scholarly journals Linking Pathology Datasets – Trials and Triumphs

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Brian Stokes ◽  
Matthew Jose ◽  
Nadine Wiggins ◽  
Tim Albion
Keyword(s):  
Kidney Disease ◽  
Data Linkage ◽  
Study Cohort ◽  
Complex Data ◽  
Public And Private ◽  
Treatment Services ◽  
Linkage Design ◽  
Island State ◽  
Conventional Models ◽  
End Stage

Background with rationaleThe burden of chronic kidney disease (CKD) has increased rapidly in Australia over recent years. The financial cost of treating people with end-stage kidney failure by conventional models of dialysis or transplantation represents a substantial healthcare cost and is likely to continue to increase in coming years. Tasmania, the smallest state of Australia and its only island state, has the highest burden of chronic disease nationally, including kidney disease. The aim of this study was to use data-linkage to develop a state-wide dataset to quantify the burden and distribution of CKD, including identifying barriers to dialysis treatment services. Methods/ApproachThe Tasmanian Data Linkage Unit (TDLU) used a complex data linkage design comprising seven disparate datasets representing public and private pathology, public hospital admitted patient and emergency department data, cancer records, dialysis and transplant records and death notifications. A cohort was selected from public and private providers of pathology services in the state to support the establishment of a comprehensive researchable dataset. The datasets spanned the period 2004-2017 and included linkage of both state and national data. ResultsThe study cohort comprised just under 490,000 individuals in the Tasmanian population from the two pathology datasets, with a combined total of 1,347,00 total links made across all datasets. Individual unit records were geocoded according to the Australian Statistical Geographic Standard (2011) with over 92% of the 374,000 unique addresses identified in the public pathology dataset geocoded to address level. ConclusionThe final researchable dataset compiled by the research team following linkage is providing an enormously powerful asset to help answer questions specific to CKD in Tasmania, and that in turn is anticipated to result in greater access to services, improved care and better patient outcomes.

scholarly journals Preparing Pathology Data for Linkage

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Nadine Wiggins ◽  
Tim Albion ◽  
Brian Stokes ◽  
Matthew Jose
Keyword(s):  
Data Linkage ◽  
Query Language ◽  
Complex Data ◽  
Large Dataset ◽  
Public And Private ◽  
Dialysis Treatment ◽  
Private Providers ◽  
Treatment Services ◽  
Linkage Design ◽  
Pathology Data

IntroductionThe Tasmanian Data Linkage Unit (TDLU) undertook a complex data linkage project in 2019 linking public and private pathology data to five disparate health datasets. Having linked pathology data previously, the unit was aware of the challenges it faced linking a large dataset covering a fourteen-year time span. The aim of this study was to use data-linkage to develop a Tasmanian dataset to quantify the burden and distribution of chronic kidney disease, including identifying barriers to dialysis treatment services. Objectives and ApproachA cohort was selected from public and private providers of pathology services in Tasmania from 2004-2017 to support the establishment of a comprehensive researchable dataset. A linkage plan was developed that included detailed processes for cleaning and de-duplicating the pathology data prior to linkage. The larger private pathology dataset comprised 3.9 million records and data cleaning strategies were implemented. De-duplication created extensive clerical review and methods to reduce this work were devised and implemented as part of the linkage process. ResultsDe-duplication based on exact matches reduced the size of the dataset from 3.9 million to just over 520,000 individuals. Internal linkage of the dataset resulted in approximately 47,000 ‘groups’ eligible for review. Structured Query Language (SQL) queries were constructed and the number of groups eligible for review decreased by 42%. Further analysis was conducted, which resulted in an appropriate ‘cut off’ threshold being determined for clerical review and an estimate of false positive links remaining was calculated. Conclusion / ImplicationsMethods of reducing the amount of manual clerical review can be incorporated into a linkage design when there is a thorough understanding of the characteristics and content of the dataset to be linked. The methods used for this linkage project will be utilised for future projects using pathology data.

