The Economic Impact of Pre-Dialysis Epoetin Alfa on Health Care and Work Loss Costs in Chronic Kidney Disease: An Employer's Perspective

Objectives This qualitative descriptive study explored the primary health care decisions of a group of 12 Australians in Stages 3B to 5 with chronic kidney disease in the preservation of kidney health. Methods Questioning within the qualitative interviews focused on gaining an understanding of the participants’ perceptions of their kidney health and the decisions made as a consequence of their interaction within the Australian primary health care system. Results Participants were dependent on their General Practitioner to recognise their symptoms, make the correct diagnosis and authorise the correct referral for specialist nephrology care. Three pathways in this process were identified: ‘easy’; ‘difficult’ and ‘protracted’. Clinician failure to correctly attribute symptoms to chronic kidney disease influenced the ‘difficult’ pathway, while failure to adequately communicate kidney health status influenced the ‘protracted’ pathway. Use of the language of ‘recovery’, ‘stability’ and ‘protection’ held meaning to the participants in gaining an understanding of their kidney health. Discussion Identifying pathways to diagnosis and referral can raise awareness of the challenges kidney health consumers face in their participation within the primary health care arena. Using consumer meaningful language improves the capacity of these consumers to engage in their own primary health care agenda.

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Diagnosis dan tatalaksana renal sel karsinoma

Jurnal Penyakit Dalam Udayana ◽

10.36216/jpd.v2i2.17 ◽

2018 ◽

Vol 2 (2) ◽

pp. 23-27

Author(s):

Ni Made Dwi Adnyani ◽

I Gde Raka Widiana

Keyword(s):

Health Care ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Chronic Pyelonephritis ◽

Health Care Associated Pneumonia ◽

Single Kidney

Karsinoma sel renal (KSR) merupakan kanker yang cukup sering terjadi, sekitar 3 sampai 4% kasus di Amerika Serikat, namun di Asia kasusnya cukup jarang. Insiden KSR semakin menigkat dalam beberapa tahun terakhir. Perokok aktif dan pasif seperti juga hipertensi merupakan faktor risiko KSR. Dilaporkan sebuah kasus, perempuan, 61 tahun, dengan Chronic Kidney Disease (CKD) stadium V et causa chronic pyelonephritis (PNC) single kidney, batu ureter 1/3 distal sinistra, hidronefrosis derajat IV ginjal sinistra, adenokarsinoma (Adeno Ca) renal dextra stadium III post radical nefrectomy. Pasca operasi kondisi pasien sempat membaik, produksi urine cukup ± 800 cc/24 jam, dan ada penurunan serum kreatinin. Pasien sempat menjalani beberapa kali hemodialis selama perawatan dan direncanakan hemodialisis regular. Sepuluh hari paska MRS pasien kembali dirawat dengan pneumonia (Health Care Associated Pneumonia) dan diberikan antibiotik empiris, dalam perkembanganya kondisi semakin memburuk dan akhirnya meninggal dengan penyebab kematian syok sepsis. Kasus ini diangkat untuk memperdalam mengenai diagnosis dan tatalaksana seorang penderita dengan renal sel karsinoma sehingga dapat mencegah terjadinya prognosis buruk di kemudian hari.

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Best Practices to Promote Patient and Donor Engagement to Care in Living Donor Transplant

Health Literacy ◽

10.4018/978-1-5225-1928-7.ch015 ◽

2017 ◽

pp. 306-327

Author(s):

Emanuela Saita ◽

Susanna Zanini ◽

Enrico Minetti ◽

Chiara Acquati

Keyword(s):

Health Care ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Best Practices ◽

Health Care Providers ◽

Living Donor ◽

Care Providers ◽

Health Care Outcomes ◽

Care Outcomes ◽

Donor Kidney Transplantation

Increasing evidence has demonstrated that patients' involvement promotes better health care outcomes and cost-effectiveness of services. However, limited literature is available about the experience of living donor kidney transplantation and best practices to promote patients and donors' engagement. Aim of the present chapter is to review the literature about patient engagement in the context of chronic kidney disease, and to introduce an innovative protocol developed to promote potential donors and recipients' participation and adherence to care at the Niguarda Ca' Granda Hospital in Milan (Italy). Results are critical to reflect on the identification of best practices for patients' engagement in the context of chronic kidney disease. Through a better understanding of the emotional and affective dynamics and the relational implications that may influence the elaboration of the information given by health care providers, it will be possible to develop evidence-informed interventions.

