Minneapolis, MN, United States
Minneapolis, MN, United States

Time filter

Source Type

Obrador G.T.,Panamerican University of Mexico | Mahdavi-Mazdeh M.,Tehran University of Medical Sciences | Collins A.J.,Chronic Disease Research Group
American Journal of Kidney Diseases | Year: 2011

The Global Kidney Disease Prevention Network is an international public health organization devoted to encouraging and enhancing efforts to increase awareness and recognition of kidney disease, detect it early, and provide treatment to prevent disease progression, improve patient outcomes, and decrease costs. Twenty-six participants from 12 low-, middle-, and high-income countries attended the first meeting, held in Geneva, Switzerland, on September 12-13, 2009. Work groups discussed target populations for chronic kidney disease (CKD) screening, optimal parameters for screening on a public health level, evaluating the impact of early screening programs, and use of screening data to inform health care policy. Of the screening programs discussed, most have targeted populations at high risk of CKD and have included medical history; weight, height, and blood pressure measurements; and blood and urine tests. In screenees, CKD prevalence ranged from 11%-33%. In screenees with CKD, few were aware of the disease, although substantial proportions had been seen by a physician in the previous 6-12 months. At the policy level, prevention of CKD implies prevention and control of risk-factor conditions, including diabetes, hypertension, and others. Given the high prevalence and under-recognition of CKD in different countries, a concerted effort to globally improve primary and secondary CKD prevention appears to be warranted. © 2011 National Kidney Foundation, Inc.

Gilbertson D.T.,Chronic Disease Research Group | Monda K.L.,Amgen | Bradbury B.D.,Amgen | Collins A.J.,Chronic Disease Research Group
American Journal of Kidney Diseases | Year: 2013

Background: Changes in anemia management over the past decade have produced downward shifts in hemoglobin concentrations. We aimed to examine the effect on use of red blood cell (RBC) transfusions. Study Design: Retrospective cohort study. Setting & Participants: We identified point prevalent Medicare hemodialysis patients as of January 1 of each year (1999-2010) and categorized them based on 3-month (April to June) mean hemoglobin levels (<10 or ≥10 g/dL) in each year. Predictors: Hemoglobin patterns over time and clinical profiles based on achieved hemoglobin concentrations. Outcomes: RBC transfusion use. Measurements: We used negative binomial modeling to examine the effect of hemoglobin level <10 g/dL on transfusion use, adjusting for case-mix differences. Results: Proportions of patients with mean hemoglobin levels <10 g/dL decreased from 10% (1999) to ∼4% (2005), but began increasing after 2006 and reached 6% by 2010. Accounting for case-mix differences, transfusion rates remained relatively constant at approximately 7.9 per 100 person-months for patients with hemoglobin levels <10 g/dL and 2 per 100 person-months for patients with hemoglobin levels ≥10 g/dL. Patients with average hemoglobin levels <10 g/dL were more likely to receive transfusions (risk ratio, 2.2; 95% CI, 2.1-2.2) even after adjustment; the risk ratio doubled if hemoglobin levels remained <10 g/dL for 6 months (4.4; 95% CI, 3.7-5.2). Limitations: Limited in generalizability to patients with Medicare as primary payer; residual confounding from factors such as frailty and chronic inflammation cannot be excluded; categorizing patients based on an average of 3 outpatient hemoglobin measurements may introduce some misclassification. Conclusions: Risk of transfusion increases substantially with hemoglobin concentrations <10 g/dL; risk appears to be independent of other clinical factors. If anemia management patterns shift toward lower hemoglobin concentrations, RBC transfusion use likely will increase in dialysis patients. © 2013 National Kidney Foundation, Inc.

