Mark A Brown

UNSW Sydney | UNSW · St George Clinical School

Background: Emerging research suggests that quality of life (QOL) outcomes, such as maintenance of independence, rather than length of life, are the main priority for many patients with end stage kidney disease (ESKD). There is therefore a need to focus on whether QOL for older patients on dialysis differs significantly from conservative kidney man...

Background Hypertensive disorders of pregnancy have longer-term implications, increasing women’s lifetime cardiovascular disease risk. The Blood Pressure Postpartum study is a multi-centre randomised three-arm trial of interventions, ranging in intensity and including education and lifestyle coaching, to support women to maintain or adopt healthy e...

Background Shared decision making (SDM) is important when considering whether an older patient with advanced CKD should be managed with dialysis or conservative kidney management (CKM). Physicians may find these conversations difficult because of the relative paucity of data on patients managed without dialysis. Methods This prospective observatio...

Background There is no accepted definition or standardized monitoring for white coat hypertension in pregnancy. This Delphi procedure aimed to reach consensus on out-of-office blood pressure (BP) monitoring, and white coat hypertension diagnostic criteria and monitoring. Method Relevant international experts completed three rounds of a modified De...

Shared decision making is important when deciding the appropriateness of dialysis for any individual, particularly for older patients with advanced CKD who have high mortality. Emerging evidence suggests that patients with advanced age, high comorbidity burden and poor functional status may not have any survival advantage on dialysis compared to th...

Background and aims Preeclampsia (PE) is associated with life-long increased risk of cardiovascular disease. One of the main protective functions of high-density lipoprotein (HDL) is its role in reverse cholesterol transport. HDL-mediated cholesterol efflux capacity (CEC) is decreased during pregnancy in women with PE. Whether this persists postpar...

Background As healthcare is responsible for 7% of Australia's carbon emissions, it was recognised that a policy implemented at St George Hospital, Sydney to reduce non-urgent pathology testing to two days per week and on other days only if essential, would also result in a reduction in carbon emissions. The aim of the study was to measure the impac...

All units managing hypertensive pregnant women should maintain and review uniform departmental management protocols and conduct regular audits of maternal & fetal outcomes. The cause(s) of pre-eclampsia and the optimal clinical management of the hypertensive disorders of pregnancy remain uncertain; therefore, we recommend that every hypertensive pr...

Objectives Hypertensive disorders of pregnancy are associated with subsequent increased risk of cardiometabolic disease. Adverse cardiometabolic measures are noted soon after hypertensive versus normotensive pregnancy (NP); to what degree these persist into a subsequent pregnancy (SP) is unknown. This study aimed to assess women’s physiology early...

Objective: Stillbirth is a potentially preventable complication of pregnancy. Identifying women at risk can guide decisions on closer surveillance or timing of birth to prevent fetal death. Prognostic models have been developed to predict the risk of stillbirth, but none have yet been externally validated. We externally validated published predict...

Taste alteration is a common, but poorly understood, symptom in end-stage kidney disease. The pathophysiology of taste alteration is complex; to date, management has been largely empirical. As our understanding of pathophysiology grows so does the evidence base for its management. This article introduces a clinical tool—the CKD Taste Plate—to assis...

Background Mortality risk is high soon after dialysis initiation in patients with kidney failure, and dialysis withdrawal is a major cause of early mortality, attributed to psychosocial or medical reasons. The temporal trends and risk factors associated with cause-specific early dialysis withdrawal within 12 months of dialysis initiation remain unc...

Intrauterine preeclampsia exposure affects the lifelong cardiometabolic health of the child. Our study aimed to compare the growth (from birth to 6 months) of infants exposed to either a normotensive pregnancy or preeclampsia and explore the influence of being born small for gestational age (SGA). Participants were children of women participating i...

Across the world, challenges for clinicians providing health care during the coronavirus disease 2019 (COVID-19) pandemic are highly prevalent and have been widely reported. Perspectives of provider groups have conveyed wide-ranging experiences of adversity, distress, and resilience. In understanding and responding to the emotional and psychologica...

