MP403PREVALENCE OF HYPERURICAEMIA WITHIN THE IRISH HEALTH SYSTEM AND RELATIONSHIPS WITH CHRONIC KIDNEY DISEASE

Abstract Background and Aims Lithium is implicated as a causative factor in the development and progression of chronic kidney disease (CKD). Few studies have assessed the independent impact of plasma levels and duration of lithium therapy on CKD progression. We examined the influence of lithium on CKD progression in the Irish health system. Method We utilised data from the Irish Kidney Disease Surveillance System (IKDSS) to explore associations of lithium levels and duration of exposure with kidney function in a regional cohort. A retrospective cohort study was conducted between 1999 to 2014 from the Midwest Region. All adult patients with lithium levels were identified and followed longitudinally. Kidney function was assessed at baseline and longitudinally using serum creatinine and estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI. Patients with < 2 lithium values, missing data on creatinine were excluded. The index date was the date of the first lithium blood test. Toxicity from lithium was defined as levels >1.2mmol/L as per NICE guidelines while duration of treatment was calculated based on patient –years of exposure as determined by positive blood lithium levels. Relationships between baseline kidney function, lithium levels, duration of exposure and each patients most recent eGFR value on follow up were assessed using multiple linear regression Results We identified 1,978 patients exposed to lithium from 1999-2014, mean age was 47.4 (15.6), 45.1% were men, eGFR [median (IQR)] at baseline was 84.4 (32.1) ml/min1.73m and the median duration of exposure was 3.0 years (IQR=4 years). Frequency of lithium testing increased from 1.77 in 1999 to 2.66 in 2014. In multiple linear regression, the final eGFR on follow-up was significantly lower in older patients (-0.48 ml/min/1.73m per year increase in age), P<0.001; in patients with elevated baseline lithium levels (-2.18 ml/min1.73m lower per unit increase), P<0.05, with long duration of exposure (-1.42 ml/min/1.73m lower for each year on lithium), P<0.001, and for patients with low GFR at baseline (P<0.001). Together these variables explained 58% of the variation in the final model. Conclusion Both the magnitude of and the duration of lithium exposure are both independently associated with CKD progression among lithium users in the Irish health system. Higher baseline lithium values had a more deleterious impact on kidney function. Continued efforts should be expended in minimising the risks of lithium induced nephrotoxicity through switching to alternatives and dose reduction when over possible. Funding This study is funded by the Health Research Board and the Midwest Research and Education Foundation (MKid).

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ANALISA DRUG RELATED PROBLEMS (DRPs) PADA PASIEN CHRONIC KIDNEY DISEASE (CKD) DI INSTALASI RAWAT INAP KLINIK SARI MEDIKA KABUPATEN SEMARANG

Jurnal Farmasi & Sains Indonesia ◽

10.52216/jfsi.v4i1.57 ◽

2021 ◽

Vol 4 (1) ◽

pp. 1-5

Author(s):

Poppy Diah Palupi ◽

Veronika Jayaningsih

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Health System ◽

Clinical Pathway ◽

Drug Related Problems ◽

Purposive Sampling ◽

Henry Ford

Drug Related Problems (DRPs) merupakan kejadian yang tidak diinginkan yang dialami oleh pasien dan berkaitan dengan pengobatan sehingga berpotensi mengganggu keberhasilan terapi. Penelitian ini bertujuan untuk mengetahui dan menganalisa DRPs yang terjadi pada pasien Chronic Kidney Disease (CKD) di instalasi rawat inap klinik Sari Medika kabupaten Semarang. Penelitian ini merupakan penelitian deskriptif dengan pengumpulan data secara retrospektif pada pasien CKD yang diperoleh dari data rekam medis. Pengambilan sampel menggunakan teknik purposive sampling. Acuan yang digunakan pada penelitian ini adalah Pharmacotherapy Handbook 9th edition 2015, Kidney Disease Improving Global Outcomes (KDIGO), The Renal Drug Handbook 3rd edition 2009, Panduan Praktik Klinis & Clinical Pathway Penyakit Jantung, Pembuluh Darah 2016, dan Henry Ford Health System 6th edition 2011. Hasil penelitian yang dilakukan pada 84 pasien CKD menunjukkan bahwa terdapat DRPs pada 66 pasien dengan kategori yaitu indikasi tanpa terapi (30.86%), terapi tanpa indikasi (6.17%), dosis sub terapi (1.23%), dosis obat berlebih (13.58%), pemilihan obat tidak tepat (45.68%), dan penderita gagal menerima obat (2.47%).

