Trends and perspectives for improving quality of chronic kidney disease care: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Kidney International, Год журнала: 2023, Номер 104(5), С. 888 - 903

Опубликована: Май 27, 2023

Chronic kidney disease (CKD) affects over 850 million people globally, and the need to prevent its development progression is urgent. During past decade, new perspectives have arisen related quality precision of care for CKD, owing tools interventions CKD diagnosis management. New biomarkers, imaging methods, artificial intelligence techniques, approaches organizing delivering healthcare may help clinicians recognize determine etiology, assess dominant mechanisms at given time points, identify patients high risk or events. As opportunities apply concepts medicine identification management continue be developed, an ongoing discussion potential implications delivery required. The 2022 KDIGO Controversies Conference on Improving Quality Care: Trends Perspectives examined discussed best practices improving prognosis, managing complications enhancing safety care, maximizing patient life. Existing currently available treatment were identified, with current barriers their implementation strategies delivered CKD. Key knowledge gaps areas research also identified.

Язык: Английский

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Hypertension and Drug Adherence in the Elderly

Frontiers in Cardiovascular Medicine, Год журнала: 2020, Номер 7

Опубликована: Апрель 7, 2020

Hypertension is highly prevalent after the age of 65 years affecting more than 60% individuals in developed countries. Today, there sufficient evidence from clinical trials that treating elderly subjects with hypertension antihypertensive medications has a positive benefit/risk ratio even very patients (>80 years). In recent years, partial or total non-adherence been recognized as major issues long-term management all categories. However, whether frequent hypertensive older not still matter debate and common belief adherence lower younger patients. Are data supporting this belief? brief review, we discuss topic drug context medical treatment hypertension. Studies show actually better aged to 80 when compared (80 years) prevalence does increase. patients' group, are specific risk factors for such cognitive ability, depression health believes, addition classical non-adherence. One important aspect prescription potentially inappropriate will interfere necessary treatments. context, an interesting new concept was few ago, i.e. process deprescribing. Thus, today, conventional guidelines recommendations (use single pill combinations, individualization treatments), evaluation abilities, regular assessment deprescribing appear be three additional steps improve thereby ameliorate global

Язык: Английский

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Decision Algorithm for Prescribing SGLT2 Inhibitors and GLP-1 Receptor Agonists for Diabetic Kidney Disease

Clinical Journal of the American Society of Nephrology, Год журнала: 2020, Номер 15(11), С. 1678 - 1688

Опубликована: Июнь 9, 2020

Diabetic kidney disease and its comorbid conditions, including atherosclerotic cardiovascular disease, heart failure, diabetes, obesity, are interconnected conditions that compound the risk of failure mortality, exponentiate health care costs. Sodium glucose cotransporter 2 inhibitor (SGLT2i) glucagon-like peptide 1 receptor agonist (GLP-1 RA) novel diabetes medications prevent events failure. Clinical trials exploring outcomes SGLT2i GLP-1 RA have fundamentally shifted treatment paradigm diabetes. guidelines for management recommend a more holistic approach beyond glycemic control emphasize protection RA. However, adoption prescribing patients with high has been slow. In this review, we provide decision-making tool to help clinicians determine when consider protection. First, discuss comprehensive assessment diabetic disease. We compare effectiveness different categories. Then, present decision algorithm using stratification strength current evidence use Lastly, review adverse effects propose mitigation strategies.

Язык: Английский

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Medication burden and inappropriate prescription risk among elderly with advanced chronic kidney disease

BMC Geriatrics, Год журнала: 2020, Номер 20(1)

