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The 2004 Canadian recommendations for the management of hypertension: Part II--Therapy.

https://arctichealth.org/en/permalink/ahliterature181498
Source
Can J Cardiol. 2004 Jan;20(1):41-54
Publication Type
Article
Date
Jan-2004
Author
Nadia A Khan
Finlay A McAlister
Norman R C Campbell
Ross D Feldman
Simon Rabkin
Jeff Mahon
Richard Lewanczuk
Kelly B Zarnke
Brenda Hemmelgarn
Marcel Lebel
Mitchell Levine
Carol Herbert
Author Affiliation
Division of General Internal Medicine, University of British Columbia, Vancouver, Canada.
Source
Can J Cardiol. 2004 Jan;20(1):41-54
Date
Jan-2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antihypertensive Agents - administration & dosage
Blood Pressure Determination - standards
Canada - epidemiology
Cardiovascular Diseases - prevention & control
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Therapy, Combination
Evidence-Based Medicine - standards
Female
Humans
Hypertension - diagnosis - drug therapy - epidemiology
Male
Middle Aged
Prognosis
Risk assessment
Severity of Illness Index
Societies, Medical
Treatment Outcome
Abstract
To provide updated, evidence-based recommendations for the management of hypertension in adults.
For patients who require pharmacological therapy for hypertension, a number of antihypertensive agents may be used. Randomized trials evaluating first-line therapy with diuretics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers (CCBs), alpha-blockers, centrally acting agents or angiotensin receptor antagonists were reviewed. Also, randomized trials evaluating other agents, such as statins or acetylsalicylic acid, in patients with hypertension were reviewed. Changes in cardiovascular morbidity and mortality were the primary outcomes of interest. In addition, other relevant outcomes such as development of end-stage renal disease or changes in blood pressure were examined where appropriate.
MEDLINE searches were conducted from November 2001 to October 2003 to update the 2001 Recommendations for the management of hypertension. Reference lists were scanned, experts were contacted, and the personal files of the subgroup members and authors were used to identify additional published studies. All relevant articles were reviewed and appraised independently, using prespecified levels of evidence by content and methodology experts.
This document contains detailed recommendations and supporting evidence on treatment thresholds, target blood pressures and choice of agents for hypertensive patients with or without comorbidities. Lifestyle modifications are a key component of any antiatherosclerotic management strategy and detailed recommendations are contained in a separate document. Key recommendations for pharmacotherapy include the following: treatment thresholds and targets should take into account each individual's global atherosclerotic risk, target organ damage and comorbidities, with particular attention to systolic blood pressure; blood pressure should be lowered to 140/90 mmHg or less in all patients, and 130/80 mmHg or less in those with diabetes mellitus or renal disease (125/75 mmHg or less in those with nondiabetic renal disease and more than 1 g of proteinuria per day); most adults with hypertension require more than one agent to achieve target blood pressures; for adults without compelling indications for other agents, initial therapy should include thiazide diuretics; other agents appropriate for first-line therapy for diastolic hypertension with or without systolic hypertension include beta-blockers (in those younger than 60 years), ACE inhibitors (in non-Blacks), long-acting dihydropyridine CCBs or angiotensin receptor antagonists; other agents appropriate for first-line therapy for isolated systolic hypertension include long-acting dihydropyridine CCBs or angiotensin receptor antagonists; certain comorbidities provide compelling indications for first-line use of other agents: in patients with angina, recent myocardial infarction or heart failure, beta-blockers and ACE inhibitors are recommended as first-line therapy; in patients with diabetes mellitus, ACE inhibitors or angiotensin receptor antagonists (or thiazides in patients with diabetes mellitus without albuminuria) are appropriate first-line therapies; and in patients with mild to moderate nondiabetic renal disease, ACE inhibitors are recommended; all hypertensive patients should have their fasting lipids screened and those with dyslipidemia should be treated using the thresholds, targets and agents as per the Recommendations for the management of dyslipidemia and the prevention of cardiovascular disease; and selected patients with hypertension should also receive statin and/or acetylsalicylic acid therapy.