Dharnidharka V.R.,University of Florida | Lamb K.E.,University of Florida | Lamb K.E.,Chronic Disease Research Group | Gregg J.A.,University of Florida | Meier-Kriesche H.-U.,University of Florida
American Journal of Transplantation | Year: 2012

In a prior multiorgan transplant database study, recipient Epstein - Barr virus (EBV) seronegativity was not associated with increased risk for posttransplant lymphoproliferative disorders (PTLD) in liver transplants (LTX), at variance with prior single center reports and with data from kidney and heart transplants (KTX and HTX). The Scientific Registry of Transplant Recipients (SRTR) in the United States is the only other registry with data on the required variables for comparison. Our study set comprised 112 756 KTX (580 PTLDs; 0.51%), 13 937 HTX (140 PTLDs; 1.0%) and 40 437 LTX (383 PTLDs; 0.95%) performed January 2003 onward. The unadjusted hazard ratio (HR) for PTLD if recipient EBV seronegative was 5.005 for KTX, 6.528 for HTX and 2.615 for LTX (p < 0.001 for all). In models adjusted for multiple covariates, the adjusted HR was 3.583 (p < 0.001) for KTX, 4.037 (p < 0.001) for HTX, 1.479 (p = 0.03) for LTX. Interaction models using EBV seropositive KTX as reference group showed significantly higher risk for all other EBV seronegative organ transplant groups and also for EBV seropositive LTX (AHR 2.053, p < 0.0001).Recipient EBV seronegativity is still significantly associated with risk for PTLD in LTX, though less so because of higher baseline risk in the EBV seropositive LTX group. © Copyright 2011 The American Society of Transplantation and the American Society of Transplant Surgeons.

Majhail N.S.,Center for International Blood and Marrow Transplant Research | Mau L.W.,Chronic Disease Research Group | Denzen E.M.,National Marrow Donor Program | Arneson T.J.,Chronic Disease Research Group
Bone Marrow Transplantation | Year: 2013

There is a lack of multi-center cost-identification studies for hematopoietic cell transplantation (HCT). We used a single longitudinal administrative claims database representing a national, commercially insured population to evaluate the feasibility of identifying HCT recipients and to establish a cohort of autologous and allogeneic HCT recipients to study inpatient and outpatient direct medical costs from transplant hospitalization through first 100 days post-transplantation. Using ICD-9 procedure and diagnosis codes, we identified 3365 patients who had received their first transplant in the United States between 2007 and 2009 (autologous, 1678, allogeneic, 1320, graft source not specified, 367). The median 100-day total costs for autologous HCT were 99 899 (interquartile range (IQR), 73 914-140 555), and for allogeneic HCT were 203 026 (IQR, 141 742-316 426). The majority of costs (>75%) occurred during the initial transplant hospitalization for both autologous and allogeneic HCT recipients. Costs were greater among pediatric (≤20 years) compared with adult (>20 years) recipients and this difference was more pronounced with allogeneic HCT. Using a claims database representing a national HCT population, we highlight the high costs associated with autologous and allogeneic HCT. Our study lays the foundation for using claims data for future research on economic aspects of HCT. © 2013 Macmillan Publishers Limited All rights reserved.

Weinhandl E.D.,Chronic Disease Research Group | Liu J.,Chronic Disease Research Group | Gilbertson D.T.,Chronic Disease Research Group | Arneson T.J.,Chronic Disease Research Group | And 2 more authors.
Journal of the American Society of Nephrology | Year: 2012

Frequent hemodialysis improves cardiovascular surrogates and quality-of-life indicators, but its effect on survival remains unclear. We used a matched-cohort design to assess relative mortality in daily home hemodialysis and thrice-weekly in-center hemodialysis patients between 2005 and 2008. We matched 1873 home hemodialysis patients with 9365 in-center patients (i.e., 1:5 ratio) selected from the prevalent population in the US Renal Data System database. Matching variables included first date of follow-up, demographic characteristics, and measures of disease severity. The cumulative incidence of death was 19.2% and 21.7% in the home hemodialysis and in-center patients, respectively. In the intention-to-treat analysis, home hemodialysis associated with a 13% lower risk for all-cause mortality than in-center hemodialysis (hazard ratio [HR], 0.87; 95%confidence interval [95%CI], 0.78-0.97). Cause-specificmortality HRs were 0.92 (95% CI, 0.78-1.09) for cardiovascular disease, 1.13 (95% CI, 0.84-1.53) for infection, 0.63 (95% CI, 0.41-0.95) for cachexia/dialysis withdrawal, 1.06 (95%CI, 0.81-1.37) for other specified cause, and 0.59 (95% CI, 0.44-0.79) for unknown cause. Findings were similar using as-treated analyses. We did not detect statistically significant evidence of heterogeneity of treatment effects in subgroup analyses. In summary, these data suggest that relative to thrice-weekly in-center hemodialysis, daily home hemodialysis associates with modest improvements in survival. Continued surveillance should strengthen inference about causes of mortality and determine whether treatment effects are homogeneous throughout the dialysis population. Copyright © 2012 by the American Society of Nephrology.

