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  • 1
    facet.materialart.web_resource
    facet.materialart.web_resource
    2015
    Language: German
    Description: Provider: Deutsche Digitale Bibliothek - Institution: Deutsche Nationalbibliothek - Data provided by Europeana Collections- All metadata published by Europeana are available free of restriction under the Creative Commons CC0 1.0 Universal Public Domain Dedication. However, Europeana requests that you actively acknowledge and give attribution to all metadata sources including Europeana
    Subject(s): Bibliotheks- und Informationswissenschaft ; Bibliotheks- und Informationswissenschaften ; Library and information sciences ; PDA Patron-Driven-Acquisition Öffentliche Bibliothek Leihverkehrs- und Ergänzungsbibliothek Schleswig-Holstein
    Source: Europeana Collections
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  • 2
    Language: English
    In: F1000 research, 2019, Vol.8, p.1618
    Description: Background: Evidence for kidney function monitoring intervals in primary care is weak, and based mainly on expert opinion. In the absence of trials of monitoring strategies, an approach combining a model for the natural history of kidney function over time combined with a cost-effectiveness analysis offers the most feasible approach for comparing the effects of monitoring under a variety of policies. This study aimed to create a model for kidney disease progression using routinely collected measures of kidney function. Methods: This is an open cohort study of patients aged ≥18 years, registered at 643 UK general practices contributing to the Clinical Practice Research Datalink between 1 April 2005 and 31 March 2014. At study entry, no patients were kidney transplant donors or recipients, pregnant or on dialysis. Hidden Markov models for estimated glomerular filtration rate (eGFR) stage progression were fitted to four patient cohorts defined by baseline albuminuria stage; adjusted for sex, history of heart failure, cancer, hypertension and diabetes, annually updated for age. Results: Of 1,973,068 patients, 1,921,949 had no recorded urine albumin at baseline, 37,947 had normoalbuminuria (〈3mg/mmol), 10,248 had microalbuminuria (3–30mg/mmol), and 2,924 had macroalbuminuria (〉30mg/mmol). Estimated annual transition probabilities were 0.75–1.3%, 1.5–2.5%, 3.4–5.4% and 3.1–11.9% for each cohort, respectively. Misclassification of eGFR stage was estimated to occur in 12.1% (95%CI: 11.9–12.2%) to 14.7% (95%CI: 14.1–15.3%) of tests. Male gender, cancer, heart failure and age were independently associated with declining renal function, whereas the impact of raised blood pressure and glucose on renal function was entirely predicted by albuminuria. Conclusions: True kidney function deteriorates slowly over time, declining more sharply with elevated urine albumin, increasing age, heart failure, cancer and male gender. Consecutive eGFR measurements should be interpreted with caution as observed improvement or deterioration may be due to misclassification.
    ISSN: 2046-1402
    E-ISSN: 2046-1402
    Source: PubMed Central
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  • 3
    Language: English
    In: PLoS medicine, 2020-12, Vol.17 (12), p.e1003478-e1003478
    Description: People with reduced kidney function have increased cardiovascular disease (CVD) risk. We present a policy model that simulates individuals' long-term health outcomes and costs to inform strategies to reduce risks of kidney and CVDs in this population. We used a United Kingdom primary healthcare database, the Clinical Practice Research Datalink (CPRD), linked with secondary healthcare and mortality data, to derive an open 2005-2013 cohort of adults (≥18 years of age) with reduced kidney function (≥2 measures of estimated glomerular filtration rate [eGFR] 〈90 mL/min/1.73 m2 ≥90 days apart). Data on individuals' sociodemographic and clinical characteristics at entry and outcomes (first occurrences of stroke, myocardial infarction (MI), and hospitalisation for heart failure; annual kidney disease stages; and cardiovascular and nonvascular deaths) during follow-up were extracted. The cohort was used to estimate risk equations for outcomes and develop a chronic kidney disease-cardiovascular