All recommendations were graded according to the strength of the evidence and voted on by the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. Individuals with irreconcilable competing interests (declared by all members, compiled and circulated before the meeting) relative to any specific recommendation were excluded from voting on that recommendation. Only recommendations achieving at least 70% consensus are reported here. These guidelines will continue to be updated annually.
PubMed ID
14968142 View in PubMed
Less detail

The 2007 Canadian Hypertension Education Program recommendations for the management of hypertension: part 2 - therapy.

https://arctichealth.org/en/permalink/ahliterature163300
Source
Can J Cardiol. 2007 May 15;23(7):539-50
Publication Type
Conference/Meeting Material
Article
Date
May-15-2007
Author
Nadia A Khan
Brenda Hemmelgarn
Raj Padwal
Pierre Larochelle
Jeff L Mahon
Richard Z Lewanczuk
Finlay A McAlister
Simon W Rabkin
Michael D Hill
Ross D Feldman
Ernesto L Schiffrin
Norman R C Campbell
Alexander G Logan
Malcolm Arnold
Gordon Moe
Tavis S Campbell
Alain Milot
James A Stone
Charlotte Jones
Lawrence A Leiter
Richard I Ogilvie
Robert J Herman
Pavel Hamet
George Fodor
George Carruthers
Bruce Culleton
Kevin D Burns
Marcel Ruzicka
Jacques deChamplain
George Pylypchuk
Norm Gledhill
Robert Petrella
Jean-Martin Boulanger
Luc Trudeau
Robert A Hegele
Vincent Woo
Phil McFarlane
Rhian M Touyz
Sheldon W Tobe
Author Affiliation
Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia. nakhan@shaw.ca
Source
Can J Cardiol. 2007 May 15;23(7):539-50
Date
May-15-2007
Language
English
Publication Type
Conference/Meeting Material
Article
Keywords
Antihypertensive Agents - therapeutic use
Canada
Diet, Sodium-Restricted
Health promotion
Humans
Hypertension - drug therapy - prevention & control - therapy
Patient Education as Topic
Randomized Controlled Trials as Topic
Risk Reduction Behavior
Abstract
To provide updated, evidence-based recommendations for the prevention and management of hypertension in adults.
For lifestyle and pharmacological interventions, evidence was reviewed from randomized controlled trials and systematic reviews of trials. Changes in cardiovascular morbidity and mortality were the primary outcomes of interest. However, for lifestyle interventions, blood pressure lowering was accepted as a primary outcome given the lack of long-term morbidity and mortality data in this field. For treatment of patients with kidney disease, the progression of kidney dysfunction was also accepted as a clinically relevant primary outcome.
A Cochrane collaboration librarian conducted an independent MEDLINE search from 2005 to August 2006 to update the 2006 Canadian Hypertension Education Program recommendations. In addition, reference lists were scanned and experts were contacted to identify additional published studies. All relevant articles were reviewed and appraised independently by both content and methodological experts using prespecified levels of evidence.