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Pharmacoeconomic considerations in the health system management of anaemia in patients with chronic kidney disease and end stage renal disease

Expert Opinion on Pharmacotherapy ◽

10.1517/14656566.4.9.1461 ◽

2003 ◽

Vol 4 (9) ◽

pp. 1461-1469 ◽

Cited By ~ 5

Author(s):

Donald F Brophy ◽

Elizabeth BD Ripley ◽

David A Holdford

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Renal Disease ◽

Health System ◽

End Stage Renal Disease ◽

System Management ◽

Stage Renal Disease ◽

End Stage

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Evaluating a novel health system intervention for chronic kidney disease care using the RE-AIM framework: Insights after two years

Contemporary Clinical Trials ◽

10.1016/j.cct.2016.10.003 ◽

2017 ◽

Vol 52 ◽

pp. 20-26 ◽

Cited By ~ 6

Author(s):

Denise M. Hynes ◽

Michael J. Fischer ◽

Linda A. Schiffer ◽

Rani Gallardo ◽

Ifeanyi Beverly Chukwudozie ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Health System ◽

System Intervention ◽

Chronic Kidney Disease Care ◽

Health System Intervention

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P0818IMPROVING MORTALITY TRENDS FOR PATIENTS WITH CHRONIC KIDNEY DISEASE IN THE IRISH HEALTH SYSTEM: THE IRISH KIDNEY DISEASE SURVEILLANCE SYSTEM (IKDSS)

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0818 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Matthew Laird ◽

Raihan Alheyali ◽

Leonard Browne ◽

Liam Plant ◽

Cathal Walsh ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Health System ◽

Surveillance System ◽

Disease Surveillance ◽

Age Distribution ◽

Mortality Rates ◽

Mortality Data ◽

Irish Population ◽

Disease Surveillance System

Abstract Background and Aims It is unclear whether targeted efforts for the treatment of chronic kidney disease (CKD) has led to a sustained reduction in mortality rates. We examined annual trends in mortality for patients with and without CKD in the Irish health system. Method We utilised data from the Irish Kidney Disease Surveillance System (IKDSS) to explore 1-year mortality rates among patients with and without CKD in the health system. The principal data sources included; regional laboratory information systems; dialysis registers; and mortality data files from the national Central Statistics Office (CSO). We created multi-annual cohorts of patients, age > 18 years with one or more serum creatinine values who received healthcare within the Irish health system from 2008 to 2012. Serum creatinine values (first test in fiscal year) were used to calculate glomerular filtration rate (eGFR) and CKD was defined as GFR < 60ml/min/1.73m. Mortality data were available from the national mortality files with vital status up to December 31st 2013. Age standardised death rates were determined for the Irish population (IRE) and the European Standard Population (ESP) (standardised to the age distribution of a standard European population in 2012. Comparisons were conducted using segmented linear regression. Results We included 351,223 adult individuals between 2008 and 2012. Age standardised mortality rates (EU) were more than 2-fold higher for patients with CKD than without, P<0.001. From 2008-2012, age-standardised mortality rates decreased significantly in patients with CKD from a peak of 47.7 to 31 per 1000 person-years, P for trend=p=0.012, and from a peak of 17.8 to 15.5 per 1000 person-years in patients without CKD, P=0.006. Mortality rates for men were significantly higher than for women in patients with and without CKD, but the pattern of improvement was similar for both sexes. These patterns were replicated when comparisons were made using Irish standard age distribution. Conclusion Mortality rates among CKD patients have declined in the Irish population from 2008 to 2012 in both men and women. The processes and interventions that have led to these reductions need further exploration. Figure 1. (a) Crude and age standardised mortality rates (b-c) of those with and without CKD in the Irish Health System between 2008-2012 .

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