scholarly journals Preliminary demonstration of benchtop NMR metabolic profiling of feline urine: chronic kidney disease as a case study

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Natalie Finch ◽  
Benita Percival ◽  
Elena Hunter ◽  
Robin J. Blagg ◽  
Emily Blackwell ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Metabolic Profiling ◽  
Clinical Decision Making ◽  
Decision Support Tool ◽  
Urinary Metabolites ◽  
Clinical Decision ◽  
Support Tool ◽  
Disease Case ◽  
Metabolic Conditions

Abstract Objective The use of benchtop metabolic profiling technology based on nuclear magnetic resonance (NMR) was evaluated in a small cohort of cats with a view to applying this as a viable and rapid metabolic tool to support clinical decision making. Results Urinary metabolites were analysed from four subjects consisting of two healthy controls and two chronic kidney disease (CKD) IRIS stage 2 cases. The study identified 15 metabolites in cats with CKD that were different from the controls. Among them were acetate, creatinine, citrate, taurine, glycine, serine and threonine. Benchtop NMR technology is capable of distinguishing between chronic kidney disease case and control samples in a pilot feline cohort based on metabolic profile. We offer perspectives on the further development of this pilot work and the potential of the technology, when combined with sample databases and computational intelligence techniques to offer a clinical decision support tool not only for cases of renal disease but other metabolic conditions in the future.

scholarly journals Cronic Kidney Disease, Life Quality Assessment Of Patients

2016 ◽  
Vol 12 (6) ◽  
pp. 103
Author(s):  
Marsida Duli ◽  
Qamil Dika ◽  
Matilda Bushati
Keyword(s):  
Quality Of Life ◽  
Chronic Kidney Disease ◽  
Decision Making ◽  
Kidney Disease ◽  
Clinical Decision Making ◽  
Well Being ◽  
Clinical Decision ◽  
Healthy Population ◽  
Important Indicator

Assessing quality of life in patients with varying degrees of chronic kidney disease is an important issue because of its impact on clinical decision-making as increasing the efficiency of resources in the health system. Through this survey provided an attempt to assess the quality of life of patients with chronic kidney disease undergoing dialysis. Commitment to maximize their functioning and well-being constitutes the essence of the purpose of health care. In recent decades elaborate SF 36 is cut by a gauge derive so simple and basic that helps to evaluate the function of the target of researchers, a certain age group, a disease or a treatment group. Short questionnaire forms SF36 instrument gauge is used to determine the level of quality of life in patients with chronic renal failure under the different stages of treatment with dialysis. The study involved 206 people, 112 from patients to Tirana and Shkodra and 94 healthy persons, who collaborated consensually for completing the questionnaires. Based on the results, the quality of life of dialysis patients is significantly worse than that of the healthy population and patients with other injuries less severe of renal function. Survey indicates that a more holistic approach to be used in the treatment of patients with chronic kidney disease including clinical decision making and patient perception. Precisely for this it is recommended to enter the practice of clinical interest that a set of questionnaires that provide information on patients' perception of health as an important indicator that facilitates the physician-patient collaboration in order to better treatment of the disease and increase the quality the life of the patient.

scholarly journals An easy-to-operate web-based calculator for predicting the progression of chronic kidney disease

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Qian Xu ◽  
Yunyun Wang ◽  
Yiqun Fang ◽  
Shanshan Feng ◽  
Cuiyun Chen ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Decision Making ◽  
Area Under The Curve ◽  
Progression Free Survival ◽  
Clinical Decision ◽  
Training Set ◽  
Web Based ◽  
Free Survival ◽  
Validation Set

Abstract Background This study aimed to establish and validate an easy-to-operate novel scoring system based on simple and readily available clinical indices for predicting the progression of chronic kidney disease (CKD). Methods We retrospectively evaluated 1045 eligible CKD patients from a publicly available database. Factors included in the model were determined by univariate and multiple Cox proportional hazard analyses based on the training set. Results Independent prognostic factors including etiology, hemoglobin level, creatinine level, proteinuria, and urinary protein/creatinine ratio were determined and contained in the model. The model showed good calibration and discrimination. The area under the curve (AUC) values generated to predict 1-, 2-, and 3-year progression-free survival in the training set were 0.947, 0.931, and 0.939, respectively. In the validation set, the model still revealed excellent calibration and discrimination, and the AUC values generated to predict 1-, 2-, and 3-year progression-free survival were 0.948, 0.933, and 0.915, respectively. In addition, decision curve analysis demonstrated that the model was clinically beneficial. Moreover, to visualize the prediction results, we established a web-based calculator (https://ncutool.shinyapps.io/CKDprogression/). Conclusion An easy-to-operate model based on five relevant factors was developed and validated as a conventional tool to assist doctors with clinical decision-making and personalized treatment.