Dietary lifestyle modifications for prevention of hypertension, in addition to a well-balanced diet, include a dietary sodium intake of less than 100 mmol/day. In hypertensive patients, the dietary sodium intake should be limited to 65 mmol/day to 100 mmol/day. Other lifestyle modifications for both normotensive and hypertensive patients include: performing 30 min to 60 min of aerobic exercise four to seven days per week; maintaining a healthy body weight (body mass index of 18.5 kg/m2 to 24.9 kg/m2) and waist circumference (less than 102 cm in men and less than 88 cm in women); limiting alcohol consumption to no more than 14 units per week in men or nine units per week in women; following a diet reduced in saturated fat and cholesterol, and one that emphasizes fruits, vegetables and low-fat dairy products, dietary and soluble fibre, whole grains and protein from plant sources; and considering stress management in selected individuals with hypertension. For the pharmacological management of hypertension, treatment thresholds and targets should take into account each individual's global atherosclerotic risk, target organ damage and any comorbid conditions: blood pressure should be lowered to lower than 140/90 mmHg in all patients and lower than 130/80 mmHg in those with diabetes mellitus or chronic kidney disease. Most patients require more than one agent to achieve these blood pressure targets. In adults without compelling indications for other agents, initial therapy should include thiazide diuretics; other agents appropriate for first-line therapy for diastolic and/or systolic hypertension include angiotensin-converting enzyme (ACE) inhibitors (except in black patients), long-acting calcium channel blockers (CCBs), angiotensin receptor blockers (ARBs) or beta-blockers (in those younger than 60 years of age). First-line therapy for isolated systolic hypertension includes long-acting dihydropyridine CCBs or ARBs. Certain comorbid conditions provide compelling indications for first-line use of other agents: in patients with angina, recent myocardial infarction, or heart failure, beta-blockers and ACE inhibitors are recommended as first-line therapy; in patients with cerebrovascular disease, an ACE inhibitor plus diuretic combination is preferred; in patients with nondiabetic chronic kidney disease, ACE inhibitors are recommended; and in patients with diabetes mellitus, ACE inhibitors or ARBs (or, in patients without albuminuria, thiazides or dihydropyridine CCBs) are appropriate first-line therapies. All hypertensive patients with dyslipidemia should be treated using the thresholds, targets and agents outlined in the Canadian Cardiovascular Society position statement (recommendations for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease). Selected high-risk patients with hypertension who do not achieve thresholds for statin therapy according to the position paper should nonetheless receive statin therapy. Once blood pressure is controlled, acetylsalicylic acid therapy should be considered.
All recommendations were graded according to strength of the evidence and voted on by the 57 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here achieved at least 95% consensus. These guidelines will continue to be updated annually.
Notes
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Comment In: Can J Cardiol. 2007 May 15;23(7):603-417593584
PubMed ID
17534460 View in PubMed
Less detail

The 2009 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 2--therapy.

https://arctichealth.org/en/permalink/ahliterature151164
Source
Can J Cardiol. 2009 May;25(5):287-98
Publication Type
Article
Date
May-2009
Author
Nadia A Khan
Brenda Hemmelgarn
Robert J Herman
Chaim M Bell
Jeff L Mahon
Lawrence A Leiter
Simon W Rabkin
Michael D Hill
Raj Padwal
Rhian M Touyz
Pierre Larochelle
Ross D Feldman
Ernesto L Schiffrin
Norman R C Campbell
Gordon Moe
Ramesh Prasad
Malcolm O Arnold
Tavis S Campbell
Alain Milot
James A Stone
Charlotte Jones
Richard I Ogilvie
Pavel Hamet
George Fodor
George Carruthers
Kevin D Burns
Marcel Ruzicka
Jacques DeChamplain
George Pylypchuk
Robert Petrella
Jean-Martin Boulanger
Luc Trudeau
Robert A Hegele
Vincent Woo
Phil McFarlane
Michel Vallée
Jonathan Howlett
Simon L Bacon
Patrice Lindsay
Richard E Gilbert
Richard Z Lewanczuk
Sheldon Tobe
Author Affiliation
Division of General Internal Medicine, University of British Columbia, Vancouver, Canada. nakhan@shaw.ca
Source
Can J Cardiol. 2009 May;25(5):287-98
Date
May-2009
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antihypertensive Agents - therapeutic use
Blood Pressure Determination - standards
Canada
Case Management - standards
Combined Modality Therapy
Diet, Sodium-Restricted
Female
Health Promotion - organization & administration
Humans
Hypertension - diagnosis - therapy
Life Style
Male
Middle Aged
Patient Education as Topic
Prognosis
Program Evaluation
Randomized Controlled Trials as Topic
Treatment Outcome
Abstract
To update the evidence-based recommendations for the prevention and management of hypertension in adults for 2009.
For lifestyle and pharmacological interventions, evidence from randomized controlled trials and systematic reviews of trials was preferentially reviewed. Changes in cardiovascular morbidity and mortality were the primary outcomes of interest. However, for lifestyle interventions, blood pressure lowering was accepted as a primary outcome given the lack of long-term morbidity and mortality data in this field. Progression of kidney dysfunction was also accepted as a clinically relevant primary outcome among patients with chronic kidney disease.