scholarly journals Absolute risk and risk factors for stroke mortality in patients with end-stage kidney disease (ESKD): population-based cohort study using data linkage

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e026263 ◽  
Author(s):  
Nicole Louise De La Mata ◽  
Maria Alfaro-Ramirez ◽  
Patrick J Kelly ◽  
Philip Masson ◽  
Rustam Al-Shahi Salman ◽  
...  
Keyword(s):  
Risk Factors ◽  
New Zealand ◽  
Kidney Disease ◽  
Cerebrovascular Disease ◽  
Cumulative Incidence ◽  
Data Linkage ◽  
Polycystic Kidney ◽  
End Stage Kidney Disease ◽  
End Stage ◽  
Stroke Death

IntroductionPeople with end-stage kidney disease (ESKD) have up to 30-fold higher risk of stroke than the general population.ObjectiveTo determine risk factors associated with stroke death in the ESKD population.MethodsWe identified all patients with incident ESKD in Australia (1980–2013) and New Zealand (1988–2012) from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) registry. We ascertained underlying cause of death from data linkage with national death registries and risk factors from ANZDATA. Using a competing risks multivariable regression model, we estimated cumulative incidence of stroke and non-stroke deaths, and risk factors for stroke deaths (adjusted sub-HR, SHR).ResultsWe included 60 823 people with ESKD. There were 941 stroke deaths and 33 377 non-stroke deaths during 381 874 person-years of follow-up. Overall, the cumulative incidence of stroke death was 0.9% and non-stroke death was 36.8% 5 years after starting ESKD treatment. The risk of stroke death was higher at older ages (SHR 1.92, 95% CI 1.45 to 2.55), in females (SHR 1.41, 95% CI 1.21 to 1.64), in people with cerebrovascular disease (SHR 2.39, 95% CI 1.99 to 2.87), with ESKD caused by hypertensive/renovascular disease (SHR 1.39, 95% CI 1.09 to 1.78) or polycystic kidney disease (SHR 1.38, 95% CI 1.00 to 1.90), with earlier year of ESKD treatment initiation (SHR 1.93, 95% CI 1.56 to 2.39) and receiving dialysis (transplant vs haemodialysis SHR 0.27, 95% CI 0.09 to 0.84).ConclusionPatients with ESKD with higher risk of stroke death are older, women, with cerebrovascular disease, with hypertensive/renovascular or polycystic kidney disease cause of ESKD, with earlier year of ESKD treatment and receiving dialysis. These groups may benefit from targeted stroke prevention interventions.

scholarly journals ASSESSMENT OF NUTRITIONAL STATUS IN END STAGE KIDNEY DISEASE PATIENTS ON MAINTENANCE HEMODIALYSIS.

2020 ◽  
pp. 1-3
Author(s):  
P. C Sandhya ◽  
Himanshu Sharma ◽  
M. Gupta
Keyword(s):  
Kidney Disease ◽  
Nutritional Status ◽  
Dietary Protein ◽  
Calorie Intake ◽  
Maintenance Hemodialysis ◽  
Study Cohort ◽  
End Stage Kidney Disease ◽  
Nutritional Counselling ◽  
End Stage ◽  
The Impact

ABSTRACT Background: Malnutrition is a common problem in patients with end-stage-kidney-disease (ESKD) and is a strong risk factor for morbidity and mortality. ESKDis a maladaptive metabolic state and patients need to increase their dietary protein and calorie intake especially when on maintenance dialysis. In a developing country like India, the economic and knowledge barrier affects the diet of the patient. In this study we assessed the prevalence of malnutrition and the impact of dietary counselling on improvement in nutritional status of the patient. Method: This study enrolled patients undergoing maintenance hemodialysis in our centre between June 2017 and June 2019. The prevalence of malnutrition was assessed by Subjective Global Assessment (SGA). Dietary history was recorded with a 24-hour dietary recall method. The patient was then periodically counselled regarding adequate dietary protein and calorie requirement and was re-assessed for the prevalence of malnutrition at the end of 6 months. Results: The mean age of study cohort was 38.76±10.85 years and 64 % were male.Hypertension (38.89%) and Diabetes (11.11%) were the most common co-morbid illnesses.The prevalence of PEW was 92% at baseline and 86% at the end of 6 months of follow up. There was a significant increase in BMI from 19.97 to 20.38 (p=0.022). Most of the study patients were from very low socioeconomic status (78% Class V modified Prasad's scale). Conclusions: There is a very high prevalence of protein-energy malnutrition among ESKD patients on maintenance haemodialysis. Nutritional counselling resulted in statistically significant improvement in the prevalence of malnutrition. Hence,nutritional counselling must be given regularly to patients with kidney disease.

