Establishing the Global Kidney Disease Prevention Network (KDPN): A Position Statement From the National Kidney Foundation

Universidad Panamericana School of Medicine, Mexico City, Mexico.
American Journal of Kidney Diseases (Impact Factor: 5.9). 03/2011; 57(3):361-70. DOI: 10.1053/j.ajkd.2010.12.006
Source: PubMed


The Global Kidney Disease Prevention Network is an international public health organization devoted to encouraging and enhancing efforts to increase awareness and recognition of kidney disease, detect it early, and provide treatment to prevent disease progression, improve patient outcomes, and decrease costs. Twenty-six participants from 12 low-, middle-, and high-income countries attended the first meeting, held in Geneva, Switzerland, on September 12-13, 2009. Work groups discussed target populations for chronic kidney disease (CKD) screening, optimal parameters for screening on a public health level, evaluating the impact of early screening programs, and use of screening data to inform health care policy. Of the screening programs discussed, most have targeted populations at high risk of CKD and have included medical history; weight, height, and blood pressure measurements; and blood and urine tests. In screenees, CKD prevalence ranged from 11%-33%. In screenees with CKD, few were aware of the disease, although substantial proportions had been seen by a physician in the previous 6-12 months. At the policy level, prevention of CKD implies prevention and control of risk-factor conditions, including diabetes, hypertension, and others. Given the high prevalence and under-recognition of CKD in different countries, a concerted effort to globally improve primary and secondary CKD prevention appears to be warranted.

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Available from: Mitra Mahdavi-Mazdeh,
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    • "Chronic kidney disease (CKD) is a global public health concern ([1,2]). The tip of the CKD ‘iceberg’ is manifest in end stage renal disease (ESRD), when, to sustain life, some mode of renal replacement therapy (RRT) becomes necessary. "
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    ABSTRACT: Ten years on from the National Institute of Health and Clinical Excellence' technology appraisal guideline on haemodialysis in 2002; the clinical community is yet to rise to the challenge of providing home haemodialysis (HHD) to 10-15% of the dialysis cohort. The renal registry report, suggests underutilization of a treatment type that has had a lot of research interest and several publications worldwide on its apparent benefit for both physical and mental health of patients. An understanding of the drivers to introducing and sustaining the modality, from organizational, economic, clinical and patient perspectives is fundamental to realizing the full benefits of the therapy with the potential to provide evidence base for effective care models. Through the BASIC-HHD study, we seek to understand the clinical, patient and carer related psychosocial, economic and organisational determinants of successful uptake and maintenance of home haemodialysis and thereby, engage all major stakeholders in the process.Design and methods: We have adopted an integrated mixed methodology (convergent, parallel design) for this study. The study arms include a. patient; b. organization; c. carer and d. economic evaluation. The three patient study cohorts (n = 500) include pre-dialysis patients (200), hospital haemodialysis (200) and home haemodialysis patients (100) from geographically distinct NHS sites, across the country and with variable prevalence of home haemodialysis. The pre-dialysis patients will also be prospectively followed up for a period of 12 months from study entry to understand their journey to renal replacement therapy and subsequently, before and after studies will be carried out for a select few who do commence dialysis in the study period. The process will entail quantitative methods and ethnographic interviews of all groups in the study. Data collection will involve clinical and biomarkers, psychosocial quantitative assessments and neuropsychometric tests in patients. Organizational attitudes and dialysis unit practices will be studied together with perceptions of healthcare providers on provision of home HD. Economic evaluation of home and hospital haemodialysis practices will also be undertaken and we will apply scenario ("what ... if") analysis using system dynamics modeling to investigate the impact of different policy choices and financial models on dialysis technology adoption, care pathways and costs. Less attention is often given to the patient's carers who provide informal support, often of a complex nature to patients afflicted by chronic ailments such as end stage kidney disease. Engaging the carers is fundamental to realizing the full benefits of a complex, home-based intervention and a qualitative study of the carers will be undertaken to elicit their fears, concerns and perception of home HD before and after patient's commencement of the treatment. The data sets will be analysed independently and the findings will be mixed at the stage of interpretation to form a coherent message that will be informing practice in the future. The BASIC-HHD study is designed to assemble pivotal information on dialysis modality choice and uptake, investigating users, care-givers and acre delivery processes and study their variation in a multi-layered analytical approach within a single health care system. The study results would define modality specific service and patient pathway redesign.Study Registration: This study has been reviewed and approved by the Greater Manchester West Health Research Authority National Research Ethics Service (NRES) The study is on the NIHR (CLRN) portfolio.
    BMC Nephrology 09/2013; 14(1):197. DOI:10.1186/1471-2369-14-197 · 1.69 Impact Factor
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    • "International efforts through numerous campaigns such as World Kidney Day have made the medical community aware of the common frequency of chronic kidney disease (CKD), its strong association with diabetes, and higher attributed mortality [7]. Because screening without follow-up is of little use, many countries have started screening and prevention programs to tackle the increasing burden, which is mainly due to higher premature mortality and disability because of progression to ESRD [5,8-10]. However, one of the main concerns of health authorities is the quantitative effect of medical care of detected CKD patients after diagnosis in postponing or prevention of these outcomes. "
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    ABSTRACT: Background Many countries have started screening and prevention programs for chronic kidney disease (CKD). However, one of the main concerns of health authorities is whether management strategies for diagnosed CKD patients can decrease mortality or morbidity. This study aimed to investigate the effect of two competing clinical strategies of treatments under nephrologists’ supervision compared with no treatment on the frequency of the need to start renal replacement therapy (RRT) and mortality in CKD patients. Methods Our cohort comprised consecutive newly diagnosed patients with CKD in an outpatient clinic in Tehran between October 2002 and October 2011. CKD Patient enrollment occurred if two criteria of high plasma creatinine level and chronicity of renal disease by at least 3 months of clinical history or small sized kidneys in ultrasound findings were met. Demographic data and time of RRT or mortality in patients who had been followed up regularly were compared with those in the control group. The control group included those patients who did not attend a nephrology clinic to receive CKD management package for at least 1 year during the study period. Results The cohort included 76 patients in the control group and 389 patients in the supervised group. The mean age of the patients was 61.33±14.9 years (16–95 years). The ratio of males/females was 1.47 (277/188). The mean follow-up in the control and supervised groups was 33.29±20.50 (7–111) and 36.03±25.24 (6–124) months , respectively, and the total patient years of follow-up was 1382.3. A substantial number of patients survived without RRT until the first year of follow up (96%) in both groups, but afterward, those in the control group had more deaths or need to start RRT in comparison with those who received medical advice (20 vs. 67 months; p= 0.029). This cohort also showed a higher survival and a longer time to show a GFR of less than 15 cc/min (84 vs 34 months, p<0.0001) in patients who had been under physician supervision compared with the control group. Conclusions Active follow-up of CKD patients appears to significantly decrease the risk of death or progression to end-stage renal disease and the requirement to start renal replacement therapy.
    BMC Nephrology 10/2012; 13(1):138. DOI:10.1186/1471-2369-13-138 · 1.69 Impact Factor
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    08/2011; 68(4):259-261.
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