scholarly journals Estimation of Kidney Function in Oncology

2019 ◽  
Vol 14 (4) ◽  
pp. 587-595 ◽  
Author(s):  
Morgan A. Casal ◽  
Thomas D. Nolin ◽  
Jan H. Beumer
Keyword(s):  
Chronic Kidney Disease ◽  
Decision Making ◽  
Kidney Disease ◽  
Kidney Function ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Drug Dosing ◽  
Disease Epidemiology ◽  
Patients With Cancer ◽  
Agent Selection

Estimation of kidney function in patients with cancer directly affects drug dosing, agent selection, and eligibility for clinical trials of novel agents. Overestimation of kidney function may lead to overdosing or inappropriate agent selection and corresponding toxicity. Conversely, underestimation of kidney function may lead to underdosing or inappropriate agent exclusion and subsequent therapeutic failure. It would seem obvious that the most accurate estimates of kidney function should be used to reduce variability in decision making and ultimately, the therapeutic outcomes of toxicity and clinical benefit. However, clinical decision making is often more complex. The Cockcroft–Gault formula remains the most universally implemented estimator of kidney function in patients with cancer, despite its relative inaccuracy compared with the Chronic Kidney Disease Epidemiology Collaboration equation. The Chronic Kidney Disease Epidemiology Collaboration equation is a more precise estimator of kidney function; however, many currently used kidney function cutoff values were determined before the development of the Chronic Kidney Disease Epidemiology Collaboration equation and creatinine assay standardization using Cockcroft–Gault estimates. There is a need for additional studies investigating the validity of currently used estimates of kidney function in patients with cancer and the applicability of traditional anticancer dosing and eligibility guidelines to modern and more accurate estimates of kidney function. In this review, we consider contemporary calculation methods used to estimate kidney function in patients with cancer. We discuss the clinical implications of using these various methods, including the potential influence on drug dosing, drug selection, and clinical trial eligibility, using carboplatin and cisplatin as case studies.

scholarly journals Renal diets in cats with chronic kidney disease

2015 ◽  
Vol 176 (14) ◽  
pp. 360-361
Author(s):  
Rachel Dean ◽  
Martin Downes
Keyword(s):  
Chronic Kidney Disease ◽  
Decision Making ◽  
Veterinary Medicine ◽  
Kidney Disease ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Based ◽  
Veterinary Record ◽  
The University

BestBETs for Vets are generated by the Centre for Evidence-based Veterinary Medicine at the University of Nottingham to help answer specific questions and assist in clinical decision making. Although evidence is often limited, they aim to find, present and draw conclusions from the best available evidence, using a standardised framework. A more detailed description of how BestBETs for Vets are produced is published on pp 354-356 of this issue of Veterinary Record

scholarly journals Towards optimising chronic kidney disease detection and management in primary care: Underlying theory and protocol for technology development using an Integrated Knowledge Translation approach

2021 ◽  
Vol 27 (2) ◽  
pp. 146045822110082
Author(s):  
Jo-Anne Manski-Nankervis ◽  
Karyn Alexander ◽  
Ruby Biezen ◽  
Julia Jones ◽  
Barbara Hunter ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Design Thinking ◽  
Clinical Decision Making ◽  
Technology Development ◽  
Clinical Decision ◽  
Practice Variation ◽  
Service Users ◽  
Future Health ◽  
Technological Platform

