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Hillege HL, et al. Microalbuminuria is common, also in a nondiabetic, nonhypertensive population,
and an independent indicator of cardiovascular risk factors and cardiovascular morbidity. Weight
loss interventions in chronic kidney disease: a systematic review and meta-analysis. TW contributed
to the design and implementation of the research, the analysis of the data and the writing of the
manuscript. Chang, Neil Docherty and the other, anonymous, reviewer(s) for their contribution to the
peer review of this work. Of these models, 19 (58%) modelled patients from the explicit state of
dialysis or transplant, and the remaining 14 (42%) initiated patients from a pre-dialysis health state
with or without ESRD, including health states describing pre-dialysis CKD stage 5 and other
broader CKD health state definitions. Immersive virtual reality and psychological well-being in adult
chronic Introduction Individuals with chronic physical illness are at increased risk of negative
psychological sequelae. Median survival varied widely by study region (A), age group (B), year of
study publication (C), and approach to conservative care (D). We conducted a systematic review to
summarize the recent epidemiologic literature examining the relationship between As, Cd, or Pb with
CKD. Evidence Review MEDLINE, Embase (Excerpta Medica Database), and CINAHL
(Cumulative Index of Nursing and Allied Health Literature) were searched from inception through
December 3, 2021, for all English language longitudinal studies of adults in whom there was an
explicit decision not to pursue maintenance dialysis. Transplantation, however, did not restore quality
of life to levels seen in those without CKD. We also found that some symptoms did not differ
significantly across clinical groups and therefore may be largely unrelated to kidney function
specifically, or the confidence intervals may preclude accurate interpretation. When evaluating time
with ESRD, CKD models predicted extended ESRD survival over diabetes models with
nephropathy (mean time with ESRD: 8.0 vs. 3.8 years). 4 Discussion This review qualitatively
describes how the progression of kidney disease was incorporated in economic models. There is a
high risk of stroke in patients with ESKD undergoing dialysis and a high mortality rate in the event
of stroke. The corresponding author had full access to all the data in the report and had final
responsibility for the decision to submit for publication. BMJ disclaims all liability and responsibility
arising from any reliance placed on the content. Support for third-party writing assistance for this
article, provided by Acaster Lloyd, was funded by AstraZeneca plc in accordance with Good
Publication Practice (GPP3) guidelines ( ). Chronic subdural hematoma: epidemiological and
prognostic analysis of 176 cases. Future research The findings of this review highlight several areas
that warrant further research. Markov model: A more fluid extension of the decision tree principle,
defined as a type of cohort-based mathematical model containing a finite number of mutually
exclusive health states, with time periods of uniform length, in which the probability of movement
from one state to another depends on the current state. For uncertainties surrounding the relevance
of a study, the corresponding full text was obtained, so a decision was made based on a thorough
assessment of the study. In past retrospective studies, it has been reported that the 30 days mortality
rate for SDH patients with ESKD requiring dialysis is 19% ( 34 ). Emerging research consistently
indicates that VR therapeutic interventions can be safely offered to mitigate the consequences of
chronic physical illness and improve individual adjustment reactions. In addition, further clinical and
observational research is warranted to provide a better understanding of prognostic factors and data
sources to improve economic modelling accuracy in CKD. This is an open access article distributed
in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which
permits others to copy, redistribute, remix, transform and build upon this work for any purpose,
provided the original work is properly cited, a link to the licence is given, and indication of whether
changes were made. See:. Statistics from Altmetric.com Request permissions. The studies included
varied in terms of their design (cross-sectional survey, randomised trial, prospective observational
study) and used different instruments which made comparisons between them challenging.
Prevention of renal failure in Chinese patients with newly diagnosed type 2 diabetes: a cost-
effectiveness analysis. DS, TW, SR and PM are employees of Health Economics and Outcomes
Research Ltd. At present, comprehensive measurement of symptoms would require that patients
complete multiple PROMs, which may include large numbers of items or may have items that
overlap. Chronic conditions Psychological care Data availability statement All data relevant to the
study are included in the article. A new equation to estimate glomerular filtration rate.