A Cochrane collaboration librarian conducted an independent MEDLINE search from 2007 to August 2008 to update the 2008 recommendations. To identify additional published studies, reference lists were reviewed and experts were contacted. All relevant articles were reviewed and appraised independently by both content and methodological experts using prespecified levels of evidence.
For lifestyle modifications to prevent and treat hypertension, restrict dietary sodium to less than 2300 mg (100 mmol)/day (and 1500 mg to 2300 mg [65 mmol to 100 mmol]/day in hypertensive patients); perform 30 min to 60 min of aerobic exercise four to seven days per week; maintain a healthy body weight (body mass index 18.5 kg/m(2) to 24.9 kg/m(2)) and waist circumference (smaller than 102 cm for men and smaller than 88 cm for women); limit alcohol consumption to no more than 14 units per week in men or nine units per week in women; follow a diet that is reduced in saturated fat and cholesterol, and that emphasizes fruits, vegetables and low-fat dairy products, dietary and soluble fibre, whole grains and protein from plant sources; and consider stress management in selected individuals with hypertension. For the pharmacological management of hypertension, treatment thresholds and targets should be predicated on by the patient's global atherosclerotic risk, target organ damage and comorbid conditions. Blood pressure should be decreased to lower than 140/90 mmHg in all patients, and to lower than 130/80 mmHg in those with diabetes mellitus or chronic kidney disease. Most patients will require more than one agent to achieve these target blood pressures. Antihypertensive therapy should be considered in all adult patients regardless of age (caution should be exercised in elderly patients who are frail). For adults without compelling indications for other agents, initial therapy should include thiazide diuretics. Other agents appropriate for first-line therapy for diastolic and/or systolic hypertension include angiotensin- converting enzyme (ACE) inhibitors (in patients who are not black), long-acting calcium channel blockers (CCBs), angiotensin receptor antagonists (ARBs) or beta-blockers (in those younger than 60 years of age). A combination of two first-line agents may also be considered as the initial treatment of hypertension if the systolic blood pressure is 20 mmHg above the target or if the diastolic blood pressure is 10 mmHg above the target. The combination of ACE inhibitors and ARBs should not be used. Other agents appropriate for first-line therapy for isolated systolic hypertension include long- acting dihydropyridine CCBs or ARBs. In patients with angina, recent myocardial infarction or heart failure, beta-blockers and ACE inhibitors are recommended as first-line therapy; in patients with cerebrovascular disease, an ACE inhibitor/diuretic combination is preferred; in patients with proteinuric nondiabetic chronic kidney disease, ACE inhibitors or ARBs (if intolerant to ACE inhibitors) are recommended; and in patients with diabetes mellitus, ACE inhibitors or ARBs (or, in patients without albuminuria, thiazides or dihydropyridine CCBs) are appropriate first-line therapies. All hypertensive patients with dyslipidemia should be treated using the thresholds, targets and agents outlined in the Canadian Cardiovascular Society position statement (recommendations for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease). Selected high-risk patients with hypertension who do not achieve thresholds for statin therapy according to the position paper should nonetheless receive statin therapy. Once blood pressure is controlled, acetylsalicylic acid therapy should be considered.
All recommendations were graded according to strength of the evidence and voted on by the 57 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here achieved at least 95% consensus. These guidelines will continue to be updated annually.
Notes
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PubMed ID
19417859 View in PubMed
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Anti-diabetic drug use and the risk of motor vehicle crash in the elderly.

https://arctichealth.org/en/permalink/ahliterature169929
Source
Can J Clin Pharmacol. 2006;13(1):e112-20
Publication Type
Article
Date
2006
Author
Brenda Hemmelgarn
Linda E Lévesque
Samy Suissa
Author Affiliation
Department of Medicine, University of Calgary, Alberta, Canada.
