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  • 1
    Online Resource
    Online Resource
    Association of Surge Conditions with Mortality Among Critically Ill Patients with COVID-19
    SAGE Publications ; 2022
    In:  Journal of Intensive Care Medicine Vol. 37, No. 4 ( 2022-04), p. 500-509
    Details
    In: Journal of Intensive Care Medicine, SAGE Publications, Vol. 37, No. 4 ( 2022-04), p. 500-509
    Abstract: To determine whether surge conditions were associated with increased mortality. Design Multicenter cohort study. Setting U.S. ICUs participating in STOP-COVID. Patients Consecutive adults with COVID-19 admitted to participating ICUs between March 4 and July 1, 2020. Interventions None Measurements and Main Results The main outcome was 28-day in-hospital mortality. To assess the association between admission to an ICU during a surge period and mortality, we used two different strategies: (1) an inverse probability weighted difference-in-differences model limited to appropriately matched surge and non-surge patients and (2) a meta-regression of 50 multivariable difference-in-differences models (each based on sets of randomly matched surge- and non-surge hospitals). In the first analysis, we considered a single surge period for the cohort (March 23 – May 6). In the second, each surge hospital had its own surge period (which was compared to the same time periods in matched non-surge hospitals). Our cohort consisted of 4342 ICU patients (average age 60.8 [sd 14.8], 63.5% men) in 53 U.S. hospitals. Of these, 13 hospitals encountered surge conditions. In analysis 1, the increase in mortality seen during surge was not statistically significant (odds ratio [95% CI] : 1.30 [0.47-3.58], p = .6). In analysis 2, surge was associated with an increased odds of death (odds ratio 1.39 [95% CI, 1.34-1.43] , p  〈  .001). Conclusions Admission to an ICU with COVID-19 in a hospital that is experiencing surge conditions may be associated with an increased odds of death. Given the high incidence of COVID-19, such increases would translate into substantial excess mortality.
    Type of Medium: Online Resource
    ISSN: 0885-0666 , 1525-1489
    URL: Article
    DOI: 10.1177/08850666211067509
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2001472-7
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  • 2
    Online Resource
    Online Resource
    Barriers to Increasing Use of Peritoneal Dialysis in Bangladesh: A Survey of Patients and Providers
    SAGE Publications ; 2017
    In:  Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis Vol. 37, No. 2 ( 2017-03), p. 234-237
    Details
    In: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, SAGE Publications, Vol. 37, No. 2 ( 2017-03), p. 234-237
    Abstract: Despite a lower requirement for technology and equipment than hemodialysis (HD), peritoneal dialysis (PD) is an underutilized modality in low- and middle-income countries (LMICs). Bangladesh has the lowest use of PD in the world (fewer than 2% of prevalent patients). We evaluated nephrologists’ attitudes toward PD and examined differences between patients on HD and PD in Dhaka. We asked nephrologists to fill out an English-language questionnaire. Using convenience sampling but targeting both public and private hospitals in Dhaka, we asked trained nurses to administer a Bangla-language questionnaire to patients on HD ( n = 116) and PD ( n = 41). We validated the questionnaires on a sub-sample (n = 10 for each group). Of the 43 nephrologists surveyed, 27 (63%) had patients on PD. When compared with nephrologists without patients on PD, those with patients on PD were less likely to believe that survival and quality of life on PD was worse than on HD (odds ratio [OR] = 0.21, 95% confidence interval [CI] 0.05 - 0.83 and OR = 0.11, 95% CI 0.02 - 0.67 respectively) but were not more likely to have received training for PD. Nephrologists named cost of PD as the predominant barrier to increasing use of PD, followed by concerns about patient hygiene and lack of trained nurses. Fifty-two HD patients (45%) did not know about a home-based modality. When compared with patients on HD, patients on PD were more likely to have been educated by non-nephrologists about dialysis, to be “forewarned” about the need for dialysis, to be paying fully, and to be living in a permanent home with a non-communal water source. Some barriers to increasing access to PD—i.e., patient living conditions and cost—are unique to LMICs. Our study also highlights that issues encountered in high-income countries—i.e., nephrologists’ subjective preference and lack of patient knowledge about an alternate modality to HD—may play a role as well.
    Type of Medium: Online Resource
    ISSN: 0896-8608 , 1718-4304
    URL: Article
    DOI: 10.3747/pdi.2016.00177
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
    detail.hit.zdb_id: 2075957-5
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  • 3
    Online Resource
    Online Resource
    Kidney function while on immune checkpoint inhibitors: Trends in incidence of acute kidney injury, and its causes and outcomes
    SAGE Publications ; 2023
    In:  Journal of Onco-Nephrology Vol. 7, No. 2 ( 2023-06), p. 57-65
    Details
    In: Journal of Onco-Nephrology, SAGE Publications, Vol. 7, No. 2 ( 2023-06), p. 57-65
    Abstract: Immune checkpoint inhibitor (ICI) use is increasing in the United States, real world data on acute kidney injury (AKI) in the expanding population are sparse. We evaluated trends in AKI incidence, and causes and management of AKI among 1914 persons receiving ICIs in a single center over a period of 5 years. Methods: We included all adults who received ICIs at the Stanford Healthcare System from July 1, 2015 to June 30, 2020. We defined AKI as an increase in serum creatinine to 1.5 times the baseline or an increase of ⩾0.3 mg/dL, and determined mean cumulative incidence of first and repeated episodes of AKI over three time periods. Results: Among the 1914 patients treated with ICIs, mean age was 64.9 (SD 14.3) years, 43% were women, 25% had baseline chronic kidney disease (CKD), 34% had lung and 23% had skin cancer as the indication. The overall cumulative incidence of any AKI and immune-related AKI at 1 year after initiating immunotherapy was 32% and 1.3% respectively. Among 586 cases of AKI, the most common cause was volume depletion (64%). Although 4% of AKI was immune-related, ICI therapy was discontinued in 14% of patients with AKI. Nephrology was consulted in 6%. The risk for AKI was higher among patients with a comorbidity index ⩾3 (vs CMI 0, HR 1.65 [95% CI 1.26–2.17]), digestive system cancer (vs skin cancer, 1.65 [1.13–2.43] ), and lower baseline estimated glomerular filtration rate (30–59 and 〈 30 vs 〉 60) (HR 1.69 [1.32–2.16] and 1.85 [1.16–2.97] respectively). Conclusions: AKI occurs in up to 1 in 3 patients, and 1 in 10 will have repeated episodes during the first year of ICI therapy. Incidence of AKI has remained similar over 5-year time span. The cause of AKI while on ICI is rarely an immune-related adverse event.
