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Cost-effectiveness analysis of a randomized trial comparing care models for chronic kidney disease.

https://arctichealth.org/en/permalink/ahliterature134145
Source
Clin J Am Soc Nephrol. 2011 Jun;6(6):1248-57
Publication Type
Article
Date
Jun-2011
Author
Robert B Hopkins
Amit X Garg
Adeera Levin
Anita Molzahn
Claudio Rigatto
Joel Singer
George Soltys
Steven Soroka
Patrick S Parfrey
Brendan J Barrett
Ron Goeree
Author Affiliation
PATH Research Institute, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada. hopkinr@mcmaster.ca
Source
Clin J Am Soc Nephrol. 2011 Jun;6(6):1248-57
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Aged
Biological Markers - blood
Canada
Cardiovascular Agents - economics - therapeutic use
Cardiovascular Diseases - economics - etiology - prevention & control
Chronic Disease
Cost Savings
Cost-Benefit Analysis
Creatinine - blood
Disease Progression
Drug Costs
Female
General Practice - economics - organization & administration
Glomerular Filtration Rate
Health Care Costs
Hematinics - economics - therapeutic use
Hospital Costs
Hospitalization - economics
Humans
Hypoglycemic Agents - economics - therapeutic use
Hypolipidemic Agents - economics - therapeutic use
Kidney - physiopathology
Kidney Diseases - complications - diagnosis - economics - nursing - physiopathology - therapy
Length of Stay - economics
Male
Middle Aged
Models, Economic
Nurse Clinicians - economics - organization & administration
Patient Care Team - economics - organization & administration
Platelet Aggregation Inhibitors - economics - therapeutic use
Preventive Health Services - economics - organization & administration
Prospective Studies
Quality-Adjusted Life Years
Risk assessment
Risk factors
Risk Reduction Behavior
Severity of Illness Index
Smoking Cessation
Time Factors
Treatment Outcome
Up-Regulation
Abstract
Potential cost and effectiveness of a nephrologist/nurse-based multifaceted intervention for stage 3 to 4 chronic kidney disease are not known. This study examines the cost-effectiveness of a chronic disease management model for chronic kidney disease.
Cost and cost-effectiveness were prospectively gathered alongside a multicenter trial. The Canadian Prevention of Renal and Cardiovascular Endpoints Trial (CanPREVENT) randomized 236 patients to receive usual care (controls) and another 238 patients to multifaceted nurse/nephrologist-supported care that targeted factors associated with development of kidney and cardiovascular disease (intervention). Cost and outcomes over 2 years were examined to determine the incremental cost-effectiveness of the intervention. Base-case analysis included disease-related costs, and sensitivity analysis included all costs.
Consideration of all costs produced statistically significant differences. A lower number of days in hospital explained most of the cost difference. For both base-case and sensitivity analyses with all costs included, the intervention group required fewer resources and had higher quality of life. The direction of the results was unchanged to inclusion of various types of costs, consideration of payer or societal perspective, changes to the discount rate, and levels of GFR.
The nephrologist/nurse-based multifaceted intervention represents good value for money because it reduces costs without reducing quality of life for patients with chronic kidney disease.
Notes
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Comment In: Clin J Am Soc Nephrol. 2011 Jun;6(6):1229-3121617089
PubMed ID
21617091 View in PubMed
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Diagnostic accuracy of cystatin C-based eGFR equations at different GFR levels in children.