Source
Can J Clin Pharmacol. 2006;13(1):e112-20
Date
2006
Language
English
Publication Type
Article
Keywords
Accidents, Traffic - statistics & numerical data
Aged
Diabetes Mellitus - drug therapy
Female
Humans
Hypoglycemic Agents - adverse effects - therapeutic use
Logistic Models
Male
Metformin - adverse effects - therapeutic use
Quebec - epidemiology
Sulfonylurea Compounds - adverse effects - therapeutic use
Abstract
Studies of the risk of motor vehicle crash associated with diabetes have produced conflicting results.
To assess whether the use of anti-diabetic drugs among the elderly increases the risk of motor vehicle crash.
The computerized databases of the various universal insurance programs of Québec were linked to form a cohort of all 224,734 elderly drivers that was followed from 1990-1993. Using a nested case-control approach, all 5,579 drivers involved in an injurious crash (cases) and a random sample of 13,300 control subjects were identified. Exposure to anti-diabetic drugs was assessed in the year preceding the index date, namely the date of the crash for the cases and a randomly selected date during follow-up for the controls.
The adjusted rate ratio of an injurious crash was 1.4 (95% CI: 1.0-2.0) for current users of insulin monotherapy relative to non-users and 1.3 (95% CI: 1.0-1.7) for sulfonylurea and metformin combined. Monotherapy, using either a sulfonylurea or metformin, was not associated with an increased risk. There was a dose-response effect in subjects using high doses of combined oral therapy (RR 1.4; 95% CI: 1.0-2.0). For users of insulin monotherapy or of high doses of combined oral therapy, the increase corresponds to an excess rate of 32 crashes per 10,000 elderly drivers per year.
L Elderly drivers treated with insulin monotherapy or a combination of sulfonylurea and metformin, especially at high doses, have a small increased risk of injurious crashes. There is no increased risk associated with any regimen of oral monotherapy.
PubMed ID
16585812 View in PubMed
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Association between glycemic control and adverse outcomes in people with diabetes mellitus and chronic kidney disease: a population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature129274
Source
Arch Intern Med. 2011 Nov 28;171(21):1920-7
Publication Type
Article
Date
Nov-28-2011
Author
Sabin Shurraw
Brenda Hemmelgarn
Meng Lin
Sumit R Majumdar
Scott Klarenbach
Braden Manns
Aminu Bello
Matthew James
Tanvir Chowdhury Turin
Marcello Tonelli
Author Affiliation
Divisions of Nephrology, University of Alberta, Edmonton, Canada.
Source
Arch Intern Med. 2011 Nov 28;171(21):1920-7
Date
Nov-28-2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alberta - epidemiology
Biological Markers - blood
Cardiovascular Diseases - etiology - metabolism
Cohort Studies
Diabetes Mellitus - metabolism - mortality - therapy
Diabetic Nephropathies - metabolism
Female
Glomerular Filtration Rate
Hemoglobin A, Glycosylated - metabolism
Hospitalization - statistics & numerical data
Humans
Kidney Failure, Chronic - complications - metabolism
Male
Middle Aged
Abstract
Better glycemic control as reflected by lower hemoglobin A(1c) (HbA(1c)) level may prevent or slow progression of nephropathy in people with diabetes mellitus (DM). Whether a lower HbA(1c) level improves outcomes in people with DM and chronic kidney disease (CKD) is unknown.
From all people with serum creatinine measured as part of routine care in a single Canadian province from 2005 through 2006, we identified those with CKD based on laboratory data (estimated glomerular filtration rate [eGFR],
Notes
Comment In: Arch Intern Med. 2011 Nov 28;171(21):1927-822123801
Comment In: Arch Intern Med. 2012 Apr 9;172(7):596; discussion 596-722493472
PubMed ID
22123800 View in PubMed
Less detail

Association between LDL-C and risk of myocardial infarction in CKD.