disease (CKD-CVD) health outcomes model, a Markov state transition model simulating individuals' long-term outcomes, healthcare costs, and quality of life based on their characteristics at entry. Model-simulated cumulative risks of outcomes were compared with respective observed risks using a split-sample approach. To illustrate model value, we assess the benefits of partial (i.e., at 2013 levels) and optimal (i.e., fully compliant with clinical guidelines in 2019) use of cardioprotective medications. The cohort included 1.1 million individuals with reduced kidney function (median follow-up 4.9 years, 45% men, 19% with CVD, and 74% with only mildly decreased eGFR of 60-89 mL/min/1.73 m2 at entry). Age, kidney function status, and CVD events were the key determinants of subsequent morbidity and mortality. The model-simulated cumulative disease risks corresponded well to observed risks in participant categories by eGFR level. Without the use of cardioprotective medications, for 60- to 69-year-old individuals with mildly decreased eGFR (60-89 mL/min/1.73 m2), the model projected a further 22.1 (95% confidence interval [CI] 21.8-22.3) years of life if without previous CVD and 18.6 (18.2-18.9) years if with CVD. Cardioprotective medication use at 2013 levels (29%-44% of indicated individuals without CVD; 64%-76% of those with CVD) was projected to increase their life expectancy by 0.19 (0.14-0.23) and 0.90 (0.50-1.21) years, respectively. At optimal cardioprotective medication use, the projected health gains in these individuals increased by further 0.33 (0.25-0.40) and 0.37 (0.20-0.50) years, respectively. Limitations include risk factor measurements from the UK routine primary care database and limited albuminuria measurements. The CKD-CVD policy model is a novel resource for projecting long-term health outcomes and assessing treatment strategies in people with reduced kidney function. The model indicates clear survival benefits with cardioprotective treatments in this population and scope for further benefits if use of these treatments is optimised.
    Subject(s): Markov Chains ; Prognosis ; Cardiovascular Diseases - prevention & control ; Humans ; Middle Aged ; Male ; Preventive Health Services - economics ; Renal Insufficiency, Chronic - therapy ; Time Factors ; England - epidemiology ; Aged, 80 and over ; Cardiovascular Diseases - mortality ; Renal Insufficiency, Chronic - mortality ; Female ; Renal Insufficiency, Chronic - economics ; Kidney - physiopathology ; Cardiovascular Diseases - economics ; Databases, Factual ; Models, Theoretical ; Glomerular Filtration Rate ; Risk Assessment ; Risk Factors ; Renal Insufficiency, Chronic - physiopathology ; Health Care Costs ; Quality of Life ; Aged ; Health Status ; Usage ; Chronic kidney failure ; Analysis ; Medical care ; Research ; Cardiovascular diseases ; Health aspects ; Risk factors ; Quality management ; Complications and side effects ; Kidney function tests ; Patient outcomes ; Diagnosis ; Kidney diseases ; Methods ; Index Medicus ; Heart failure ; Creatinine ; Heart attacks ; Statistical analysis ; Kidneys ; Epidermal growth factor receptors ; Mortality ; Cardiovascular disease ; Population studies ; Patients ; Primary care ; Medical prognosis ; Registration ; Age
    ISSN: 1549-1277
    E-ISSN: 1549-1676
    Source: Academic Search Ultimate
    Source: PubMed Central
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  • 4
    Article
    Article
    2014
    ISSN: 0009-9104  ISSN: 1365-2249 
    Language: English
    In: Clinical and experimental immunology, 2014, Vol.178 (1), p.18-20
    Subject(s): Immunologic Deficiency Syndromes - therapy ; Immunization, Passive - methods ; Immunoglobulins - immunology ; Europe ; Humans ; Registries ; Immunoglobulins - therapeutic use ; Immunologic Deficiency Syndromes - immunology ; Pediatrics ; Immunization ; Immunoglobulins ; Clinical Laboratory Medicine ; Passive ; Pediatrik ; methods ; therapy ; Klinisk laboratoriemedicin ; Immunologic Deficiency Syndromes ; immunology ; therapeutic use
    ISSN: 0009-9104
    ISSN: 1365-2249
    E-ISSN: 1365-2249
    Source: Hellenic Academic Libraries Link
    Source: Academic Search Ultimate
    Source: PubMed Central
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