Background Preeclampsia is a major pregnancy complication associated with long-term maternal cardiometabolic disease. Research generally is focused on metabolic and pathophysiological changes during pregnancy, however, there is much less focus on the early postpartum period in subjects who suffered preeclampsia. The aim of this study was to (a) cha...

Background: Chronic kidney disease (CKD) is increasingly prevalent in Australia's ageing population. Over the past decade, there has been growing recognition that dialysis does not benefit every patient with end-stage kidney disease (ESKD). Patients with advanced age, significant comorbidities and poor functional status may not gain a survival ben...

Women who have had hypertension in pregnancy, both pre‐eclampsia and gestational hypertension, have a two‐ to three‐fold increased risk of cardiovascular disease later in life. It is unclear whether this is an unmasking of latent risk, the result of damage to the vascular tree during pregnancy, or both. Irrespective of the underlying pathophysiolog...

Rationale and Objective An important component of hemodialysis management involves delivery of complex dietary recommendations. The aim of this study was to determine the feasibility of a mobile phone text message intervention to improve dietary behavior in people on hemodialysis. Study design Six-month randomized feasibility study. Setting and p...

Objectives: To (1) assess women's current knowledge regarding long-term cardiovascular health after hypertensive disorders of pregnancy (2) elicit women's preferred educational content and format regarding health after hypertensive disorders of pregnancy. Design and setting: A custom-created online survey exploring Australian women's knowledge a...

Background and objectives People with kidney failure typically receive KRT in the form of dialysis or transplantation. However, studies have suggested that not all patients with kidney failure are best suited for KRT. Additionally, KRT is costly and not always accessible in resource-restricted settings. Conservative kidney management is an alternat...

Background Hypertensive disorders of pregnancy (HDP) affect 5–10% of pregnant women. Women after HDP have 2–3 times increased risk of heart attack, stroke and diabetes, as soon as 5–10 years after pregnancy. Australian healthcare providers’ knowledge of cardiovascular disease (CVD) risks for women after HDP is unknown, and this study aimed to explo...

Background There is increased risk of hypertension, early cardiovascular disease, and premature mortality in women who have had preeclampsia. This study was undertaken to determine the upper limit of normal blood pressure (BP) 6 months postpartum and the frequency of women with prior preeclampsia who had BP above these limits, as part of the P4 (Po...

Objective: To develop a core outcome set for pre-eclampsia. Design: Consensus development study. Setting: International. Population: Two hundred and eight one healthcare professionals, 41 researchers, and 110 patients, representing 56 countries, participated METHODS: Modified Delphi method and Modified Nominal Group Technique. Results: A l...

There is a huge gap between the number of patients worldwide requiring versus those actually receiving safe, sustainable, and equitable care for kidney failure. To address this, the International Society of Nephrology coordinated the development of a Strategic Plan for Integrated Care of Patients with Kidney Failure. Implementation of the plan will...

Background In international studies, cognitive impairment is a common but underdetected issue in dialysis patients. Chronic Kidney Disease (CKD) shares risk factors with and is an independent risk factor for cognitive impairment. There is a lack of Australian data of cognitive impairment in this at‐risk population. This has implications on service...

Objectives Women who had hypertensive disorders of pregnancy (HDP) are twice as likely to experience maternal cardiovascular disease later in life. The primary aim of this study (BP²) is to compare outcomes of 3 different management strategies (including lifestyle behaviour change (LBC) in the first 12 months postpartum in women who had HDP in thei...

Objectives Gastrointestinal symptoms are common in end-stage kidney disease (ESKD) and have been associated with reduced health-related quality of life and malnutrition. The aim of this study is to describe the prevalence of taste changes in an ESKD population and to evaluate whether taste changes are associated with the presence or severity of oth...

Background and Aims Nutritional management is an important, but complex, component of treatment for people on haemodialysis. Dietary recommendations are poorly adhered to, and novel strategies to improve self-management are needed. The aim of this study was to determine the feasibility and effectiveness of a mobile phone text message intervention t...