Weinhandl E.D.,Chronic Disease Research Group | Arneson T.J.,Chronic Disease Research Group | St. Peter W.L.,Chronic Disease Research Group | St. Peter W.L.,University of Minnesota
American Journal of Kidney Diseases | Year: 2013

Background: Reducing medication-related problems and improving medication adherence in hemodialysis patients may improve clinical outcomes. In 2005, a large US dialysis organization created an integrated pharmacy program for its patients. We aimed to compare the outcomes of hemodialysis patients enrolled in this program and matched control patients. Study Design: Quality improvement report. Setting & Participants: Hemodialysis patients with concurrent Medicare and Medicaid eligibility who chose to receive program services and propensity score-matched controls; the propensity score was an estimated function of demographic characteristics, comorbid conditions, medication exposure, serum concentrations, and vascular access method. Quality Improvement Plan: Program services included medication delivery, refill management, medication list reviews, telephonic medication therapy management, and prior authorization assistance. Outcomes: Relative rates of death and hospitalization. Measurements: Survival estimates calculated with the Kaplan-Meier method; mortality hazards compared with Cox regression; hospitalization rates compared with Poisson regression. Results: In outcome models, there were 8,864 patients receiving integrated pharmacy services and 43,013 matched controls. In intention-to-treat and as-treated analyses, mortality HRs for patients receiving integrated pharmacy services versus matched controls were 0.92 (95% CI, 0.86-0.97) and 0.79 (95% CI, 0.74-0.84), respectively. Corresponding relative rates of hospital admissions were 0.98 (95% CI, 0.95-1.01) and 0.93 (95% CI, 0.90-0.96), respectively, and of hospital days, 0.94 (95% CI, 0.90-0.98) and 0.86 (95% CI, 0.82-0.90), respectively. Cumulative incidences of disenrollment from the pharmacy program were 23.4% at 12 months and 37.0% at 24 months. Limitations: Patients were not randomly assigned to receive integrated pharmacy services; as-treated analyses may be biased because of informative censoring by disenrollment from the pharmacy program; data regarding use of integrated pharmacy services were lacking. Conclusions: Receipt of integrated pharmacy services was associated with lower rates of death and hospitalization in hemodialysis patients with concurrent Medicare and Medicaid eligibility. Studies are needed to measure pharmacy program use and assess detailed clinical and economic outcomes. © 2013 National Kidney Foundation, Inc.

Foley R.N.,Chronic Disease Research Group | Foley R.N.,University of Minnesota | Ibrahim H.N.,University of Minnesota
Current Opinion in Nephrology and Hypertension | Year: 2010

Purpose of Review: Partial renal ablation in laboratory animals leads initially to compensatory glomerular hyperfiltration and progressive, sclerotic kidney disease. In addition, modest declines in kidney function are associated with premature mortality in epidemiological studies. Hence, the long-term safety of living-kidney donation is an important issue. The purpose of this review was to examine existing research on outcomes among living-kidney transplant donors, with a focus on longer term outcomes. RECENT FINDINGS: Although studies with sibling controls are unavailable, the current evidence base suggests that kidney donors have mortality and end-stage renal disease risks that are equivalent to similar individuals in the general population. Although findings for albuminuria and hypertension vary between studies, risks may be acceptable if donors receive optimal follow-up and care. Parenthetically, viewed as an experimental model of kidney-function loss, the neutrality of outcomes among donors may have major implications for the population at large: the robust associations between modest declines in kidney function and mortality seen in the general population suggest a confounded relationship and finding these confounders could have major implications for future research directions and for public health. Summary: Long-term outcomes suggest that kidney donation is not a major threat to longevity. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Weinhandl E.D.,Chronic Disease Research Group | Nieman K.M.,Chronic Disease Research Group | Gilbertson D.T.,Chronic Disease Research Group | Collins A.J.,Chronic Disease Research Group | Collins A.J.,University of Minnesota
American Journal of Kidney Diseases | Year: 2014