https://arctichealth.org/en/permalink/ahliterature113782
Source
J Am Soc Nephrol. 2013 May;24(6):979-86
Publication Type
Article
Date
May-2013
Author
Marcello Tonelli
Paul Muntner
Anita Lloyd
Braden Manns
Scott Klarenbach
Neesh Pannu
Matthew James
Brenda Hemmelgarn
Author Affiliation
Department of Medicine, University of Alberta, Edmonton, Canada. mtonelli-admin@med.ualberta.ca
Source
J Am Soc Nephrol. 2013 May;24(6):979-86
Date
May-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Alberta - epidemiology
Cholesterol, LDL - blood
Female
Follow-Up Studies
Heart rate
Hospitalization - statistics & numerical data
Humans
Incidence
Male
Middle Aged
Myocardial Infarction - epidemiology - metabolism
Prevalence
Registries - statistics & numerical data
Renal Insufficiency, Chronic - epidemiology - metabolism
Risk factors
Abstract
LDL cholesterol (LDL-C) is an important marker of coronary risk in the general population, but its utility in people with CKD is unclear. We studied 836,060 adults from the Alberta Kidney Disease Network with at least one measurement of fasting LDL-C, estimated GFR (eGFR), and proteinuria between 2002 and 2009. All participants were free of stage 5 CKD at cohort entry. We followed participants from first eGFR measurement to March 31, 2009; we used validated algorithms applied to administrative data to ascertain primary outcome (hospitalization for myocardial infarction) and Cox regression to calculate adjusted hazard ratios (HRs) for myocardial infarction by LDL-C categories within eGFR strata. During median follow-up of 48 months, 7762 patients were hospitalized for myocardial infarction, with incidence highest among participants with the lowest eGFR. Compared with 2.6-3.39 mmol/L (referent), the risk associated with having LDL-C above 4.9 mmol/L seemed greatest for GFR=90 ml/min per 1.73 m(2) and least for eGFR=15-59.9 ml/min per 1.73 m(2). Specifically, the adjusted HRs (95% confidence intervals) of myocardial infarction associated with LDL-C of =4.9 compared with 2.6-3.39 mmol/L in participants with eGFR=15-59.9, 60-89.9, and =90 ml/min per 1.73 m(2) were 2.06 (1.59, 2.67), 2.30 (2.00, 2.65), and 3.01 (2.46, 3.69). In conclusion, the association between higher LDL-C and risk of myocardial infarction is weaker for people with lower baseline eGFR, despite higher absolute risk of myocardial infarction. Increased LDL-C may be less useful as a marker of coronary risk among people with CKD than the general population.
Notes
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Comment In: Nat Rev Nephrol. 2013 Jul;9(7):36923752890
Comment In: J Am Soc Nephrol. 2013 May;24(6):870-223687358
PubMed ID
23687359 View in PubMed
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Association between proximity to the attending nephrologist and mortality among patients receiving hemodialysis.

https://arctichealth.org/en/permalink/ahliterature160680
Source
CMAJ. 2007 Oct 23;177(9):1039-44
Publication Type
Article
Date
Oct-23-2007
Author
Marcello Tonelli
Braden Manns
Bruce Culleton
Scott Klarenbach
Brenda Hemmelgarn
Natasha Wiebe
John S Gill
Author Affiliation
Division of Nephrology and Transplant Immunology, Department of Medicine, University of Alberta, Edmonton, Alta. mtonelli-admin@med.ualberta.ca
Source
CMAJ. 2007 Oct 23;177(9):1039-44
Date
Oct-23-2007
Language
English
Publication Type
Article
Keywords
Aged
Canada - epidemiology
Female
Health Services Accessibility
Humans
Male
Middle Aged
Professional Practice Location
Proportional Hazards Models
Prospective Studies
Registries
Renal Dialysis - mortality
Renal Insufficiency - epidemiology - therapy
Risk factors
Survival Rate
Travel
Abstract
Many Canadian patients who receive hemodialysis live far from their attending nephrologist, which may affect clinical outcomes. We investigated whether patients receiving hemodialysis who live farther from their attending nephrologist are more likely to die than those who live closer.
