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Advances in Chronic Kidney Disease

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https://www.readbyqxmd.com/read/28115082/the-esrd-quality-incentive-program-the-current-limitations-of-evidence-and-data-to-develop-measures-drive-improvement-and-incentivize-outcomes
#1
REVIEW
Louis H Diamond, Andrew D Howard
This article describes the current state of facilitating the integration of evidence into practice to support initiatives focused on patients with ESRD. We will use the Centers for Medicare and Medicaid Services (CMS) ESRD Quality Incentive Program (QIP) as an example, including a description of the health information infrastructure needed to support the translation of evidence into practice and some of the challenges encountered. The process from the generation of evidence to integration of this evidence into practice includes policy development leading to clinical practice guidelines, clinical performance measures, and clinical decision support tools...
November 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/28115081/identifying-potential-biases-in-the-nephrology-literature
#2
REVIEW
Thomas W Ferguson, Navdeep Tangri
Observational studies are common in the nephrology literature, particularly given the lack of large randomized trials. While these studies have identified important associations, potential biases, if unrecognized, can result in misinterpreted conclusions. In this review, we present an example of four potentially important biases (lead time bias, survivor bias, immortal time bias, and index event bias) that can result in inaccurate estimates of association between risk factors or treatments and outcomes. Recognition of these potential biases can help improve study design and interpretation...
November 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/28115080/observational-research-using-propensity-scores
#3
REVIEW
Karthik Raghunathan, J Bradley Layton, Tetsu Ohnuma, Andrew D Shaw
In most observational studies, treatments or other "exposures" (in an epidemiologic sense) do not occur at random. Instead, treatments or other such interventions depend on several patient-related and patient-independent characteristics. Such factors, associated with the receipt vs nonreceipt of treatment, may also be-independently-associated with outcomes. Thus, confounding exists making it difficult to ascertain the true association between treatments and outcomes. Propensity scores (PS) represent an intuitive set of approaches to reduce the influence of such "confounding" factors...
November 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/28115079/use-of-surrogate-outcomes-in-nephrology-research
#4
REVIEW
Joshua Samuels
Clinical trials are large and expensive and could require exceedingly long-term follow-up for subjects to reach clinically meaningful end points. To combat these methodologic issues, researchers sometimes use biomarkers as surrogate end points. A biomarker is an objectively measured characteristic that is indicative of some underlying phenomenon or process, while a surrogate is a biomarker that "takes the place" of a clinically meaningful outcome, usually earlier in the disease process. This paper reviews the history, strengths, and weaknesses of surrogate outcome use in clinical research and then discusses potential surrogate outcomes in nephrology research...
November 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/28115078/an-evidence-based-approach-to-conducting-systematic-reviews-on-ckd
#5
REVIEW
Nandita S Mani, Emily Ginier
With the growing need to integrate best evidence to inform clinical care, systematic reviews have continued to flourish. Although this type of review is integral to the synthesis of evidence-based information, systematic reviews are often conducted omitting well-established processes that ensure the validity and replicability of the study; elements of which are integral based on standards developed by the Cochrane Collaboration and the National Academy of Medicine. This review article will share best practices associated with conducting systematic reviews on the topic of CKD using an 8-step process and an evidence-based approach to retrieving and abstracting data...
November 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/28115077/unique-study-designs-in-nephrology-n-of-1-trials-and-other-designs
#6
REVIEW
Joyce P Samuel, Cynthia S Bell
Alternatives to the traditional parallel-group trial design may be required to answer clinical questions in special populations, rare conditions, or with limited resources. N-of-1 trials are a unique trial design which can inform personalized evidence-based decisions for the patient when data from traditional clinical trials are lacking or not generalizable. A concise overview of factorial design, cluster randomization, adaptive designs, crossover studies, and n-of-1 trials will be provided along with pertinent examples in nephrology...
November 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/28115076/cognitive-bias-and-the-creation-and-translation-of-evidence-into-clinical-practice
#7
REVIEW
Donald A Molony
The optimal translation of evidence into the clinical practice of nephrology follows validated evidence-based medicine (EBM) principles. Most importantly, the evidence-based medicine practitioner requires that the evidence, as much as possible, addresses in an unbiased manner clinical questions of importance to patients and reflects the truth. In this chapter, we evaluate how cognitive biases that affect medical decision making might systematically bias the overall management of patients with kidney disease and, thus, distort the observations about disease causation, prognosis, diagnosis, and management that are derived from analysis of administrative databases or electronic medical records of health care systems...
November 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/28115075/translation-of-evidence-into-clinical-practice
#8
EDITORIAL
Donald A Molony, Joshua Samuels
No abstract text is available yet for this article.
November 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/28115074/one-isn-t-the-loneliest-of-numbers-n-of-1-trials
#9
EDITORIAL
Jerry Yee
No abstract text is available yet for this article.
November 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27742389/do-federal-regulations-have-an-impact-on-kidney-transplant-outcomes
#10
REVIEW
Kenneth J Woodside, Randall S Sung
Transplantation is one of the most highly regulated fields in health care. An important component of transplant oversight is the performance assessment of transplant centers as measured by 1-year patient and graft survival outcomes. The use of the Organ Procurement and Transplantation Network and Scientific Registry of Transplant Recipients flagging mechanism for quality improvement as criteria for Center for Medicare and Medicaid Services certification has resulted in greater importance in transplant program operations...
September 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27742388/protocol-biopsies-utility-and-limitations
#11
REVIEW
Yihung Huang, Evan Farkash
As both T cell and antibody-mediated rejection can have a subclinical phase, protocol biopsies provide an early opportunity to intervene before the onset of clinical allograft dysfunction. Protocol biopsies are usually done after reperfusion to establish baseline, between 3 and 6 months to identify subclinical rejection, and at 6-12 months to assess chronicity and persistent inflammation that have prognostic implication. Treatment of both subclinical T cell and antibody-mediated rejection prevents progression of rejection and development of interstitial fibrosis/tubular atrophy or transplant glomerulopathy...