Background: Cardiovascular disease is a common cause of hospitalization in dialysis patients. Daily hemodialysis improves some parameters of cardiovascular function, but whether it associates with lower hospitalization risk is unclear. Study Design: Observational cohort study using US Renal Data System data. Setting & Participants: Medicare-enrolled daily (5 or 6 sessions weekly) home hemodialysis (HHD) patients initiating NxStage System One use from January 1, 2006, through December 31, 2009, and contemporary thriceweekly in-center hemodialysis patients, matched 5 to 1. Predictor: Daily HHD or thrice-weekly in-center hemodialysis. Outcomes & Measurements: All-cause and cause-specific hospital admissions, hospital readmissions, and hospital days assessed from Medicare Part A claims. Results: For 3,480 daily HHD and 17,400 thrice-weekly in-center hemodialysis patients in intention-to-treat analysis, the HR of all-cause admission for daily HHD versus in-center hemodialysis was 1.01 (95% CI, 0.98- 1.03). Cause-specific admission HRs were 0.89 (95% CI, 0.86-0.93) for cardiovascular disease, 1.18 (95% CI, 1.13-1.23) for infection, 1.01 (95% CI, 0.93-1.09) for vascular access dysfunction, and 1.02 (95% CI, 0.99- 1.06) for other morbidity. Regarding cardiovascular disease, first admission and readmission HRs for daily HHD versus in-center hemodialysis were 0.91 and 0.87, respectively. Regarding infection, first admission and readmission HRs were 1.35 and 1.03, respectively. Protective associations of daily HHD with heart failure and hypertensive disease were most pronounced, as were adverse associations of daily HHD with bacteremia/sepsis, cardiac infection, osteomyelitis, and vascular access infection. Limitations: Results may be confounded by unmeasured factors, including vascular access type; information about dialysis frequency, duration, and dose was lacking; causes of admission may be misclassified; results may not apply to patients without Medicare coverage. Conclusions: All-cause hospitalization risk was similar in daily HHD and thrice-weekly in-center hemodialysis patients. However, risk of cardiovascular-related admission was lower with daily HHD, and risk of infection-related admission was higher. More attention should be afforded to infection in HHD patients. © 2014 by the National Kidney Foundation, Inc.

Liu J.,Chronic Disease Research Group | Foley R.N.,Chronic Disease Research Group
Kidney International | Year: 2012

Zhang et al. studied the relationship between day of the week and all-cause and cardiovascular mortality in the United States, Europe, and Japan. The study confirms findings of studies of US patients that risk of all-cause and cardiac mortality is higher after a long interdialytic interval, and shows that this is also true in Europe and Japan. Alternate-day dialysis may improve patient survival on hemodialysis, but randomized trials are necessary to establish a new schedule. © 2012 International Society of Nephrology.

Foley R.N.,Chronic Disease Research Group
Nature Reviews Nephrology | Year: 2010

The stimulation of erythropoiesis is a rapidly evolving area of research, with mechanistic insights often developing rapidly into therapeutic agents. A broad range of erythropoiesis-stimulating agents are currently in clinical use and many more under development are likely to enter the marketplace in the near future. To date, much of the investigative activity in this field has targeted activation of the erythropoietin receptor and factors that modulate hypoxia-related pathways of erythropoietin production within cells. This Review discusses newer erythropoiesis-stimulating agents currently under assessment for the treatment of anemia in patients with chronic kidney disease. Such agents include proteins and peptides that activate erythropoietin receptors, non-protein agents, and strategies with targets other than erythropoietin receptors. © 2010 Macmillan Publishers Limited. All rights reserved.

Loading Chronic Disease Research Group collaborators
Loading Chronic Disease Research Group collaborators