We studied a random sample of 18,722 patients who began hemodialysis between 1990 and 2000 in Canada. We calculated the distance between each patient's residence location at the start of dialysis and the practice location of their attending nephrologist. We used Cox proportional hazards models to examine the adjusted relation between distance and clinical outcomes (death from all causes, infectious causes and cardiovascular causes) over a follow-up period of up to 14 years.
During the follow-up period (median 2.5 yr, interquartile range 1.0-4.7 yr), 11,582 (62%) patients died. Compared with patients who lived within 50 km of their nephrologist, the adjusted hazard ratio of death among those who lived 50.1-150 km away was 1.06 (95% confidence interval [CI] 1.01-1.12), 1.13 (95% CI 1.04-1.22) for those who lived 150.1-300 km away and 1.13 (95% CI 1.03-1.24) for those who lived more than 300 km from their nephrologist (p for trend
Notes
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Comment In: CMAJ. 2007 Oct 23;177(9):1055-617954895
PubMed ID
17954893 View in PubMed
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Association between residence location and likelihood of transplantation among pediatric dialysis patients.

https://arctichealth.org/en/permalink/ahliterature125363
Source
Pediatr Transplant. 2012 Nov;16(7):735-41
Publication Type
Article
Date
Nov-2012
Author
Susan M Samuel
Brenda Hemmelgarn
Alberto Nettel-Aguirre
Bethany Foster
Andrea Soo
R Todd Alexander
Marcello Tonelli
Author Affiliation
Alberta Children's Hospital, Calgary, AB, Canada. s.samuel@albertahealthservices.ca
Source
Pediatr Transplant. 2012 Nov;16(7):735-41
Date
Nov-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Canada
Child
Child, Preschool
Female
Geography
Health Services Research
Humans
Infant
Infant, Newborn
Kidney Transplantation - methods - utilization
Male
Renal Dialysis - methods - utilization
Renal Insufficiency - ethnology - therapy
Residence Characteristics
Treatment Outcome
Abstract
Many children with ESRD reside far from a kidney transplant center. It is unknown whether this geographical barrier affects likelihood of transplantation. We used data from a national ESRD database. Patients = 18 yr old who started renal replacement in nine Canadian provinces during 1992-2007 were followed until death or last contact. Primary outcome was kidney transplantation (living or deceased donor). Distance between nearest pediatric transplant center and each patient's residence was categorized as:
PubMed ID
22489932 View in PubMed
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Association of modality with mortality among Canadian Aboriginals.

https://arctichealth.org/en/permalink/ahliterature120493
Source
Clin J Am Soc Nephrol. 2012 Dec;7(12):1988-95
Publication Type
Article
Date
Dec-2012
Author
Manish M Sood
Brenda Hemmelgarn
Claudio Rigatto
Paul Komenda
Karen Yeates
Steven Promislow
Julie Mojica
Navdeep Tangri
Author Affiliation
Department of Medicine, Section of Nephrology, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada. Msood99@gmail.com
Source
Clin J Am Soc Nephrol. 2012 Dec;7(12):1988-95
Date
Dec-2012
Language
English
Publication Type
Article
Keywords
Age Factors
Canada - epidemiology
Confidence Intervals
European Continental Ancestry Group - statistics & numerical data
Healthcare Disparities
Humans
Indians, North American - statistics & numerical data
Kidney Failure, Chronic - ethnology - mortality - therapy
Multivariate Analysis
Peritoneal Dialysis - statistics & numerical data
Proportional Hazards Models
Renal Dialysis - statistics & numerical data
Treatment Failure
Abstract
Previous studies have shown that Aboriginals and Caucasians experience similar outcome on dialysis in Canada. Using the Canadian Organ Replacement Registry, this study examined whether dialysis modality (peritoneal or hemodialysis) impacted mortality in Aboriginal patients.
This study identified 31,576 adult patients (hemodialysis: Aboriginal=1839, Caucasian=21,430; peritoneal dialysis: Aboriginal=554, Caucasian=6769) who initiated dialysis between January of 2000 and December of 2009. Aboriginal status was identified by self-report. Dialysis modality was determined 90 days after dialysis initiation. Multivariate Cox proportional hazards and competing risk models were constructed to determine the association between race and mortality by dialysis modality.
