Showing papers by "Robert R. Quinn published in 2020"
University of Sydney1, Children's Hospital at Westmead2, Flinders University3, Los Angeles Biomedical Research Institute4, University of Queensland5, Translational Research Institute6, Princess Alexandra Hospital7, University of Hong Kong8, Hammersmith Hospital9, Sunnybrook Research Institute10, Peking University11, University of Washington12, University of the Witwatersrand13, Pontifícia Universidade Católica do Paraná14, University of Toronto15, University of Sheffield16
TL;DR: An international SONG-PD stakeholder consensus workshop was convened in May 2018 in Vancouver, Canada, and all stakeholders supported inclusion of PD-related infection, cardiovascular disease, mortality, technique survival, and life participation as the core outcome domains for PD.
73 citations
TL;DR: A nonlinear association between log(ACR) and log(PCR) is found, with the implied albumin-to-protein ratio increasing from <30% in normal to mild proteinuria to about 70% in severe proteinuria, and with wider prediction intervals at lower levels.
Abstract: BACKGROUND Urine albumin-to-creatinine ratio (ACR) and protein-to-creatinine ratio (PCR) are used to measure urine protein. Recent guidelines endorse ACR use, and equations have been developed incorporating ACR to predict risk of kidney failure. For situations in which PCR only is available, having a method to estimate ACR from PCR as accurately as possible would be useful. METHODS We used data from a population-based cohort of 47,714 adults in Alberta, Canada, who had simultaneous assessments of urine ACR and PCR. After log-transforming ACR and PCR, we used cubic splines and quantile regression to estimate the median ACR from a PCR, allowing for modification by specified covariates. On the basis of the cubic splines, we created models using linear splines to develop equations to estimate ACR from PCR. In a subcohort with eGFR<60 ml/min per 1.73 m2, we then used the kidney failure risk equation to compare kidney failure risk using measured ACR as well as estimated ACR that had been derived from PCR. RESULTS We found a nonlinear association between log(ACR) and log(PCR), with the implied albumin-to-protein ratio increasing from <30% in normal to mild proteinuria to about 70% in severe proteinuria, and with wider prediction intervals at lower levels. Sex was the most important modifier of the relationship between ACR and PCR, with men generally having a higher albumin-to-protein ratio. Estimates of kidney failure risk were similar using measured ACR and ACR estimated from PCR. CONCLUSIONS We developed equations to estimate the median ACR from a PCR, optionally including specified covariates. These equations may prove useful in certain retrospective clinical or research applications where only PCR is available.
44 citations
TL;DR: In contrast to the steady age-related decline in kidney function in non-donors, post-donation kidney function on average initially increased by 1 mL/min/1.73 m2 per year attributable to glomerular hyperfiltration, which began to plateau by five years post-Donation.
35 citations
University of Queensland1, Princess Alexandra Hospital2, University of Sydney3, Children's Hospital at Westmead4, Flinders University5, Veterans Health Administration6, University of Alabama at Birmingham7, University Health Network8, University of Toronto9, Monash University10, Monash Medical Centre11, University of Calgary12, Cleveland Clinic13, Ghent University Hospital14, Ghent University15, Peking University16, Pontifícia Universidade Católica do Paraná17, University of Pittsburgh18, Fresenius Medical Care19, Fiona Stanley Hospital20, University of Western Australia21, Translational Research Institute22
TL;DR: Vascular access function was the most critically important outcome among patients/caregivers and health professionals, and consistent reporting of this outcome across trials in HD will strengthen their value in supporting vascular access practice and shared decision making in patients requiring HD.
Abstract: Vascular access outcomes reported across haemodialysis (HD) trials are numerous, heterogeneous and not always relevant to patients and clinicians. This study aimed to identify critically important vascular access outcomes. Outcomes derived from a systematic review, multi-disciplinary expert panel and patient input were included in a multilanguage online survey. Participants rated the absolute importance of outcomes using a 9-point Likert scale (7-9 being critically important). The relative importance was determined by a best-worst scale using multinomial logistic regression. Open text responses were analysed thematically. The survey was completed by 873 participants [224 (26%) patients/caregivers and 649 (74%) health professionals] from 58 countries. Vascular access function was considered the most important outcome (mean score 7.8 for patients and caregivers/8.5 for health professionals, with 85%/95% rating it critically important, and top ranked on best-worst scale), followed by infection (mean 7.4/8.2, 79%/92% rating it critically important, second rank on best-worst scale). Health professionals rated all outcomes of equal or higher importance than patients/caregivers, except for aneurysms. We identified six themes: necessity for HD, applicability across vascular access types, frequency and severity of debilitation, minimizing the risk of hospitalization and death, optimizing technical competence and adherence to best practice and direct impact on appearance and lifestyle. Vascular access function was the most critically important outcome among patients/caregivers and health professionals. Consistent reporting of this outcome across trials in HD will strengthen their value in supporting vascular access practice and shared decision making in patients requiring HD.