In particular, additional high-quality studies exploring symptom severity are required in order to
generate more precise estimates. Patients with MS were randomly assigned to a game-based or
environment-based relaxing VR programme, where participants were encouraged to engage in goal-
based or self-directed activity to explore a VR environment designed on classic relaxation principles.
In three studies interventions were offered by two intervention providers—either a psychologist and
nurse, 30 or a nurse and unspecified intervention provider. 32 33 The interventions in the remaining
studies were offered by either a nurse 29 or an unspecified intervention provider. 31 34 35 No study
specified information on the intervention provider’s professional background, degree of expertise or
level of training with the VR intervention. Regression methods are an option to provide refined
HSU values from longitudinal studies while meta-analytical methods could help explore differences
when using aggregate data. Across models, CKD was generally described and modelled as a single
disease, thus ignoring (perhaps relevant) differences in aetiologies. Regional variation in the
management of nontraumatic subdural hematomas across the United States. Support for third-party
writing assistance for this article, provided by Acaster Lloyd, was funded by AstraZeneca plc in
accordance with Good Publication Practice (GPP3) guidelines ( ). The 14-year incidence of lower-
extremity amputations in a diabetic population. No single PROM measured the majority of reported
symptoms across the CKD population. Download citation Published: 30 September 2019 Issue Date:
December 2019 DOI: Share this article Anyone you share the following link with will be able to read
this content: Sorry, a shareable link is not currently available for this article. Measuring the
population burden of chronic kidney disease: a systematic In 2002, a new and globally adopted
definition of CKD was introduced. However, the variability of individual patients’ GFR and
albuminuria trajectories perhaps provides rationale for a model structure designed around the
prediction of individual patients’ GFR trajectories. Cochrane data collection form for intervention
review for RCTS and non-RCTs - template. There were two common variations to this structure:
first, models differed in the approach to modelling dialysis and, second, they differed on how kidney
function was modelled post-transplant. In addition, further clinical and observational research is
warranted to provide a better understanding of prognostic factors and data sources to improve
economic modelling accuracy in CKD. Where reported, the underlying disease aetiologies are
described in Supplementary Table 8 (Resource 4 of the ESM). Microalbuminuria reduction with
valsartan in patients with type 2 diabetes mellitus. Kidney failure and anticoagulants Except for one
case of acute anuretic kidney failure undergoing HD, the remaining 73 patients were on chronic HD
with unexplained causes of chronic kidney failure. First, in studies for which mean eGFR, median
survival, and IQR were estimated based on available data reported, these values are imprecise and
limit the reliability of our findings. The occurrence of nontraumatic SDH (NSDH) in ESKD patients
undergoing HD has rarely been reported and was mainly presented in the form of case reports or a
small case series. Polkinghorne KR. Estimated glomerular filtration rate versus albuminuria in the
assessment of kidney function: what’s more important. The search was performed on 9 March 2023
across the following databases: Medline, PsycINFO, Embase, Web of Science and Scopus. If the
measures are not in agreement, then this could be explored (and perhaps controlled for) using a meta-
regression approach. Participants not receiving RRT could progress to (or remain in) any CKD
category, with transition probabilities estimated using multivariate multinomial logistic regression.
Article CAS PubMed PubMed Central Google Scholar Beby AT, et al. In addition, many of the
current methods did not explicitly consider patient heterogeneity or underlying disease aetiology,
except for diabetes. While the number of patients assessed differed substantially between studies, by
HSU instruments used and CKD stages, this did not seem to influence HSUs reported as they
seemed aligned for each instrument and CKD stage regardless of sample size. Irrespective of the
type of diabetes, most models applied a core sub-model structure of diabetic nephropathy based on a
disease pathway of five health states: no nephropathy (or normoalbuminuria), microalbuminuria,
macroalbuminuria (or gross proteinuria), ESRD (comprising dialysis or transplant as absorbing states)
and death (Fig. 3 ). Some models also included a health state of macroalbuminuria with impaired
(estimated or measured) GFR. Data Availability: All relevant data are within the manuscript and its
Supporting information files. Treatments for Chronic Kidney Disease: A Systematic Literature
Review Delaying disease progression and reducing the risk of mortality are key goals in the
treatment of chronic kidney disease (CKD).