During the study period, 939 (51.1%) Aboriginals and 12,798 (53.3%) Caucasians initiating hemodialysis died, whereas 166 (30.0%) and 2037 (30.1%), respectively, initiating peritoneal dialysis died. Compared with Caucasians, Aboriginals on hemodialysis had a comparable risk of mortality (adjusted hazards ratio=1.04, 95% confidence interval=0.96-1.11, P=0.37). However, on peritoneal dialysis, Aboriginals experienced a higher risk of mortality (adjusted hazards ratio=1.36, 95% confidence interval=1.13-1.62, P=0.001) and technique failure (adjusted hazards ratio=1.29, 95% confidence interval=1.03-1.60, P=0.03) than Caucasians. The risk of technique failure varied by patient age, with younger Aboriginals (
Notes
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PubMed ID
22997343 View in PubMed
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Associations among estimated glomerular filtration rate, proteinuria, and adverse cardiovascular outcomes.

https://arctichealth.org/en/permalink/ahliterature134918
Source
Clin J Am Soc Nephrol. 2011 Jun;6(6):1418-26
Publication Type
Article
Date
Jun-2011
Author
Aminu K Bello
Brenda Hemmelgarn
Anita Lloyd
Matthew T James
Braden J Manns
Scott Klarenbach
Marcello Tonelli
Author Affiliation
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Source
Clin J Am Soc Nephrol. 2011 Jun;6(6):1418-26
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Alberta - epidemiology
Angioplasty, Balloon, Coronary - statistics & numerical data
Biological Markers - blood
Cardiovascular Diseases - epidemiology - therapy
Chronic Disease
Coronary Artery Bypass - statistics & numerical data
Creatinine - blood
Female
Glomerular Filtration Rate
Heart Failure - epidemiology
Hospitalization - statistics & numerical data
Humans
Ischemic Attack, Transient - epidemiology
Kidney - physiopathology
Kidney Diseases - diagnosis - epidemiology - physiopathology
Longitudinal Studies
Male
Middle Aged
Peripheral Arterial Disease - epidemiology
Proteinuria - diagnosis - epidemiology - physiopathology
Risk assessment
Risk factors
Severity of Illness Index
Stroke - epidemiology
Time Factors
Abstract
Most studies of chronic kidney disease (CKD) and outcomes focus on mortality and ESRD, with limited data on other adverse outcomes. This study examined the associations among proteinuria, eGFR, and adverse cardiovascular (CV) events.
This was a population-based longitudinal study with patients identified from province-wide laboratory data from Alberta, Canada, between 2002 and 2007. Selected for this study from a total of 1,526,437 patients were 920,985 (60.3%) patients with at least one urine dipstick measurement and 102,701 patients (6.7%) with at least one albumin-creatinine ratio (ACR) measurement. Time to hospitalization was considered for one of four indications: congestive heart failure (CHF), coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI), peripheral vascular disease (PVD), and stroke/transient ischemic attacks [TIAs] (cerebrovascular accident [CVA]/TIA).
After a median follow-up of 35 months, in fully adjusted models and compared with patients with estimated GFR (eGFR) of 45 to 59 ml/min per 1.73 m(2) and no proteinuria, patients with heavy proteinuria by dipstick and eGFR = 60 ml/min per 1.73 m(2) had higher rates of CABG/PCI and CVA/TIA. Similar results were obtained in patients with proteinuria measured by ACR.
Risks of major CV events at a given level of eGFR increased with higher levels of proteinuria. The findings extend current data on risk of mortality and ESRD. Measurement of proteinuria is of incremental prognostic benefit at every level of eGFR. The data support use of proteinuria measurement with eGFR for definition and risk stratification in CKD.
Notes
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Comment In: Clin J Am Soc Nephrol. 2011 Jun;6(6):1235-721597027
PubMed ID
21527648 View in PubMed
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