Опубликована: Март 4, 2020

Elderly patients with chronic kidney disease (CKD) frequently present comorbidities that put them at risk of polypharmacy and medication-related problems. This study aims to describe the overall medication profile aged ≥75 years advanced CKD from a multicenter French specifically renally (RIMs) potentially inappropriate-for-the-elderly medications (PIMs) they take.This is cross-sectional analysis profiles individuals eGFR < 20 ml/min/1.73 m2 followed by nephrologist, who collected their active prescriptions inclusion visit. Medication were first analyzed according route administration, therapeutic classification. Second, classified potential problems, based on whether prescription was RIM or PIM. RIMs PIMs have been defined renal appropriateness guidelines Beer's criteria in elderly. subclassified 4 types category: (a) contraindication; (b) dose modification recommended creatinine clearance (CrCl); (c) CrCl not but maximum daily mentioned, (d) no specific recommendations CrCl: "use caution", "avoid severe impairment", "careful monitoring required" "reduce dose".We 5196 individual for 556 patients, median 9 [7-11]. Antihypertensive agents, antithrombotics, antianemics classes most prescribed. Moreover, 77.0% had least 1 as RIM. They accounted 31.3% drugs prescribed 9.25% contraindicated drugs. At PIM taken 57.6 45.5% one The requiring reassessment due adverse effects proton pump inhibitors allopurinol. which deprescription especially important this population are rilmenidine, long-term benzodiazepines, anticholinergic such hydroxyzine.We showed drug-related problems elderly CKD. Healthcare providers must reassess each population, particularly identified here.NCT02910908.

Язык: Английский

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Association of Polypharmacy with Kidney Disease Progression in Adults with CKD

Clinical Journal of the American Society of Nephrology, Год журнала: 2021, Номер 16(12), С. 1797 - 1804

Опубликована: Ноя. 16, 2021

Background and objective Polypharmacy is common in patients with CKD reportedly associated adverse outcomes. However, its effect on kidney outcomes among has not been adequately elucidated. Hence, this investigation was aimed at exploring the association between polypharmacy failure requiring KRT. Design, setting, participants, measurements We retrospectively examined 1117 participants (median age, 66 years; 56% male; median eGFR, 48 ml/min per 1.73 m 2 ) enrolled Fukushima Cohort Study to investigate number of prescribed medications such as failure, all-cause mortality, cardiovascular events Japanese nondialysis-dependent CKD. hyperpolypharmacy were defined regular use 5–9 ≥10 day, respectively. Results The eight; prevalence each 38%. During observation period (median, 4.8 years), 120 developed 153 events, 109 died. Compared fewer than five medications, adjusted hazard ratios (95% confidence intervals) 2.28 (1.00 5.21) 2.83 (1.21 6.66) for 1.60 (0.85 3.04) 3.02 (1.59 5.74) 1.25 (0.62 2.53) 2.80 (1.41 5.54) mortality. Conclusions a high risk mortality under nephrology care.

Язык: Английский

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Overcoming barriers to implementing new guideline-directed therapies for chronic kidney disease

Nephrology Dialysis Transplantation, Год журнала: 2022, Номер 38(3), С. 532 - 541

Опубликована: Окт. 20, 2022

For the first time in many years, guideline-directed drug therapies have emerged that offer substantial cardiorenal benefits, improved quality of life and longevity patients with chronic kidney disease (CKD) type 2 diabetes. These treatment options include sodium-glucose cotransporter-2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists glucagon-like peptide-1 agonists. However, despite compelling evidence from multiple clinical trials, their uptake has been slow routine practice, reminiscent historical evolution angiotensin-converting enzyme inhibitor angiotensin II blocker use. The delay implementation these evidence-based highlights challenges to optimal CKD care, including: (i) inertia; (ii) low awareness; (iii) suboptimal education among providers; (iv) lack patient community engagement; (v) multimorbidity polypharmacy; (vi) primary care setting; (vii) fragmented care; (viii) disparities underserved populations; (ix) public policy focused on health equity; (x) high prices. barriers outcomes can be ameliorated by a multifaceted approach, using Chronic Care Model framework, provider education, self-management programs, shared decision making, electronic support tools, improvement initiatives, clear practice guidelines, multidisciplinary collaborative accountability, robust information technology. It is incumbent global take multidimensional perspective addressing patient-, community-, provider-, healthcare system- policy-level barriers.

