PUBLICATIONS - KEY DATABASE
Quick links: CKD in Australia I Health Professional Publications
EARLY DETECTION AND PREVENTION
Major Findings - KEY Kidney Health Check Kidney Health Australia's pilot studies
Screening for chronic kidney disease in Australia: a pilot study in the community and workplace
Kidney International (2010) 77 (Suppl 116), S9–S16; doi:10.1038/ki.2009.538
The pilot program Kidney Evaluation for You (KEY) was conducted in Australia to screen for chronic kidney disease (CKD). Targeting people at high risk (those with diabetes, hypertension, a first-degree relative with kidney failure, or age >50 years), KEY aimed to establish community-based screening protocols, assess efficacy in promoting changes in risk-factor management, and explore participant CKD awareness.
KEY offered free cardiovascular and kidney checks using point-of-care testing for on-site pathology measurements (estimated glomerular filtration rate, hemoglobin A1c, cholesterol, hemoglobin, albuminuria), lifestyle assessment, and exit interviews. Participants were phoned at 3 months to ascertain whether KEY advice had been followed. Community and health professional support was strong; 99% of participants rated involvement as beneficial. Of 402 high-risk individuals recruited, findings were suggestive of CKD in 20.4%. Of these, 69% had hypertension, 30% diabetes, and 40% elevated total cholesterol. All participants with CKD stage 3b or higher were aged >61 years. Overall, 58% of participants were referred to their primary care providers for further action; of these, 82% saw their doctors in the next 3 months and 94% discussed KEY results. Follow-up telephone contact was successful for 82% of participants. Change in management occurred for 67%. Thus, the KEY approach to early detection of CKD and selected referral of participants was largely successful.
Correspondence: Dr Tim Mathew, Level 1, 25 North Tce, Hackney SA 5069 Australia tim.mathew@kidney.org.au
Review article: Early detection of chronic kidney disease in Australia: Which way to go?
A KHA 12-month pilot study with funding from BHP Billiton and Commonwealth Department of Health and Ageing. The KEY Health Check was launched February 2008 and recruited over 400 participants from three diverse Australian communities (Townsville, Roxby Downs, and Perth) who were offered a free and comprehensive evaluation of kidney function, cardiovascular health and diabetes risk.
Guidelines for the assessment of absolute cardiovascular disease risk
© 2009 National Heart Foundation of Australia ISBN: 978-1-921226-40-3 CON-064
Absolute risk as defined in these guidelines is the numerical probability of a cardiovascular event occurring within a five-year period. It reflects a person’s ‘individualised’ risk of cardiovascular disease (CVD), recommendations adults aged 45-74 years (35 years and above for Aboriginal or Torres Strait Islander adults). They feature sections on assessing adults - without known CVD, with diabetes or chronic kidney disease and who are overweight or obese. Clinical decisions based on absolute risk can lead to improved health outcomes by identifying people most at risk and directing the right treatments to them. Endorsed by National Health and Medical Research Council.
Absolute cardiovascular disease risk assessment - quick reference guide for health professionals
Initiative of the National Vascular Disease Prevention Alliance (NVDPA) - Diabetes Australia, Kidney Health Australia, National Heart Foundation of Australia and National Stroke Foundation©
National Evidence Based Guideline Patient Education in type 2 Diabetes (DM2) 2009
Colagiuri R, Girgis S, Eigenmann C, Gomez M, Griffiths R - Diabetes Australia and the NHMRC Canberra 2009
MAJOR RESEARCH PROJECTS
Kidney Health Australia working with The George Institute - Renal and Metabolic Division
Economic Impact of End-Stage Kidney Disease in Australia - Projections to 2020
Released in November 2010 - Read Executive Summary or full report
27 June 2010 - Australian New Zealand Clinical Trials Registry No 12609000266268 (10.1056/NEJ Moa 1000552) Bruce Cooper MB BS PhD, Pauline Branley BMed PhD, Liliana Bulfone B.Pharm MBA, John Collins MB ChB, Jonathan Craig MB Ch.B PhD, Margaret Fraenkel BM BS PhD, Anthony Harris MA MSc, David Johnson MB BS PhD, Joan Kesselhut, Jing Jing Li BPharm BCom, Grant Luxton MB, BS, Andrew Pilmore BSc David Tiller MB BS, David Harris MB BS MD, Carol Pollock MB BS PhD
The cost of treating end-stage kidney disease from 2009 to 2020 is estimated to be around $12 billion to the Australian Government. The incidence of kidney disease is growing at a serious rate, projected to increase by more than 54% to 2020.