September 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27742387/donor-specific-antibody-monitoring-where-is-the-beef
#12
REVIEW
Jeffrey Ma, Anita Patel, Kathryn Tinckam
This review paper discusses the impact of de novo donor-specific antibodies (DSA) to donor HLA antigens in kidney transplantation and summarizes the benefits and challenges that exist with DSA monitoring. Post-transplant DSA is associated with worse allograft outcomes and its detection may precede or coincide with clinical, biochemical, and histologic allograft dysfunction. There are no absolute features of DSA testing results that perfectly discriminate between states of disease and health. In a state of antibody-associated graft dysfunction, removal or reduction in DSA may only provide clinical benefit for some...
September 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27742386/the-bad-and-the-good-news-on-cancer-immunotherapy-implications-for-organ-transplant-recipients
#13
REVIEW
Umberto Maggiore, Julio Pascual
Cancer immunotherapy, especially the use of checkpoint inhibitors, is expanding and can be efficacious in organ transplant recipients with malignant neoplasia. In this review, we summarize clinical findings and evolution of several patients treated with CTL4-4 or PD-1 inhibitors reported in the literature. The CTL-4 inhibitor ipilimumab has been safely used in several liver and kidney allograft recipients. PD1-inhibitors look promising for tumor shrinking, but acute rejection is the rule, so they should be avoided in recipients of life-saving organs...
September 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27742385/costimulatory-blockade-and-use-of-mtor-inhibitors-avoiding-injury-part-2
#14
REVIEW
David Wojciechowski, Flavio Vincenti
Kidney transplantation immunosuppression relies on a calcineurin inhibitor backbone. Calcineurin inhibitors have reduced early-acute rejection rates but failed to improve long-term allograft survival. Their nephrotoxicity has shifted the focus of investigation to calcineurin inhibitor-free regimens. Costimulation blockade with belatacept, a second generation, higher avidity variant of CTLA4-Ig, has emerged as part of a calcineurin inhibitor-free regimen. Belatacept has demonstrated superior glomerular filtration rate compared with calcineurin inhibitors albeit with an increased risk of early and histologically severe rejection...
September 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27742384/costimulatory-blockade-and-use-of-mammalian-target-of-rapamycin-inhibitors-avoiding-injury-part-1
#15
REVIEW
Joshua Augustine, Donald E Hricik
Although calcineurin inhibitor drugs have been the mostly used therapy in modern immunosuppression in kidney transplantation, their effect on kidney allograft dysfunction has been suboptimal as far as preservation of kidney function is concerned. Additionally, there are metabolic and other nonmetabolic effects including increased risk of malignancy that has necessitated the use of mammalian target of rapamycin inhibitors to reduce exposure to calcineurin inhibitors. Mammalian target of rapamycin inhibitors, both sirolimus and everolimus, have been studied in several trials to facilitate preservation of kidney function with variable effects on kidney allograft function and immunogenicity...
September 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27742383/immunosuppression-minimization-and-avoidance-protocols-when-less-is-not-more
#16
REVIEW
Rohini Prashar, K K Venkat
Kidney transplantation is well established as the best treatment option for end-stage kidney disease. It confers not only a better quality of life but also a significant survival advantage compared to dialysis. However, despite significant improvement in short-term kidney transplant graft survival over the past three decades, long-term graft survival remains suboptimal. Concerns about the possible contribution of chronic calcineurin inhibitor (CNI) nephrotoxicity to late allograft failure and other serious adverse effects of currently used immunosuppressive agents (especially corticosteroids) have led to increasing interest in developing regimens which may better preserve kidney allograft function and minimize other immunosuppression-related problems without increasing the risk of rejection...
September 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27742382/is-kidney-transplantation-a-better-state-of-ckd-impact-on-diagnosis-and-management
#17
REVIEW
Sandesh Parajuli, Dana F Clark, Arjang Djamali
Patients with CKD are at increased risk for cardiovascular events, hospitalizations, and mortality. Kidney transplantation (KTx) is the preferred treatment for end-stage kidney disease. Although comorbidities including anemia and bone and mineral disease improve or are even halted after KTx, kidney transplant recipients carry higher cardiovascular mortality risk than the general population, as well as an increased risk of infections, malignancies, fractures, and obesity. When comparing CKD with CKD after transplantation (CKD-T), the rate of decline of estimated glomerular filtration rate (eGFR) is significantly lower in CKD-T...
September 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27742381/current-status-of-kidney-transplant-outcomes-dying-to-survive
#18
REVIEW
Jeffrey H Wang, Melissa A Skeans, Ajay K Israni
Kidney transplantation is associated with improved survival compared with maintenance dialysis. In the United States, post-transplant outcomes have steadily improved over the last several decades, with current 1-year allograft and patient survival rates well over 90%. Although short-term outcomes are similar to those in the international community, long-term outcomes appear to be inferior to those reported by other countries. Differences in recipient case mix, allocation polices, and health care coverage contribute to the long-term outcome disparity...
September 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27742380/the-struggle-for-optimization-of-long-term-outcomes-after-kidney-transplantation
#19
EDITORIAL
Anita K Patel, Millie Samaniego
No abstract text is available yet for this article.
September 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27742379/increasing-access-to-kidney-transplantation-easy-as-a-b-o
#20
EDITORIAL
Jerry Yee
No abstract text is available yet for this article.
September 2016: Advances in Chronic Kidney Disease
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