Reprints and permissions About this article Cite this article. Cooper, J., Lloyd, A., Sanchez, J.J.G. et
al. Health related quality of life utility weights for economic evaluation through different stages of
chronic kidney disease: a systematic literature review. A large quantity of data was available from
different settings, and this synthesis presents strong evidence for the ongoing and considerable
impact of CKD on patients’ lives. Clement FM, et al. An economic evaluation of erythropoiesis-
stimulating agents in CKD. The latter area is important, as it could provide insight into those
symptoms that may be attributable to changes in renal function and may provide potential targets for
symptom tracking in CKD. Case reports, qualitative studies, and the gray literature were excluded.
Schiavon, C. A. et al. Effects of bariatric surgery in obese patients with hypertension: the
GATEWAY randomized trial (Gastric Bypass to Treat Obese Patients With Steady Hypertension).
Report this Document Download now Save Save Introduction For Later 0 ratings 0% found this
document useful (0 votes) 39 views 4 pages Introduction Uploaded by Cristina L. In past
retrospective studies, it has been reported that the 30 days mortality rate for SDH patients with
ESKD requiring dialysis is 19% ( 34 ). Cochrane data collection form for intervention review for
RCTS and non-RCTs - template. We included all adult population screening studies and. Thirty-four
studies (3754 patients) 11 - 18, 20 - 23, 25 - 27, 29 - 31, 34 - 48, 50 provided information on median
survival and IQR or sufficient information to estimate these values (eTable 2 in the Supplement ).
Another study (812 patients) 51 that examined only rates of mechanical ventilation, cardiopulmonary
resuscitation, and artificial enteral nutrition found that only 4% of decedents received these intensive
procedures during the final month of life. Accordingly, more robust studies of effectiveness are
needed to establish the suitability of VR treatments as adjustment interventions in populations with
chronic disease. Records identified for full-text review were then assessed independently by two
reviewers. Two authors (S.P.Y.W. and T.R.) independently screened titles and abstracts and reviewed
full-text articles to determine study eligibility. While HSU weights were lowest for dialysis, it was
not clear if HSU differs between haemodialysis and peritoneal dialysis as different trends were
noted between the instruments used. This systematic review and synthesis of findings indicated that
immersive VR interventions are well tolerated and offer acceptable treatments with the aim of
improving psychological adjustment in patients with cancer, dementia, cardiovascular disease, MS
and kidney disease. Since all analysed studies met our grade 1 screening requirements, overall study
quality was high. The heterogeneity with respect to both patient characteristics and disease outcome
prediction, combined with a reasonable body of evidence, does seem to contribute to a wide use of
microsimulation models (compared with Markov-based cohort models) in the field of diabetes. The
review identified a large number of published studies that reported HSU weights for CKD
populations. Where possible, HSU weights used in a cost-effectiveness analysis could be limited to a
single instrument relevant to the specific research question for a cost-effectiveness analysis such as
the EQ-5D-3L for cost-effectiveness analyses submitted to NICE in England. Across all models,
cardiovascular-related risk was most frequently derived from the Framingham Heart Study, with
estimates modified to reflect differences in specific geographical populations or patient
characteristics. Immersive virtual reality (VR) is an emerging treatment that might reduce these
negative effects and increase quality of life in individuals with chronic physical illness. This annual
rate was applied to all CKD stages (progression from stage 3a to stage 5 CKD). Statistical analysis
Statistical analysis was performed using SPSS 24.0. Univariate analysis was performed using Fisher’s
exact test, and categorical variables were compared using chi-square tests. University of York:
Center for Reviews and Dissemination; 2008. p. 294. Papaioannou D, Brazier J, Paisley S. Consensus
does exist among the published literature with respect to the natural trajectory of albuminuria and
GFR, with changes in albuminuria considered variable, with both negative and positive changes often
observed in short timeframes, and changes in GFR usually considered to be progressive (i.e.
monotonically decreasing). CKD also leads to substantial healthcare resource use. Overview:
increased cardiovascular risk in patients with minor renal dysfunction: an emerging issue with far-
reaching consequences. Any discrepancies between first and second reviewer, that could not be
resolved independently, were resolved through a third reviewer.