The report estimates that increasing the use of home dialysis over the next 10 years would lead to an estimated net savings of between $378 and $430 million for our health system. Annual costs per person for home dialysis is $49,137, compared to $79,072 for hospital dialysis.
Useful references:
Projections of the incidence of treated End-Stage Kidney Disease in Australia, 2010-2020
AIHW catalogue number (PHE150) Available from the internet only (detailed below in AIHW reports)
Refers to previous KHA reports for 2008:
The Burden of Chronic Kidney Disease and the Cost-effectiveness of Early Detection and Intervention to Prevent Progression of CKD in Australia and KHA's Australian CKD Executive Strategy (2006)
A.I.H.W. REPORTS - ON ASPECTS OF CKD
RESULTS OF CONTROLLED TRIALS RELATED TO CHRONIC KIDNEY DISEASE (CKD)
IDEAL Study Randomized, Controlled Trial of Early vs Late Initiation of Dialysis
The Initiation of Renal-Replacement Therapy: Just-in-Time
Associated editorial on IDEAL Study www.nejm.org 27 June 2010
(10.1056/NEJMe1006669) Norbert Lameire MD PhD and Wim Van Biesen MD PhD
Study supports currently recommended practice, in which most nephrologists start patients on renal-replacement therapy on the basis of clinical factors rather than numerical criteria, such as the estimated GFR alone. Early referral to a nephrologist, a well-organized patient-education program and careful planning before dialysis is initiated are the cornerstones of such a strategy.
IMPAKT Study Improving Health Service Delivery and Outcomes for Indigenous Australians with Kidney Disease Examines how health systems in different Australian states provide transplant services to kidney patients. It has a particular focus on the experience of Aboriginal and Torres Strait Islanders who have ESKD and their ability to access and use transplant services.
Kanyini Vascular Collaboration Improving health outcomes for Aboriginal and Torres Strait Islander Australians with chronic disease through strategies to reduce systems barriers to necessary care.
RENAL Study RCT of Normal vs. Augmented Level of Renal Replacement Therapy in ICU
Multi-centre clinical trial of intensive vs. normal continuous renal replacement therapy in acute renal failure in the ICU setting - in collaboration with the A & NZ Intensive Care Society Clinical Trial Group.
SHARP Study Study of Heart and Renal Protection
Global clinical trial of lipid-lowering in CKD in the Australasian region.
DIALYSIS NEPHROLOGY TRANSPLANTATION (DNT) ENDORSED POSITION STATEMENT
Gadolinium contrast, renal disease and nephrogenic nephrogenic systemic fibrosis (NSF)
Currently under review by the DNT - First published 2008
Clinical recommendations for use of Gladolinium Contrast in MRI. A review of literature on Gadolinium Contrast and NSF, written by members of the Radiology and Nephrology Departments at Auckland City Hospital.
GFR REPORTING - archived files
Using the Modification of Diet in Renal Disease (MDRD) formula with every serum creatinine test ordered in adults is now replaced by the new GFR (CKD-EPI formula) calculation.
KHA webpages: Kidney Check Australia Taskforce (KCAT) I KHA-CARI Guidelines I Detecting CKD
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UPDATED 21 MARCH 2012