scholarly journals Chronic Kidney Disease in Tasmania: Protocol for a Data Linkage Study

10.2196/20160 ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. e20160
Author(s):  
Timothy Saunder ◽  
Alex Kitsos ◽  
Jan Radford ◽  
Kim Jose ◽  
Charlotte McKercher ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Data Linkage ◽  
Linkage Study ◽  
Indigenous Australians ◽  
Data Sets ◽  
Disease Epidemiology ◽  
Island State ◽  
Kidney Replacement Therapy ◽  
Study Population

Background Chronic kidney disease (CKD) is a significant and growing health burden globally. Tasmania has the highest state prevalence for non-Indigenous Australians and it has consistently had the lowest incidence and prevalence of dialysis in Australia. Objective To examine the gap between the high community prevalence of CKD in Tasmania and the low use of dialysis. Methods This is a retrospective cohort study using linked data from 5 health and 2 pathology data sets from the island state of Tasmania, Australia. The study population consists of any person (all ages including children) who had a blood measurement of creatinine with the included pathology providers between January 1, 2004, and December 31, 2017. This study population (N=460,737) includes within it a CKD cohort, which was detected via pathology or documentation of kidney replacement therapy (KRT; dialysis or kidney transplant). Kidney function (estimated glomerular filtration rate [eGFR]) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Individuals with 2 measures of eGFR<60 mL/min/1.73 m2, at least 90 days apart, were identified as having CKD and were included in the CKD cohort. Individuals treated with dialysis or transplant were identified from the Australia and New Zealand Dialysis and Transplant Registry. Results The study population consisted of 460,737 people (n=245,573 [53.30%] female, mean age 47.4 years) who were Tasmanian residents aged 18 years and older and were followed for a median of 7.8 years. During the later 5 years of the study period, 86.79% (355,622/409,729) of Tasmanian adults were represented. The CKD cohort consisted of 56,438 people (ie, 12.25% of the study population; 53.87% (30,405/56,438) female, mean age 69.9 years) followed for a median of 10.4 years with 56,039 detected via eGFR and 399 people detected via documentation of KRT. Approximately half (227,433/460,737, 49.36%) of the study population and the majority of the CKD cohort (41,448/56,438, 73.44%) had an admission episode. Of the 55,366 deaths recorded in the study population, 45.10% (24,970/55,366) had CKD. Conclusions Whole-of-population approaches to examine CKD in the community can be achieved by data linkage. Over this 14-year period, CKD affected 12.25% (56,438/460,737) of Tasmanian adult residents and was present in 45.10% (24,970/55,366) of deaths. International Registered Report Identifier (IRRID) DERR1-10.2196/20160

scholarly journals Chronic Kidney Disease in Tasmania: Protocol for a Data Linkage Study (Preprint)

2020 ◽  
Author(s):  
Timothy Saunder ◽  
Alex Kitsos ◽  
Jan Radford ◽  
Kim Jose ◽  
Charlotte McKercher ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Data Linkage ◽  
Linkage Study ◽  
Indigenous Australians ◽  
Data Sets ◽  
Disease Epidemiology ◽  
Island State ◽  
Kidney Replacement Therapy ◽  
Study Population