The staging of patients not receiving RRT was as follows: 29 studies, stage 1; 44 studies, stage 2; 80
studies, stage 3; 92 studies, stage 4; and 98 studies, stage 5. A total of 17 grade 1 studies were
included in this SR with 51 to 1767 participants, conducted in the UK, USA, Canada, China, Spain,
and multiple-countries. Future studies should aim to use RCT designs, with appropriate
consideration given to unbiased recruitment and randomisation of participants. This could reflect that
sensitivity to capture the impact of CKD progression on HRQL may be different between the
instruments reported in this systematic review. Diet and Kidney Function: a Literature Review
Introduction. Different factors may affect HRQL decline at different CKD stages. In addition, many
of the current methods did not explicitly consider patient heterogeneity or underlying disease
aetiology, except for diabetes. Liu, MD, MS; Manjula Kurella Tamura, MD, MPH JAMA Network
Open Question What are the long-term outcomes of patients with advanced kidney disease who do
not pursue maintenance dialysis. In patients with kidney diseases, studies have reported increasing
impact of limited health literacy on health outcomes. Patients with long-term HD have a 10-fold
higher risk of developing SDH than the general population ( 5, 10 ). Treatment and outcome Thirty-
four cases underwent conservative treatment, such as antihypertensive therapy, anti-epilepsy, and
change of anticoagulant for HD, including one case where conservative treatment was followed by
burr hole and one case where it was followed by craniotomy. The study conducted in patients with
IBD used a questionnaire that measured attitudes and feelings but no information on psychometric
properties was provided. This is also one of the first reviews to apply the Brazier and colleagues
(2019) guidance. Burden and management of chronic kidney disease in Japan: systematic
Introduction. Additional data gaps exist around the reporting of HSUs related to CKD stage 1,
adverse events and complications in patients with CKD. However, the variability of individual
patients’ GFR and albuminuria trajectories perhaps provides rationale for a model structure designed
around the prediction of individual patients’ GFR trajectories. Immersive virtual reality and
psychological well-being in adult chronic Introduction Individuals with chronic physical illness are at
increased risk of negative psychological sequelae. Where possible, analyses were initiated with a
standard patient profile, defined as patients aged 50 and from CKD stage 1, normo-albuminuria or
earliest disease stage modelled, to provide a consistent reference point. Dialysis adequacy and health
related quality of life in hemodialysis patients. However, the interventions under evaluation were
typically indicated across all CKD aetiologies and targeted to other diseases rather than to CKD
itself, with decision makers most interested in an evaluation of cost effectiveness across the entire
CKD population (cohort level as opposed to individual patient level). Data Availability: All relevant
data are within the manuscript and its Supporting information files. S9 Appendix. Review protocol.
S10 Appendix. Summary of symptom outcome measures. For example, models focusing on CKD
typically predicted health state occupancy in line with CKD stages in patients with established CKD,
for which GFR provides an explicit delineator. Chronic kidney disease (CKD) is a common disease
globally. You will be able to get a quick price and instant permission to reuse the content in many
different ways. However, the Brazier and colleagues (2019) guidance for identification of HSU
weights in particular does not specify the need for this type of analysis. Additional well-designed
prospective cohort studies are needed and we present recommendations for future studies.
Regression methods are an option to provide refined HSU values from longitudinal studies while
meta-analytical methods could help explore differences when using aggregate data. Economic
evaluation of palliative management versus peritoneal dialysis and hemodialysis for end-stage renal
disease: evidence for coverage decisions in Thailand. Effect of information and telephone-guided
access to community support for people with chronic kidney disease: randomised controlled trial.