Objectives To develop consensus definitions for the core outcome set for pre-eclampsia. Study design Potential definitions for individual core outcomes were identified across four formal definition development initiatives, nine national and international guidelines, 12 Cochrane systematic reviews, and 79 randomised trials. Eighty-six definitions we...

Context Symptom burden is a strong predictor of reduced health-related quality of life and survival in patients with end-stage kidney disease (ESKD). Renal supportive care (RSC) is a comprehensive approach shown to benefit symptoms in non-dialysis conservatively managed patients, though its role in dialysis patients has not been reported. Objectiv...

A key component of treatment for all people with advanced kidney disease is supportive care, which aims to improve quality of life and can be provided alongside therapies intended to prolong life, such as dialysis. This article addresses the key considerations of supportive care as part of integrated end-stage kidney disease care, with particular a...

Kidney transplant provides superior outcomes to dialysis as a treatment for end-stage kidney disease. Therefore, it is essential that kidney transplantation be part of an integrated treatment and management plan for chronic kidney disease (CKD). Developing an effective national program of transplantation is challenging because of the requirement fo...

One of the most disabling, yet neglected, symptom of patients with chronic kidney disease (CKD) is alteration in taste. The purpose of this review is to examine the extent and content of research around this symptom in CKD with the goals of (1) identifying gaps in current research knowledge and (2) guiding future research. The review summarizes the...

Moral distress occurs when individuals are unable to act in accordance with what they believe to be ethically correct or just. It results from a discrepancy between a clinician's perception of "the right thing to do" and what is actually happening and is perpetuated by perceived constraints that limit the individual from speaking up or enacting cha...

Objective Depression in dialysis patients is often undetected despite associations with poor outcomes. The aim was to determine the prevalence and associations of depressive symptoms and physician recognition of depression within a typical Australian dialysis population. Method A cross-sectional study examined haemodialysis and peritoneal dialysis...

Background: Maternal kidney disease (acute kidney injury (AKI), advanced chronic kidney disease (CKD), dependence on dialysis or a kidney transplant) has a substantial impact on pregnancy, with risks of significant perinatal morbidity. These pregnancies require integrated multidisciplinary care to manage a complex and often challenging clinical si...

Background Despite transplantation being well documented as the renal replacement therapy option that gives the best morbidity and mortality outcomes, the best quality of life and the best value for healthcare dollar, not all patients are on a kidney transplant waiting list. Objectives The aims of this study were (1) to explore possible reasons fo...

Introduction Managing nutrition is critical for reducing morbidity and mortality in patients on haemodialysis but adherence to the complex dietary restrictions remains problematic. Innovative interventions to enhance the delivery of nutritional care are needed. The aim of this phase II trial is to evaluate the feasibility and effectiveness of a tar...

Background Homelessness is an increasing societal and health issue associated with high rates of substance abuse and mental health disorders. Homeless people die more often and younger than others. Aim To identify health needs and improve healthcare for homeless men. Methods A physician‐led clinic was established on‐site at the Mission Australia...

This set of recommendations from ISSHP is designed to assist clinicians throughout the world in the recognition and management of the hypertensive disorders of pregnancy; the document includes sections written by those working in low and middle income countries so as to ensure applicability in all parts of the world. Some key points include: ISSHP...

Introduction Hypertensive disorders during pregnancy result in substantial maternal morbidity and are a leading cause of maternal deaths worldwide. Self-monitoring of blood pressure might improve the detection and management of hypertensive disorders of pregnancy but few data are available, including regarding appropriate thresholds. Objective Thi...

Objectives To investigate the repeatability of ultrasonic cardiac output monitor (USCOM) measurements of cardiac output in normotensive non-pregnant and pregnant women. Study design Using the USCOM, cardiac output was measured, five times successively within 5 min in normotensive non-pregnant (n = 30) and pregnant (n = 30) women of any gestation w...

