651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 20

Uremic toxins and their effects on multiple organ systems. 尿毒症毒素及其对多器官系统的影响。

Nephron Clinical Practice Pub Date : 2014-01-01 Epub Date: 2014-12-19 DOI: 10.1159/000369817

Barbara Lisowska-Myjak

引用次数: 97

The (99m)Tc-DTPA urinary clearance method may be preferable to the plasma disappearance method for assessing glomerular filtration rate in diabetic nephropathy. (99m)Tc-DTPA尿清除率法评估糖尿病肾病肾小球滤过率可能优于血浆消失法。

Nephron Clinical Practice Pub Date : 2014-01-01 Epub Date: 2015-01-08 DOI: 10.1159/000368901

Shih-Han S Huang, Misha Eliasziw, J David Spence, Guido Filler, William C Vezina, David N Churchill, Daniel C Cattran, Bonnie Richardson, Andrew A House

{"title":"The (99m)Tc-DTPA urinary clearance method may be preferable to the plasma disappearance method for assessing glomerular filtration rate in diabetic nephropathy.","authors":"Shih-Han S Huang, Misha Eliasziw, J David Spence, Guido Filler, William C Vezina, David N Churchill, Daniel C Cattran, Bonnie Richardson, Andrew A House","doi":"10.1159/000368901","DOIUrl":"https://doi.org/10.1159/000368901","url":null,"abstract":"Background: Isotopic glomerular filtration rate (iGFR) measurement is comparable to the inulin method. In this study, we compared urinary and plasma iGFR methodologies in patients with diabetic nephropathy.Methods: A total of 147 patients from 3 sites in the Diabetic Intervention with Vitamins to Improve Nephropathy (DIVINe) trial provided 213 sets of urine and blood collections, at baseline, 18 and 36 months.Results: The mean (with standard deviation) plasma iGFR of 60.7 (24.9) ml/min/1.73 m(2) compared to urinary iGFR of 52.0 (28.0) ml/min/1.73 m(2) was statistically significant (p value <0.001). Although plasma and urinary iGFRs were highly related (R(2) = 0.86), plasma iGFR increasingly overestimated urinary iGFRs at lower GFRs. In contrast to the cross-sectional analyses, the two measures of iGFR were weakly related (R(2) = 0.32) in regard to patients' change over 18 months of follow-up.Conclusion: Plasma iGFR may not be a suitable method for accurately measuring GFR in patients with advancing degrees of chronic kidney disease from diabetic nephropathy.","PeriodicalId":19094,"journal":{"name":"Nephron Clinical Practice","volume":"128 3-4","pages":"367-72"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000368901","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32960764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3