PLoS One. 2014;9(10):e109135. Manns B, Johnson JA, Taub K, Mortis G, Ghali WA, Donaldson C.
Once in a state of macroalbuminuria, with or without impaired GFR, patients could progress to
ESRD. Model construction, assumptions, and validation of health consequences. For transplant
recipients, the most severe symptoms were change in appearance, blurred vision, and excessive
appetite. In all models, patients in the ESRD health state received dialysis or renal transplant. Third,
the review was limited to the information available in the study publication. We excluded studies of
patients who initiated and then discontinued maintenance dialysis, those that did not include
information on baseline eGFR, and those of patients in whom it was unclear that an explicit decision
to forgo dialysis was made. Unlike other models, in discrete-event simulation, movements between
patients’ health states are usually driven by events that may occur at varying times (rather than during
cycles of fixed length), and time-to-event distributions are required for each event. SGLT2is induce
a metabolic shift towards ketogenesis, which is likely to account for sustained weight loss. See S4
Appendix for full references for included studies. However, 13 out of the 31 studies included in the
review were feasibility or pilot studies and a further four studies were considered to have a high risk
of bias. These headsets operated commercially available VR software, including: Oceans Below; A
World of Art Timelapse; Titanic Adventure Out of Time. In addition, further clinical and
observational research is warranted to provide a better understanding of prognostic factors and data
sources to improve economic modelling accuracy in CKD. Example of the core model structure of
chronic kidney disease models. The rate at which patients progressed from dialysis to transplant or
from transplant to dialysis, and the mortality risk multiplier attributable ESRD, were typically
informed by country-specific registry data. 3.5 Cardiovascular Morbidity and Mortality Given the
interrelationship between CKD and CVD, the incorporation of cardiovascular morbidity and
mortality was assessed across identified models. Several GLP1R dual or polyagonist agents are
under evaluation with the potential to achieve greater weight loss than GLP1RAs alone. Overall,
there was greater availability of transition rate data for model structures based on albuminuria than
for CKD stage-based models defined by GFR, which would be expected given the greater number
of diabetes models with CKD components identified. Customize your JAMA Network experience by
selecting one or more topics from the list below. TW contributed to the design and implementation of
the research, the analysis of the data and the writing of the manuscript. In the absence of trauma,
SDH is thought to occur spontaneously and may be associated with systemic hypertension, cerebral
atrophy, coagulation dysfunction, and use of anticoagulant drugs. Similarly, no specific measure of
adjustment was included in the search strategy. There were exceptions to these general rules, and the
choice of modelling framework was likely driven by numerous factors, such as perspective,
intervention, indication and underlying data sources used to inform disease progression, among other
considerations. Models focusing purely on CKD are typically based on (estimated or measured GFR)
decline, with GFR progression predominantly based on a linear rate of decline, which could be
adjusted for age, race, CKD stage, prevalence of proteinuria and clinical history (hypertension or
diabetes). Statistical analysis Statistical analysis was performed using SPSS 24.0. Univariate analysis
was performed using Fisher’s exact test, and categorical variables were compared using chi-square
tests. Liu, MD, MS; Manjula Kurella Tamura, MD, MPH See More About Sign up for emails based
on your interests, select your interests. You can download the paper by clicking the button above.
Comparing the health utilities index mark 3 (HUI3) with the short Form-36 preference-based SF-6D
in chronic kidney disease. Ten studies (59%) used the EQ-5D-3L, four (24%) used the SF-6D, one
(6%) used the HUI3, and two (12%) used multiple instruments (HUI2 and HUI3; EQ-5D-3L and
HUI3). Therefore, within this context, a simplification or generalisation of CKD aetiologies may be
considered appropriate. Patients with MS were randomly assigned to a game-based or environment-
based relaxing VR programme, where participants were encouraged to engage in goal-based or self-
directed activity to explore a VR environment designed on classic relaxation principles. A number of
aspects may affect the mix of patients included in the studies reported in this SR and, therefore, the
eventual HSU weights reported.