https://arctichealth.org/en/permalink/ahliterature133476
Source
Clin J Am Soc Nephrol. 2011 Jul;6(7):1599-608
Publication Type
Article
Date
Jul-2011
Author
Ajay P Sharma
Abeer Yasin
Amit X Garg
Guido Filler
Author Affiliation
Department of Pediatrics, Division of Pediatric Nephrology, Children's Hospital, London Health Sciences Centre, University of Western Ontario, London, Ontario, N6A 5W9 Canada. guido.filler@lhsc.on.ca
Source
Clin J Am Soc Nephrol. 2011 Jul;6(7):1599-608
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Biological Markers - blood
Child
Child, Preschool
Cross-Sectional Studies
Cystatin C - analysis
Female
Glomerular Filtration Rate
Humans
Kidney - physiopathology
Kidney Diseases - blood - diagnosis - physiopathology
Male
Models, Biological
Ontario
Predictive value of tests
Prognosis
Prospective Studies
Radiopharmaceuticals - diagnostic use
Reproducibility of Results
Severity of Illness Index
Technetium Tc 99m Pentetate - diagnostic use
Abstract
The diagnostic accuracy of cystatin C estimated GFR (eGFR) by various cystatin C equations have varied in different studies. We hypothesized that the GFR level of enrolled patients affects the diagnostic accuracy of a cystatin C equation.
We analyzed 240 consecutively enrolled children at a single Canadian center in a prospective and cross-sectional study. Cystatin C was analyzed with nephelometry, and cystatin C eGFR was estimated by the equations validated in children. GFR was measured by technetium-99m-diethylene-triamine penta-acetic acid (??m)Tc DTPA).
We compared various cystatin C equations across GFR strata
PubMed ID
21700821 View in PubMed
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A nurse-coordinated model of care versus usual care for stage 3/4 chronic kidney disease in the community: a randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature134146
Source
Clin J Am Soc Nephrol. 2011 Jun;6(6):1241-7
Publication Type
Article
Date
Jun-2011
Author
Brendan J Barrett
Amit X Garg
Ron Goeree
Adeera Levin
Anita Molzahn
Claudio Rigatto
Joel Singer
George Soltys
Steven Soroka
Dieter Ayers
Patrick S Parfrey
Author Affiliation
Memorial University of Newfoundland, St. John's, Newfoundland, Canada. bbarrett@mun.ca
Source
Clin J Am Soc Nephrol. 2011 Jun;6(6):1241-7
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Aged
Biological Markers - blood
Canada
Cardiovascular Agents - therapeutic use
Cardiovascular Diseases - etiology - prevention & control
Chi-Square Distribution
Chronic Disease
Creatinine - blood
Disease Progression
Female
General Practice - organization & administration
Glomerular Filtration Rate
Hematinics - therapeutic use
Humans
Hypoglycemic agents - therapeutic use
Hypolipidemic Agents - therapeutic use
Kidney - physiopathology
Kidney Diseases - complications - diagnosis - nursing - physiopathology - therapy
Linear Models
Male
Middle Aged
Nurse Clinicians - organization & administration
Patient Care Team - organization & administration
Pilot Projects
Platelet Aggregation Inhibitors - therapeutic use
Preventive Health Services - economics - organization & administration
Risk assessment
Risk factors
Risk Reduction Behavior
Severity of Illness Index
Smoking Cessation
Time Factors
Treatment Outcome
Up-Regulation
Abstract
It is unclear how to optimally care for chronic kidney disease (CKD). This study compares a new coordinated model to usual care for CKD.
A randomized trial in nephrology clinics and the community included 474 patients with median estimated GFR (eGFR) 42 ml/min per 1.73 m(2) identified by laboratory-based case finding compared care coordinated by a general practitioner (controls) with care by a nurse-coordinated team including a nephrologist (intervention) for a median (interquartile range [IQR]) of 742 days. 32% were diabetic, 60% had cardiovascular disease, and proteinuria was minimal. Guided by protocols, the intervention team targeted risk factors for adverse kidney and cardiovascular outcomes. Serial eGFR and clinical events were tracked.
The average decline in eGFR over 20 months was -1.9 ml/min per 1.73 m(2). eGFR declined by =4 ml/min per 1.73 m(2) within 20 months in 28 (17%) intervention patients versus 23 (13.9%) control patients. Control of BP, LDL, and diabetes were comparable across groups. In the intervention group there was a trend to greater use of renin-angiotensin blockers and more use of statins in those with initial LDL >2.5 mmol/L. Treatment was rarely required for anemia, acidosis, or disordered mineral metabolism. Clinical events occurred in 5.2% per year.
Patients with stage 3/4 CKD identified through community laboratories largely had nonprogressive kidney disease but had cardiovascular risk. Over a median of 24 months, the nurse-coordinated team did not affect rate of GFR decline or control of most risk factors compared with usual care.
Notes
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Comment In: Clin J Am Soc Nephrol. 2011 Jun;6(6):1229-3121617089
PubMed ID
21617090 View in PubMed
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Urine volume and change in estimated GFR in a community-based cohort study.

https://arctichealth.org/en/permalink/ahliterature131691
Source
Clin J Am Soc Nephrol. 2011 Nov;6(11):2634-41
Publication Type
Article
Date
Nov-2011
Author
William F Clark
Jessica M Sontrop
Jennifer J Macnab
Rita S Suri
Louise Moist
Marina Salvadori
Amit X Garg
Author Affiliation
Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada. William.Clark@lhsc.on.ca
Source
Clin J Am Soc Nephrol. 2011 Nov;6(11):2634-41
Date
Nov-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada - epidemiology
Chi-Square Distribution
Disease Progression
Drinking
Female
Glomerular Filtration Rate
Humans
Kidney - physiopathology
Kidney Diseases - epidemiology - physiopathology - prevention & control
Logistic Models
Male
Middle Aged
Odds Ratio
Prospective Studies
Risk assessment
Risk factors
Time Factors
Urination
Abstract
The effect of increased fluid intake on kidney function is unclear. This study evaluates the relationship between urine volume and renal decline over 6 years in a large community-based cohort.
This prospective cohort study was undertaken in Canada from 2002 to 2008. We obtained 24-hour urine samples from adult participants with an estimated GFR (eGFR) =60 ml/min per 1.73 m(2) at study entry. Percentage annual change in eGFR from baseline was categorized as average decline
Notes
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Comment In: Clin J Am Soc Nephrol. 2011 Nov;6(11):2558-6022034508
PubMed ID
21885793 View in PubMed
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