BACKGROUND Chronic kidney disease (CKD) is a significant and growing health burden globally. Tasmania has the highest state prevalence for non-Indigenous Australians and it has consistently had the lowest incidence and prevalence of dialysis in Australia. OBJECTIVE To examine the gap between the high community prevalence of CKD in Tasmania and the low use of dialysis. METHODS This is a retrospective cohort study using linked data from 5 health and 2 pathology data sets from the island state of Tasmania, Australia. The study population consists of any person (all ages including children) who had a blood measurement of creatinine with the included pathology providers between January 1, 2004, and December 31, 2017. This study population (N=460,737) includes within it a CKD cohort, which was detected via pathology or documentation of kidney replacement therapy (KRT; dialysis or kidney transplant). Kidney function (estimated glomerular filtration rate [eGFR]) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Individuals with 2 measures of eGFR&lt;60 mL/min/1.73 m<sup>2</sup>, at least 90 days apart, were identified as having CKD and were included in the CKD cohort. Individuals treated with dialysis or transplant were identified from the Australia and New Zealand Dialysis and Transplant Registry. RESULTS The study population consisted of 460,737 people (n=245,573 [53.30%] female, mean age 47.4 years) who were Tasmanian residents aged 18 years and older and were followed for a median of 7.8 years. During the later 5 years of the study period, 86.79% (355,622/409,729) of Tasmanian adults were represented. The CKD cohort consisted of 56,438 people (ie, 12.25% of the study population; 53.87% (30,405/56,438) female, mean age 69.9 years) followed for a median of 10.4 years with 56,039 detected via eGFR and 399 people detected via documentation of KRT. Approximately half (227,433/460,737, 49.36%) of the study population and the majority of the CKD cohort (41,448/56,438, 73.44%) had an admission episode. Of the 55,366 deaths recorded in the study population, 45.10% (24,970/55,366) had CKD. CONCLUSIONS Whole-of-population approaches to examine CKD in the community can be achieved by data linkage. Over this 14-year period, CKD affected 12.25% (56,438/460,737) of Tasmanian adult residents and was present in 45.10% (24,970/55,366) of deaths. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/20160

MOLECULAR ASPECTS OF SARCOPENIA PATHOGENESIS IN CHRONOC KIDNEY DISEASE: INTEGRATED ROLE OF mTOR

2018 ◽  
Vol 22 (5) ◽  
pp. 9-16 ◽  
Author(s):  
M. Z. Gasanov
Keyword(s):  
Kidney Disease ◽  
Muscle Mass ◽  
Protein Metabolism ◽  
Mammalian Target Of Rapamycin ◽  
Healthy Person ◽  
Scientific Review ◽  
Cytoskeleton Organization ◽  
Molecular Aspects ◽  
End Stage

In recent decades, the main pathogenetic mechanisms for maintaining muscle mass and strength have been discovered. Most of the scientific papers on the molecular aspects of the  pathogenesis of sarcopenia were focused on the Akt-signaling  pathway. The subject of the study were people of elderly and senile  age, immobilized patients, patients with CKD 1-4 stages, animals. However, recently more attention has been paid to the role  of protein – the mammalian target of rapamycin mTOR. It seems to be a key link in the control of muscle mass and is a promising  marker in understanding the mechanisms of the pathogenesis of  sarcopenia. Its importance in protein metabolism in patients with  end stage kidney disease is not studied and requires further research. The presented scientific review contains  information on the role of mTOR and its components – mTORC1 and mTORC2 in maintaining muscle mass and strength in a healthy  person and in the formation of sarcopenia in patients with CKD. The  general aid of mTORC1 complex is regulation of protein production  which is necessary for cell growth and differentiation. mTORC2  complex functions are not enough studied. It is established that it  plays important role in such biological processes as cytoskeleton  organization, intracellular homeostasis maintaining, so it provides  cell resistance and cell survivability in negative external and internal  impulses. mTOR protein can be considered as promising molecular  marker in diagnostics of protein metabolism early disturbances in  patients with CKD and also as additory factor of sarcopenia severity assessment.

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