Introduction Women who have had pre-eclampsia (PE) have increased risk for future hypertension and cardiovascular disease; however, what defines normal blood pressure (BP) for healthy young non-pregnant women is unclear. Objective To determine: a) the normal BP range for healthy young women who have had a normal pregnancy (NP); b) the percentage o...

Hypertensive disorders during pregnancy result in substantial maternal morbidity and are a leading cause of maternal deaths worldwide. Self-monitoring of blood pressure (BP) might improve the detection and management of hypertensive disorders of pregnancy, but few data are available, including regarding appropriate thresholds. This systematic revie...

A doctor has a legal duty to secure the informed consent of a patient prior to performing a medical or surgical procedure. The elements of the legal doctrine of informed consent include capacity, voluntariness and the provision and understanding of relevant information. This article examines the doctrine in the context of renal dialysis. Dialysis i...

Background: Numerous studies have shown a stronger relationship between ambulatory blood pressure (ABP), particularly night ABP, and cardiovascular events/mortality than for office blood pressure (OBP). A previous clinical trial (Syst-Eur) showed that pretreatment ABP was only a better predictor of outcome than OBP in placebo-treated participants....

Objectives: Diet and fluid management can reduce mortality, serious comorbidities, and debilitating symptoms in patients on hemodialysis, but restrictions may also be a major burden, and nonadherence remains high. We aimed to describe the perspectives and experiences of patients on hemodialysis regarding their dietary management to understand both...

Cardiovascular disease, including ischaemic heart disease and cerebrovascular disease, has become the number one cause of death in women worldwide. Having had a pregnancy complicated by pre-eclampsia may be more than just a risk factor for the development of cardiovascular disease later in life. Pre-eclampsia causes significant morbidity and mortal...

Background Patients with chronic kidney disease, whether on dialysis or not, frequently die in the acute hospital and have a high symptom burden. In New South Wales, a state-wide RSC service has been established to provide palliative support to nephrology services. Null hypothesis No significant improvement in indicators of quality of death at 5 a...

Objective: Examine the frequency with which the most accepted indicators for delivery in pre-eclampsia are used in a population with predominantly late-onset (birth > 32 weeks) pre-eclampsia (PE). Methods: Retrospective cohort study using the St George Public Hospital (SGH) Hypertension in Pregnancy database. Demographic, pregnancy, and outcome de...

Renal supportive care (RSC) integrates palliative and renal medicine to help patients with chronic kidney disease (CKD) to live as well as possible. Although there have been many studies investigating the experiences of patients on renal replacement therapy, there is very little research investigating the experiences of those choosing conservative...

Renal Supportive Care is an alternative treatment pathway in advanced Chronic Kidney Disease (CKD) that is being increasingly adopted, particularly in the elderly. RSC utilises principles of palliative care and has been developed to enhance the care for dialysis patients with a high symptom burden and those being managed on a non-dialysis pathway....

We report a case of a left frontal lobe meningioma presenting in a woman with proteinuric preeclampsia in her first term pregnancy. The patient had a background of antepartum migraines that resolved in the second trimester of pregnancy. Postpartum, she required urgent surgery and sustained convulsions after surgery. She had no residual disease and...

The literature reveals that current nephrology practice in obtaining informed consent for dialysis falls short of ethical and legal requirements. Meeting these requirements represents a significant challenge, especially because the benefits and risks of dialysis have shifted significantly with the growing number of older, comorbid patients. The imp...

Background In Australia, the prevalence of chronic kidney disease (CKD) is increasing steadily, especially amongst older people. The extent to which dialysis prolongs life and its effect on quality of life (QoL) of elderly patients who are frail or disabled also remains unclear. Patients and methods We conducted a single-centre, prospective study t...

Background: Women using oral contraceptives have higher ambulatory blood pressures (BPs) than other women. We sought to learn whether this was associated with an alteration in the balance of angiotensin II (Ang)/Ang (1-7) and whether this ratio and BP remained constant throughout the menstrual cycle. Method: In total, 30 (15 ovulatory, 15 taking...