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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.

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.

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.

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.

St. Peter W.L.,Chronic Disease Research Group | St. Peter W.L.,University of Minnesota | Patel U.D.,Duke University
Current Opinion in Nephrology and Hypertension | Year: 2013

PURPOSE OF REVIEW: Patients with chronic kidney disease (CKD) are complex, have many medication-related problems (MRPs) and high rates of medication nonadherence, and are less adherent to some medications than patients with higher levels of kidney function. Nonadherence in CKD patients increases the odds of uncontrolled hypertension, which can increase the risk of CKD progression. This review discusses reasons for gaps in medication-related care for CKD patients, pharmacy services to reduce these gaps and successful models that incorporate pharmacist care. RECENT FINDINGS: Pharmacists are currently being trained to deliver patient-centred care, including identification and management of MRPs and helping patients overcome barriers to improve medication adherence. A growing body of evidence indicates that pharmacist services for CKD patients, including medication reconciliation and medication therapy management, positively affect clinical and cost outcomes, including lower rates of decline in glomerular filtration rates, reduced mortality and fewer hospitalizations and hospital days, but more robust research is needed. Team-based models including pharmacists exist today and are being studied in a wide range of innovative care and reimbursement models. SUMMARY: Opportunities are growing to include pharmacists as integral members of CKD and dialysis healthcare teams to reduce MRPs, increase medication adherence and improve patient outcomes. © 2013 Wolters Kluwer Health / Lippincott Williams & Wilkins.

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