The causes and consequences of paediatric kidney disease on adult nephrology care

2021 ◽  
Author(s):  
Ruth J. Pepper ◽  
Richard S. Trompeter
Keyword(s):  
Kidney Disease ◽  
Nephrology Care

scholarly journals Where Are You Going, Nephrology? Considerations on Models of Care in an Evolving Discipline

2018 ◽  
Vol 7 (8) ◽  
pp. 199 ◽  
Author(s):  
Giorgina Piccoli ◽  
Conrad Breuer ◽  
Gianfranca Cabiddu ◽  
Angelo Testa ◽  
Christelle Jadeau ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Kidney Disease ◽  
Kidney Diseases ◽  
Models Of Care ◽  
Scientific Model ◽  
Dialysis Treatment ◽  
Cost Constraints ◽  
Common Diseases ◽  
Nephrology Care ◽  
Immunologic Diseases

Nephrology is a complex discipline, including care of kidney disease, dialysis, and transplantation. While in Europe, about 1:10 individuals is affected by chronic kidney disease (CKD), 1:1000 lives thanks to dialysis or transplantation, whose costs are as high as 2% of all the health care budget. Nephrology has important links with surgery, bioethics, cardiovascular and internal medicine, and is, not surprisingly, in a delicate balance between specialization and comprehensiveness, development and consolidation, cost constraints, and competition with internal medicine and other specialties. This paper proposes an interpretation of the different systems of nephrology care summarising the present choices into three not mutually exclusive main models (“scientific”, “pragmatic”, “holistic”, or “comprehensive”), and hypothesizing an “ideal-utopic” prevention-based fourth one. The so-called scientific model is built around kidney transplantation and care of glomerulonephritis and immunologic diseases, which probably pose the most important challenges in our discipline, but do not mirror the most common clinical problems. Conversely, the pragmatic one is built around dialysis (the most expensive and frequent mode of renal replacement therapy) and pre-dialysis treatment, focusing attention on the most common diseases, the holistic, or comprehensive, model comprehends both, and is integrated by several subspecialties, such as interventional nephrology, obstetric nephrology, and the ideal-utopic one is based upon prevention, and early care of common diseases. Each model has strength and weakness, which are commented to enhance discussion on the crucial issue of the philosophy of care behind its practical organization. Increased reflection and research on models of nephrology care is urgently needed if we wish to rise to the challenge of providing earlier and better care for older and more complex kidney patients with acute and chronic kidney diseases, with reduced budgets.

scholarly journals THE MEDICAL AND PREVENTIVE CARE TO PATIENTS OF A NEPHROLOGICAL PROFILE 2009-2012, WHAT TO DO NEXT ?

2017 ◽  
pp. 3-14
Author(s):  
M. O. Kolesnyk ◽  
N. O. Saidakova ◽  
N. I. Kozlyuk ◽  
S. S. Nikolaenko
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Preventive Care ◽  
National Registry ◽  
Nephrology Care ◽  
Basic Performance ◽  
Basic Parameters

This is a study of the basic performance of nephrology care to the population of Ukraine during 2009-2012. The paper used the data from the National registry of patients with chronic kidney disease during 2009-2012, published by the "Institute of Nephrology of NAMS of Ukraine." The results of analysis testify to considerable lag on the size of basic parameters of medical help to the patients of nephrological profile from European.

scholarly journals Provision of Kidney Disease Education Service is Associated with Improved Vascular Access Outcomes among the US Incident Hemodialysis Patients

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0004502021
Author(s):  
Rupam Ruchi ◽  
Shahab Bozorgmehri ◽  
Gajapathiraju Chamarthi ◽  
Tatiana Orozco ◽  
Rajesh Mohandas ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Vascular Access ◽  
Venous Catheter ◽  
Hemodialysis Patients ◽  
The Us ◽  
Nephrology Care ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact ◽  
Encompassing Model

