John Walls Renal Unit

Leicester, United Kingdom

John Walls Renal Unit

Leicester, United Kingdom
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Medcalf J.F.,John Walls Renal Unit | Davies C.,Public Health England | Hollinshead J.,Public Health England | Matthews B.,NHS England | O'Donoghue D.,Salford Royal NHS Foundation Trust
QJM | Year: 2016

Background/Introduction: Acute kidney injury (AKI) is common in acute hospital admission and associated with worse patient outcomes. Aim: To measure incidence, care quality and outcome of AKI in admitted hospital care. Design: Forty-six of 168 acute NHS healthcare trusts in UK caring for 2 million acute hospital admissions per annum collected information on adults identified with AKI stage 3 (3-fold rise in serum creatinine or creatinine > 354 mmol/l) through routine biochemical testing over a 5-month period in 2012. Methods: Information was collected on patient and care characteristics. Primary outcomes were survival and recovery of kidney function at 1 month. Results: A total of 15 647 patients were identified with biochemical AKI stage 3. Case note reviews were available for 7726 patients. In 80%, biochemical AKI stage 3 was confirmed clinically. Among this group, median age was 75 years, median length of stay was 12 days and the overall mortality within 1 month was 38%. Significant factors in a multivariable model predicting survival included age and some causes of AKI. Dipstick urinalysis, medication review, discussion with a nephrologist and acceptance for transfer to a renal unit were also associated with higher survival, but not early review by a senior doctor, acceptance for transfer to critical care or requirement for renal replacement therapy. Eighteen percent of people did not have their kidney function checked 1 month after the episode had resolved. Discussion/Conclusions: This large study of in-hospital AKI supports the efficacy of biochemical detection of AKI in common usage. AKI mortality remains substantial, length of stay comparable with single-centre studies, and much of the variation is poorly explained (model Cox and Snell R2=0.131) from current predictors. © The Author 2016.


Medcalf J.F.,John Walls Renal Unit | Andrews P.A.,St Helier Hospital | Bankart J.,University of Leicester | Bradley C.,Royal Holloway, University of London | And 6 more authors.
Clinical Nephrology | Year: 2011

Background: The STEPP group was established to investigate factors that affect long-term transplant outcomes including quality of life and other patient-reported outcomes between different transplant centers and patients. Methods: Data were collected for 2,650 patients whose first renal transplant took place between 1992 and 2003 in fiveUK centers. Univariable and multivariable survival analyses were performed using eleven candidate explanatory variables. Results: Graft survival was worse in Black (B) patients (HR B v W 1.57 95% CI 1.10, 2.24), and in South Asian (A) patients (HR A v W 1.39 95% CI 1.03, 1.85) compared to Whites (W) after adjusting for other factors including HLA mismatch, and time on dialysis. Time spent on dialysis pre-transplantation was non-linearly associated with patient, but not death-censored graft survival. Losing a functioning graft was a strong predictor of patient death. One site had both the best graft and the worst patient survival. Conclusions: Differences in patient and graft survival between ethnic groups cannot be explained by currently recognized factors. These, and the complex balance between optimum patient and graft survival which differs between sites in this study require further investigation. © 2011 Dustri-Verlag Dr. K. Feistle.


PubMed | John Walls Renal Unit
Type: Comparative Study | Journal: Clinical nephrology | Year: 2011

The STEPP group was established to investigate factors that affect long-term transplant outcomes including quality of life and other patient-reported outcomes between different transplant centers and patients.Data were collected for 2,650 patients whose first renal transplant took place between 1992 and 2003 in five UK centers. Univariable and multivariable survival analyses were performed using eleven candidate explanatory variables.Graft survival was worse in Black (B) patients (HR B v W 1.57 95% CI 1.10, 2.24), and in South Asian (A) patients (HR A v W 1.39 95% CI 1.03, 1.85) compared to Whites (W) after adjusting for other factors including HLA mismatch, and time on dialysis. Time spent on dialysis pre-transplantation was non-linearly associated with patient, but not death-censored graft survival. Losing a functioning graft was a strong predictor of patient death. One site had both the best graft and the worst patient survival.Differences in patient and graft survival between ethnic groups cannot be explained by currently recognized factors. These, and the complex balance between optimum patient and graft survival which differs between sites in this study require further investigation.

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