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Best Practices to Promote Patient and Donor Engagement to Care in Living Donor Transplant

Transformative Healthcare Practice through Patient Engagement - Advances in Medical Diagnosis, Treatment, and Care ◽

10.4018/978-1-5225-0663-8.ch001 ◽

2017 ◽

pp. 1-28

Author(s):

Emanuela Saita ◽

Susanna Zanini ◽

Enrico Minetti ◽

Chiara Acquati

Keyword(s):

Health Care ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Best Practices ◽

Health Care Providers ◽

Living Donor ◽

Care Providers ◽

Health Care Outcomes ◽

Care Outcomes ◽

Donor Kidney Transplantation

Increasing evidence has demonstrated that patients' involvement promotes better health care outcomes and cost-effectiveness of services. However, limited literature is available about the experience of living donor kidney transplantation and best practices to promote patients and donors' engagement. Aim of the present chapter is to review the literature about patient engagement in the context of chronic kidney disease, and to introduce an innovative protocol developed to promote potential donors and recipients' participation and adherence to care at the Niguarda Ca' Granda Hospital in Milan (Italy). Results are critical to reflect on the identification of best practices for patients' engagement in the context of chronic kidney disease. Through a better understanding of the emotional and affective dynamics and the relational implications that may influence the elaboration of the information given by health care providers, it will be possible to develop evidence-informed interventions.

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The efficacy and safety of roxadustat for anemia in patients with chronic kidney disease: a meta-analysis

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa110 ◽

2020 ◽

Author(s):

Qiyan Zheng ◽

Huisheng Yang ◽

Xinwen Fu ◽

Yishan Huang ◽

Ruojun Wei ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Placebo Group ◽

Kidney Disease ◽

Meta Analysis ◽

Transferrin Saturation ◽

Group Versus ◽

Efficacy And Safety ◽

Epoetin Alfa ◽

Electronic Resource ◽

Quality Evidence

Abstract Background Chronic kidney disease (CKD) is an increasing public health issue. Anemia, which is a complication of CKD, is associated with reduced quality of life and increased morbidity and mortality. Currently quite a few clinical studies have been conducted to compare roxadustat with epoetin alfa [all for dialysis-dependent (DD) patients] or placebo [all for nondialysis-dependent (NDD) patients]. Our meta-analysis aimed to investigate the efficacy and safety of roxadustat for anemia in patients with CKD. Methods We thoroughly searched eight electronic resource databases for randomized controlled trials (RCTs) comparing the efficacy and safety between roxadustat versus epoetin alfa or placebo for the treatment of anemia in patients with CKD. Results Four Phase 2 and two Phase 3 studies with 1010 participants were included. Hemoglobin (Hb) and transferrin levels were increased significantly in the roxadustat group versus those in the placebo {standard mean difference [SMD] 1.57 [95% confidence interval (CI) 1.17–1.98]; SMD 1.81 [95% CI 1.53–2.08]; respectively, both low-quality evidence} or epoetin alfa group [SMD 0.47 (95% CI 0.02–0.93), very low-quality evidence; SMD 1.05 (95% CI 0.81–1.29), low-quality evidence; respectively]. Hepcidin levels were reduced significantly in the roxadustat group versus those in the placebo [SMD −1.72 (95% CI −3.03 to −0.41), very low-quality evidence] or epoetin alfa group [SMD −0.23 (95% CI −0.43 to −0.02), low-quality evidence]. Ferritin and serum transferrin saturation (TSAT) levels were reduced significantly in the roxadustat group versus those in the placebo group [SMD −0.82 (95% CI −1.31 to −0.33); SMD −0.54 (95% CI −0.76 to −0.32), respectively; both low-quality evidence] and ferritin and TSAT levels in the roxadustat group were comparable to those in the epoetin alfa group [SMD 0.02 (95% CI −0.18–0.21); SMD 0.15 (95% CI −0.04–0.35), respectively, both low-quality evidence]. As for safety, the incidence of adverse events (AEs) in the roxadustat group was insignificantly different from that of the placebo group [risk ratio (RR) 0.99 (95% CI 0.83–1.18); P = 0.89, very low-quality evidence]. But the incidence of AEs in the roxadustat group was significantly higher than that in the epoetin alfa group [RR 1.25 (95% CI 1.01–1.54); P = 0.04, low-quality evidence]. There was no significant association between roxadustat and the incidence of serious AEs (SAEs) for both NDD and DD patients [RR 1.08 (95% CI 0.51–2.28) and RR 1.43 (95% CI 0.85–2.40), respectively, both very low-quality evidence]. Conclusion In this meta-analysis of RCTs, we found evidence that after the oral administration of roxadustat, NDD patients’ Hb levels were increased effectively and DD patients’ Hb levels were maintained effectively. The risk of SAEs was not observed with the short-term use of roxadustat. These findings support roxadustat for the treatment of anemia in patients with CKD.