25 citations
05 Feb 2020
TL;DR: This cohort study compares in-hospital days and intensity of care among older adults with kidney failure who were treated vs not treated with maintenance dialysis.
Abstract: Importance Comparative outcome data examining the association of dialysis initiation with hospital length of stay and intensity of care in older adults with kidney failure are scarce, and prior studies are limited to patients treated by nephrology teams. Objective To compare in-hospital days and intensity of care among older adults with kidney failure who were treated vs not treated with maintenance dialysis. Design, Setting, and Participants This population-based, retrospective cohort study included adults in Alberta, Canada, 65 years or older with kidney failure, defined by at least 2 consecutive outpatient estimated glomerular filtration rate values of less than 10 mL/min/1.73 m2spanning a period of at least 90 days from May 15, 2002, to March 31, 2014. Data were analyzed from August 1, 2017, to August 29, 2019. Exposures Time-varying exposure to maintenance dialysis for treatment of kidney failure. Main Outcomes and Measures The primary outcome was rate of in-hospital days. Secondary outcomes included rates of hospital admissions, intensive care unit admissions, cardiopulmonary resuscitations, inpatient palliative care, and emergency department visits; risk of in-hospital death; and time to admission to long-term care. Results A total of 968 patients (median age, 78.5 [interquartile range, 72.4-84.7] years; 489 men [50.5%]; median follow-up, 2.0 [interquartile range, 0.8-3.9] years) were included in the analysis. Patients who underwent dialysis spent more adjusted in-hospital days per person-year (36.25 [95% CI, 30.72-41.77] vs 14.65 [95% CI, 12.28-17.02]; incidence rate ratio [IRR], 2.47 [95% CI, 1.99-3.08]). However, the dialysis group did not have a higher rate of hospital admissions (1.18 [95% CI 1.07-1.29] vs 1.32 [95% CI 1.17-1.48] per year; IRR, 0.89 [95% CI, 0.77-1.03]). Patients in the dialysis group had a higher rate of intensive care unit admissions per 1000 hospitalizations (98.37 [95% CI, 81.09-115.65] vs 54.51 [95% CI, 37.76-71.26]; IRR, 1.80 [95% CI, 1.28-2.54]) and lower rates of inpatient palliative care per 1000 in-hospital days (3.92 [95% CI, 3.13-4.72] vs 8.60 [95% CI, 6.3-11.0]; IRR, 0.45 [95% CI, 0.32-0.64]). Conclusions and Relevance In this cohort study, compared with nondialysis care, patients who received maintenance dialysis spent more time in the hospital and were more likely to be admitted to intensive care units. This finding suggests trade-offs between longer survival and higher intensity of use of health care services as a function of dialysis initiation. Maintenance dialysis may be a proxy for the type of philosophy of care driving increased in-hospital time and intensive care and less use of palliative care.
13 citations
TL;DR: A failing kidney transplant is associated with an increased burden of mortality and morbidity beyond chronic kidney disease and the design of strategies to minimize risks is recommended.
Abstract: Background:Due to their history of renal disease and exposure to immunosuppression, kidney transplant recipients with a failing graft may be at higher risk of adverse outcomes compared to nontransp...
12 citations
TL;DR: The relationship between kidney failure and age varies with age, and an age-dependent effect, rather than a constant effect, needs to be specified to accurately predict risk.
Abstract: Background:In people with severe chronic kidney disease (CKD), there is an inverse relationship between age and kidney failure. If this relationship is the same at any age (linear), one effect (haz...
8 citations
TL;DR: Home-based peritoneal dialysis has potential benefit to patients and health care systems, however, receiving peritoneals dialysis requires support, so health care providers must understand how to best support patients and their family members.
Abstract: Background:People with end-stage kidney disease can either pursue conservative (palliative) management or kidney replacement therapy. Although transplant is preferred, there is a limited number of ...
6 citations
University of Toronto1, London Health Sciences Centre2, Ottawa Hospital Research Institute3, McMaster University4, Wake Forest University5, Vanderbilt University Medical Center6, UCLA Medical Center7, Brown University8, West Virginia University9, University of Rochester10, University of Alabama at Birmingham11, University of Calgary12
TL;DR: Insertion-related complications leading to significant adverse events following laparoscopic placement of PD catheters are common and are an important area of focus for future research and quality improvement efforts.