Язык: Английский

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Opioid Management in Older Adults with Chronic Kidney Disease: A Review

The American Journal of Medicine, Год журнала: 2019, Номер 132(12), С. 1386 - 1393

Опубликована: Июль 8, 2019

Язык: Английский

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International prescribing patterns and polypharmacy in older people with advanced chronic kidney disease: results from the European Quality study

Nephrology Dialysis Transplantation, Год журнала: 2020, Номер 36(3), С. 503 - 511

Опубликована: Март 12, 2020

People with chronic kidney disease (CKD) are at high risk of polypharmacy. However, no previous study has investigated international prescribing patterns in this group. This article aims to examine and polypharmacy among older people advanced CKD across the countries involved European Quality (EQUAL) study.The EQUAL is an prospective cohort patients ≥65 years age CKD. Baseline demographic, clinical medication data were analysed reported descriptively. Polypharmacy was defined as ≥5 medications hyperpolypharmacy ≥10. Univariable multivariable linear regressions used determine associations between country number prescribed medications. logistic regression hyperpolypharmacy.Of 1317 participants from five countries, 91% experiencing 43% hyperpolypharmacy. Cardiovascular most (mean 3.5 per person). There differences prescribing, significantly greater Germany {odds ratio (OR) 2.75 [95% confidence interval (CI) 1.73-4.37]; P < 0.001, reference group UK}, Netherlands [OR 1.91 (95% CI 1.32-2.76); = 0.001] Italy 1.57 1.15-2.15); 0.004]. Poland experienced least 0.39 0.17-0.87); 0.021].Hyperpolypharmacy common CKD, significant prescribed. Practice variation may represent a lack consensus regarding appropriate for high-risk whom pharmacological treatment great potential harm well benefit.

Язык: Английский

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<p>Frailty Screening in Chronic Kidney Disease: Current Perspectives</p>

International Journal of Nephrology and Renovascular Disease, Год журнала: 2019, Номер Volume 12, С. 229 - 239

Опубликована: Дек. 1, 2019

Frailty has been defined as a state of increased vulnerability consequence deficit accumulation. screening not yet widely implemented into routine nephrology care. Patients with chronic kidney disease (CKD) are at high risk being frail, and frailty associated worse outcomes in this population. Standard management CKD, including initiation renal replacement therapies, may have decreased benefit or potentially cause harm the presence frailty, variety interventions for modifying CKD population proposed. The optimal means patients remains unclear. This review highlights value by summarizing exploring proposed changes to frail CKD. Finally, we will propose framework how implement standard

Язык: Английский

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<p>Safe Use of Opioids in Chronic Kidney Disease and Hemodialysis Patients: Tips and Tricks for Non-Pain Specialists</p>

Therapeutics and Clinical Risk Management, Год журнала: 2020, Номер Volume 16, С. 821 - 837

Опубликована: Сен. 1, 2020

In patients suffering from moderate-to-severe chronic kidney disease (CKD) or end-stage renal (ESRD), subjected to hemodialysis (HD), pain is very common, but often underestimated. Opioids are still the mainstay of severe management; however, their prescription in CKD and HD significantly low under-treated. Altered pharmacokinetics lack clinical trials on use opioids with impairment increase physicians' concerns this specific population. This narrative review focused correct safe HD. Morphine codeine not recommended, because accumulation metabolites may cause neurotoxic symptoms. Oxycodone hydromorphone can be safely used, adequate dosage adjustments required CKD. dialyzed patients, these should considered as second-line agents carefully monitored. According different studies, buprenorphine fentanyl could first-line management CKD; appropriate undergoing Tapentadol does need adjustment mild-to-moderate conditions; no data available its ESRD. Opioid-related side effects exacerbated by common comorbidities patients. Opioid-induced constipation managed peripherally-acting-μ-opioid-receptor-antagonists (PAMORA). Unlike other PAMORA, naldemedine require any dose Accurate diagnosis, opioid titration tailoring mandatory minimize risks improve outcome analgesic therapy.

Язык: Английский

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