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P0718HEALTH CARE COSTS IN CHRONIC KIDNEY DISEASE: A LONGITUDINAL STUDY FROM THE PIRP COHORT

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0718 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Paola Rucci ◽

Dino Gibertoni ◽

Claudio Voci ◽

Maria Pia Fantini ◽

Marcora Mandreoli ◽

...

Keyword(s):

Health Care ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Direct Costs ◽

Study Cohort ◽

Local Health Authority ◽

Progression Rate ◽

Ckd Stage ◽

Per Capita ◽

Care Costs

Abstract Background and Aims Health care costs in patients with chronic kidney disease (CKD) vary widely according to patients’ severity. In patients followed up in a community-based project, it is of interest to determine cost variations over time, as a result of treatment and CKD progression. The aim of the study was to estimate the costs incurred by the health care system for CKD patients in an Italian region. Method Patients recruited in the Emilia-Romagna (Italy) PIRP project in the years 2007-2014 with CKD stage 3a to 5 were included in the study. Patients were stratified at baseline into 7 groups at different risk of progression according to the CT-PIRP classification (Rucci et al., A clinical stratification tool for chronic kidney disease progression rate based on classification tree analysis, NDT 2014). To calculate the annual medical costs, we multiplied the number of services used by the respective unit cost. Per capita costs were obtained dividing overall costs by person-years. We used DRG tariffs as a proxy of costs for hospital admissions, the regional nomenclator for outpatient visits and lab tests, and cost unit for prescribed drugs. Mixed effects generalized linear models were used to estimate the annual direct costs of CT-PIRP groups, adjusted for calendar year of entry in PIRP and local health authority of residence. Results The study cohort includes 7737 CKD patients, aged 73.2±11.6 years, 64.5% males, mostly in CKD stage 4 (3136, 40.5%) and 3b (2799, 36.2%); 697 patients (9.0%) entered the study at stage 5. The CT-PIRP classification and frequency distribution is shown in Tab.1. After 4 years, 5017 (64.8%) were still alive, 1743 (22.5%) died, 546 (7.2%) were on ESKD and 422 (5.5%) were lost. The overall direct costs of patients while still enrolled in the PIRP project decreased from 36.89 million € in the first year to 32.22 in the fourth year, while the per capita annual median costs were stable around 2200 €. The cost breakdown showed a decrease of hospitalization and drugs costs and an increase in specialty visits costs (Fig.1). The model-estimated average annual costs were significantly higher for proteinuric, low GFR patients of CT-PIRP groups 2 and 3 (7239 € and 8825 € respectively), while non-diabetic, younger patients of group 5 determined a significantly lower burden (3350 €).

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