Worldwide, Chronic Kidney Disease (CKD), directly or indirectly, causes more than 2.4 million deaths annually with symptoms generally presenting late in the disease course. Clinical guidelines support the early identification and treatment of CKD to delay progression and improve clinical outcomes. This paper reports the protocol for the codesign, implementation and evaluation of a technological platform called Future Health Today (FHT), a software program that aims to optimise early detection and management of CKD in general practice. FHT aims to optimise clinical decision making and reduce practice variation by translating evidence into practice in real time and as a part of quality improvement activities. This protocol describes the co-design and plans for implementation and evaluation of FHT in two general practices invited to test the prototype over 12 months. Service design thinking has informed the design phase and mixed methods will evaluate outcomes following implementation of FHT. Through systematic application of co-design with service users, clinicians and digital technologists, FHT attempts to avoid the pitfalls of past studies that have failed to accommodate the complex requirements and dynamics that can arise between researchers and service users and improve chronic disease management through use of health information technology.

scholarly journals A Bayesian Decision-Support Tool for Child Sexual Abuse Assessment and Investigation

Sexual Abuse ◽  
2017 ◽  
Vol 31 (4) ◽  
pp. 374-396 ◽  
Author(s):  
Alessandro Tadei ◽  
Johan Pensar ◽  
Jukka Corander ◽  
Katarina Finnilä ◽  
Pekka Santtila ◽  
...  
Keyword(s):  
Sexual Abuse ◽  
Child Sexual Abuse ◽  
Clinical Decision Making ◽  
Area Under The Curve ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Background Information ◽  
Bayesian Decision ◽  
Support Tool ◽  
Starting Point

In assessments of child sexual abuse (CSA) allegations, informative background information is often overlooked or not used properly. We therefore created and tested an instrument that uses accessible background information to calculate the probability of a child being a CSA victim that can be used as a starting point in the following investigation. Studying 903 demographic and socioeconomic variables from over 11,000 Finnish children, we identified 42 features related to CSA. Using Bayesian logic to calculate the probability of abuse, our instrument—the Finnish Investigative Instrument of Child Sexual Abuse (FICSA)—has two separate profiles for boys and girls. A cross-validation procedure suggested excellent diagnostic utility (area under the curve [AUC] = 0.97 for boys and AUC = 0.88 for girls). We conclude that the presented method can be useful in forensic assessments of CSA allegations by adding a reliable statistical approach to considering background information, and to support clinical decision making and guide investigative efforts.

Effect of CES1 and ABCB1 genotypes on the pharmacokinetics and clinical outcomes of dabigatran etexilate in patients with atrial fibrillation and chronic kidney disease

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Dmitriy Sychev ◽  
Alena Skripka ◽  
Kristina Ryzhikova ◽  
Pavel Bochkov ◽  
Roman Shevchenko ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Genetic Factors ◽  
Clinical Decision Making ◽  
Dabigatran Etexilate ◽  
Plasma Concentrations ◽  
Clinical Decision ◽  
Nucleotide Polymorphisms

Abstract Background Despite the well-studied safety profile of dabigatran, its interactions with genetic polymorphism parameters are poorly understood, especially in patients with moderate chronic kidney disease (CKD). The study assessed whether genetic factors can contribute to CKD and alter dabigatran concentration. Methods Patients with atrial fibrillation (AF) and stage 3 CKD treated with dabigatran 110 or 150 mg have been included in the study. Real-time polymerase chain reaction was used to evaluate single-nucleotide polymorphisms of the ABCB1 gene (rs1045642 and rs4148738) and CES1 gene (rs2244613). A plasma trough concentration/dose (C/D) ratio was used as a pharmacokinetic index. Results A total of 96 patients aged 51–89 years (median age: 75 years) were evaluated. Patients on a reduced regimen of 110 mg twice a day were older (79.8 vs. 67.9, p < 0.0001) and had lower creatinine clearance (49.7 vs. 62.3 mL/min/1.73 m2, p = 0.015). Patients with the rs2244613 CC genotype had lower C/D values (70% reduction in the mean C/D vs. AA genotype, p = 0.001). Linear stepwise regression has shown the CKD epidemiology collaboration to be the only significant predictor of C/D among genetic factors and kidney function characteristics. During the median follow-up of 15 months, there were 15 bleedings in 13 patients. Conclusions Polymorphism of CES1 rs2244613 can contribute to the safety of dabigatran in patients with AF and CKD. There was no influence of the aforementioned polymorphisms of ABCB1 on dabigatran trough plasma concentrations and C/D. Kidney function is a mainstay of clinical decision-making on direct oral anticoagulant (DOAC) dose, and further knowledge should be accumulated on the role of genetic factors.

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