    Type of Medium: Online Resource
    ISSN: 2399-3693 , 2399-3707
    URL: Article
    DOI: 10.1177/23993693231161875
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2964340-5
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  • 4
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    Online Resource
    An extra year of onco-nephrology fellowship training is not required for the subspecialty
    SAGE Publications ; 2021
    In:  Journal of Onco-Nephrology Vol. 5, No. 1 ( 2021-02), p. 35-38
    Details
    In: Journal of Onco-Nephrology, SAGE Publications, Vol. 5, No. 1 ( 2021-02), p. 35-38
    Abstract: Onconephrology, a new and evolving subspecialty of Nephrology. Several Universities have created onconephrology fellowships affiliated with major cancer centers. The aim of this article is to present and rationale for why a 1-year training program may not be necessary to launch a successful career in onconephrology.
    Type of Medium: Online Resource
    ISSN: 2399-3693 , 2399-3707
    URL: Article
    DOI: 10.1177/2399369320972409
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2964340-5
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  • 5
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    Online Resource
    Renal cyst formation complicating ALK inhibitors
    SAGE Publications ; 2023
    In:  Journal of Onco-Nephrology Vol. 7, No. 2 ( 2023-06), p. 95-104
    Details
    In: Journal of Onco-Nephrology, SAGE Publications, Vol. 7, No. 2 ( 2023-06), p. 95-104
    Abstract: With rapid discovery of oncogenic deriver genes over the past decade, several tyrosine kinase inhibitors (TKIs) were developed to target the anaplastic lymphoma kinase (ALK) aberration in non-small cell lung cancers (NSCLCs), including first, second and third-generation ALK inhibitors for ALK-rearranged NSCLC treatment. However with recent data published from several clinical trials and retrospective studies investigating the efficacy of these TKIs in ALK-rearranged NSCLC patients, development of renal cysts is a side effect associated with first generation TKI crizotinib; the mechanism for cyst formation, and whether it is a class effect, is unclear. In this review we will summarize published data on development of kidney injury and renal cysts associated with ALK inhibitors with focus on crizotinib-related renal cysts.
    Type of Medium: Online Resource
    ISSN: 2399-3693 , 2399-3707
    URL: Article
    DOI: 10.1177/23993693231151312
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2964340-5
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  • 6
    Online Resource
    Online Resource
    Expanding Capd in Low-Resource Settings: A Distance Learning Approach
    SAGE Publications ; 2018
    In:  Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis Vol. 38, No. 5 ( 2018-09), p. 343-348
    Details
    In: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, SAGE Publications, Vol. 38, No. 5 ( 2018-09), p. 343-348
    Abstract: Despite growing need, treatment for end-stage renal disease is limited in low- and middle-income countries due to resource restraints. We describe the development of an educational curriculum and quality improvement program to support continuous ambulatory peritoneal dialysis (CAPD) performed primarily by non-nephrology providers in Sri Lanka. Methods We developed a program of education, outcome tracking, and expert consultation to support providers in Kandy, Sri Lanka. Education included videos and in-person didactics covering core topics in CAPD. Event-tracking sheets recorded root causes and management of infections and hospitalizations. Conferences reviewed clinical cases and overall clinic management. We evaluated the patient census, peritonitis rates, and root causes and management of infections over 1 year. Results The curriculum was published through the International Society of Nephrology online academy. High provider turnover limited curriculum assessments. The CAPD patient census rose from 63 to 116 during the year. The peritonitis rate declined significantly, from 0.8 episodes per patient-year in the first 6 months to 0.4 in the latter 6 months, though the most common root causes of peritonitis, related to contamination events and hygiene, persisted. The appropriate ascertainment of culture data and prescription of antibiotics also increased. Conclusions Our project supported the expansion of a CAPD program in a resource-limited setting, while also improving peritonitis outcomes. Ongoing challenges include ensuring a durable educational system for rotating providers, tracking outcomes beyond peritonitis, and formalizing management protocols. Our program can serve as an example of how established dialysis programs can support the burgeoning work of providers in resource-limited setting.
    Type of Medium: Online Resource
    ISSN: 0896-8608 , 1718-4304
    URL: Article
    DOI: 10.3747/pdi.2017.00251
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
    detail.hit.zdb_id: 2075957-5
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