Background: Pre-end stage renal disease (ESRD) Kidney Disease Education (KDE) has been shown to improve multiple chronic kidney disease (CKD) outcomes but, its impact on vascular access outcomes is not well-studied. In 2010, Medicare launched KDE reimbursements policy for patients with advanced CKD. Methods: In this retrospective USRDS analysis, we identified all adult incident hemodialysis patients with a minimum of 6-months of pre-ESRD Medicare coverage during the first five-years of CMS-KDE policy and divided them into CMS-KDE services recipients (KDE-cohort) and non-recipients (non-KDE cohort). The primary outcome was incident arteriovenous fistula (AVF) and the composite of incident AVF or arteriovenous graft (AVG) utilization. Secondary outcomes were central venous catheter (CVC) with maturing AVF/AVG and pure CVC utilizations. Step-wise multivariate analyses were performed in four progressive models (model 1: KDE alone, model 2: multivariate model encompassing model 1 with socio-demographics, model 3: model 2 with comorbidity and functional status, and model 4: model 3 with pre-ESRD nephrology care). Results: Of the 211,990 qualifying incident hemodialysis patients during the study period, 2,887(1.4%) received KDE services before dialysis initiation. The rates of incident AVF and composite AVF/AVG were more than double (29.7% and 34.9% respectively, compared to 14.2% and 17.2%) and pure catheter use about a third lower (40.4% compared to 64.5%) in the KDE cohort compared to the non-KDE cohort. Maximally adjusted odds ratio(99% confidence interval) in model 4 for study outcomes were: incident AVF use: 1.78 (1.55-2.05), incident AVF/AVG use: 1.78 (1.56-2.03), incident CVC with maturing AVF/AVG: 1.69 (1.44-1.97)and pure CVC without any AVF/AVG: 0.51 (0.45-0.58). The benefits of KDE service were maintained even after accounting for the presence, duration and facility of ESRD care. Conclusion: Occurrence of pre-ESRD KDE service is associated with significantly improved incident vascular access outcomes. Targeted studies are needed to examine the impact of KDE on patient engagement and self-efficacy as a cause for improvement in vascular access outcomes.

scholarly journals Independent Role of Underlying Kidney Disease on Renal Prognosis of Patients with Chronic Kidney Disease under Nephrology Care

PLoS ONE ◽  
2015 ◽  
Vol 10 (5) ◽  
pp. e0127071 ◽  
Author(s):  
Luca De Nicola ◽  
Michele Provenzano ◽  
Paolo Chiodini ◽  
Silvio Borrelli ◽  
Carlo Garofalo ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Nephrology Care ◽  
Renal Prognosis

scholarly journals PUK16 Cost-Analysis of Persistent Hyperkalaemia in NON-Dialysis Chronic Kidney Disease Patients UNDER Nephrology Care in Italy

2020 ◽  
Vol 23 ◽  
pp. S753
Author(s):  
M. Provenzano ◽  
M. De Francesco ◽  
S. Iannazzo ◽  
L. Narici ◽  
B. Dirodi ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cost Analysis ◽  
Nephrology Care

scholarly journals Healthcare costs associated with nephrology care in pre-dialysis chronic kidney disease patients

2010 ◽  
Vol 13 (4) ◽  
pp. 673-680 ◽  
Author(s):  
Francis Vekeman ◽  
Nadege-Desiree Yameogo ◽  
Patrick Lefebvre ◽  
Robert A. Bailey ◽  
R. Scott McKenzie ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Healthcare Costs ◽  
Nephrology Care

scholarly journals Referring patients with chronic kidney disease back to primary care: a criteria-based analysis in outpatient renal clinics

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Carola van Dipten ◽  
Davy Gerda Hermina Antoin van Dam ◽  
Wilhelmus Joannes Carolus de Grauw ◽  
Marcus Antonius Gerard Jan ten Dam ◽  
Marcus Matheus Hendrik Hermans ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
General Practitioners ◽  
Estimated Glomerular Filtration Rate ◽  
Outpatient Clinics ◽  
Future Research ◽  
Care Facilities ◽  
Nephrology Care

Abstract Background The increased demand for nephrology care for patients with chronic kidney disease (CKD) necessitates a critical review of the need for secondary care facilities and the possibilities for referral back to primary care. This study aimed to evaluate the characteristics and numbers of patients who could potentially be referred back to primary care, using predefined criteria developed by nephrologists and general practitioners. Method We organised a consensus meeting with eight nephrologists and two general practitioners to define the back referral (BR) criteria, and performed a retrospective cohort study reviewing records from patients under nephrologist care in three hospitals. Results We reached a consensus about the BR criteria. Overall, 78 of the 300 patients (26%) in the outpatient clinics met the BR criteria. The characteristics of the patients who met the BR criteria were: 56.4% male, a median age of 70, an average of 3.0 outpatients visits per year, and a mean estimated glomerular filtration rate of 46 ml/min/1,73m2. Hypertension was present in 67.9% of this group, while 27.3% had diabetes and 16.9% had cancer. The patients who could be referred back represented all CKD stages except stage G5. The most common stage (16%) was G3bA2 (eGFR 30 ≤ 44 and ACR 3 ≤ 30). Conclusion A substantial proportion of patients were eligible for referral back to primary care. These patients often have a comorbidity, such as hypertension or diabetes. Future research should focus on generalisability of the BR criteria, the feasibility of actual implementation of the back referral, follow-up assessments of renal function and patient satisfaction.

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