Abstract: Background:Peritoneal dialysis (PD) is a more cost-effective therapy to treat kidney failure than in-center hemodialysis, but successful therapy requires a functioning PD catheter that causes minim...
5 citations
TL;DR: Among kidney transplant recipients, lower eGFR and presence of albuminuria at 1 year post-transplant were associated with an over 2-fold higher risk of hemorrhage and venous thrombosis.
Abstract: Background:Compared to the general population, kidney transplant recipients are at increased risk of hemorrhage and thrombosis. Whether this risk is affected by graft function and albuminuria is un...
4 citations
TL;DR: Patients were more likely to receive dual-induction therapy if they were sensitized, had diabetes mellitus or peripheral vascular disease, or experienced delayed graft function, and these patients experienced worse outcomes than those treated with ATG alone.
Abstract: Background:Kidney transplant recipients are given induction therapy to rapidly reduce the immune response and prevent rejection. Guidelines recommend that an interleukin-2 receptor antibody (basili...
TL;DR: A robust and transparent methodology to track technique failure over time and to compare performance between programs is presented and it is shown that the approach to reporting technique failure has an important impact on the observed results.
Abstract: Background:Technique failure is an important outcome measure in research and quality improvement in peritoneal dialysis (PD) programs, but there is a lack of consistency in how it is reported.Metho...
16 Dec 2020
TL;DR: Wang et al. as discussed by the authors extended their previous work (Attribute-Value-Association Discovery and Disentanglement) to an extended ADD for peritoneal dialysis data analysis (PD-ADD) to overcome these problems.
Abstract: Peritoneal dialysis (PD) removes waste products from blood when the kidney is malfunctioned Since there is no clear criterion for PD recommendation for patients with kidney disease, existing machine learning models (ML), which rely on credible decision criterion, are ineffective in making PD eligibility decisions, especially when the correlated traits or indicators (patterns) inherent in the PD data are diverse and subtle Furthermore, the lack of interpretable transparency in traditional ML also weakens the credibility of the decision they produce Hence, an in-depth knowledge of the patients’ characteristics is needed to render a clearer picture of the decision-making process and model to detect the rare PD eligibility cases In this paper, we extend our previous work (Attribute-Value-Association Discovery and Disentanglement (ADD)), to an extended ADD for PD data analysis (PD-ADD) to overcome these problems We show that PD-ADD is able to discover association patterns of patient profiles and symptoms to reveal PD characteristics and detect eligible rare cases Experimental results show that PDADD is much superior to existing unsupervised clustering (with accuracy of 8987% vs 7337% of K-Means) It also enables straightforward interpretation of the underlying relations of patient characteristics in an unsupervised setting
TL;DR: Health outcomes in the COVID-19 outbreak varied by province despite rapid implementation of similar health-policy interventions across Canada, and mortality rates increased with increasing rates of lab- confirmed cases in Ontario and Quebec, but not in Alberta.
Abstract: Background: The SARS-CoV-2 disease 2019 (COVID-19) pandemic has spread across the world with varying impact on health systems and outcomes. We assessed how the type and timing of public-health interventions impacted the course of the outbreak in Alberta and the other Canadian provinces. Methods: We used publicly-available data to summarize rates of laboratory data and mortality in relation to measures implemented to contain the outbreak and testing strategy. We estimated the transmission potential of SARS-CoV-2 before the state of emergency declaration for each province (R0) and at the study end date (Rt). Results: The first cases were confirmed in Ontario (January 25) and British Columbia (January 28). All provinces implemented the same health-policy measures between March 12 and March 30. Alberta had a higher percentage of the population tested (3.8%) and a lower mortality rate (3/100,000) than Ontario (2.6%; 11/100,000) or Quebec (3.1%; 31/100,000). British Columbia tested fewer people (1.7%) and had similar mortality as Alberta. Data on provincial testing strategies were insufficient to inform further analyses. Mortality rates increased with increasing rates of lab-confirmed cases in Ontario and Quebec, but not in Alberta. Ro was similar across all provinces, but varied widely from 2.6 (95% confidence intervals 1.9-3.4) to 6.4 (4.3-8.5), depending on the assumed time interval between onset of symptoms in a primary and a secondary case (serial interval). The outbreak is currently under control in Alberta, British Columbia and Nova Scotia (Rt Interpretation: COVID-19-related health outcomes varied by province despite rapid implementation of similar health-policy interventions across Canada. Insufficient information about provincial testing strategies and a lack of primary data on serial interval are major limitations of existing data on the Canadian COVID-19 outbreak.