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Article ; Online: Hospital readmission for the dialysis patient: who is (not) responsible?

Streja, Elani

2017 Volume 92, Issue 4, Page(s) 788–790

Abstract: A new study in dialysis patients demonstrates that more than one-third of rehospitalizations within 30 days of discharge occur within the first week, and these rehospitalizations are associated with worse survival. Imposing a penalty on the dialysis ... ...

Abstract	A new study in dialysis patients demonstrates that more than one-third of rehospitalizations within 30 days of discharge occur within the first week, and these rehospitalizations are associated with worse survival. Imposing a penalty on the dialysis provider for these rehospitalizations, as mandated by the Hospital Readmissions Reduction Program, may be inefficient in reducing health care costs and improving patient outcomes. Systems for improving communication between the hospital and posthospitalization nephrologist about patient care are needed.
MeSH term(s)	Humans ; Patient Discharge ; Patient Readmission ; Renal Dialysis
Language	English
Publishing date	2017
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	120573-0
ISSN	1523-1755 ; 0085-2538
ISSN (online)	1523-1755
ISSN	0085-2538
DOI	10.1016/j.kint.2017.04.046
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Article ; Online: Does the Benefit of Cholesterol-Lowering of a Given Magnitude Depend on the Drug Intervention Used?

Streja, Elani / Streja, Dan

Circulation. Cardiovascular quality and outcomes

2019 Volume 12, Issue 8, Page(s) e005599

MeSH term(s)	Cholesterol ; Ezetimibe ; Humans
Chemical Substances	Cholesterol (97C5T2UQ7J) ; Ezetimibe (EOR26LQQ24)
Language	English
Publishing date	2019-08-15
Publishing country	United States
Document type	Editorial ; Research Support, U.S. Gov't, Non-P.H.S. ; Comment
ZDB-ID	2483197-9
ISSN	1941-7705 ; 1941-7713
ISSN (online)	1941-7705
ISSN	1941-7713
DOI	10.1161/CIRCOUTCOMES.119.005599
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Article ; Online: Incident Diuretic Use and Subsequent Risk of Bone Fractures: A Large Nationwide Observational Study of US Veterans.

Sumida, Keiichi / Shrestha, Prabin / Mallisetty, Yamini / Surbhi, Satya / Thomas, Fridtjof / Streja, Elani / Kalantar-Zadeh, Kamyar / Kovesdy, Csaba P

Mayo Clinic proceedings

2024

Abstract: Objective: To investigate the association of incident use of diuretics with subsequent risk of incident bone fractures.: Patients and methods: In a nationwide cohort of 863,339 US veterans receiving care from the VA health care system between October ...

Abstract	Objective: To investigate the association of incident use of diuretics with subsequent risk of incident bone fractures. Patients and methods: In a nationwide cohort of 863,339 US veterans receiving care from the VA health care system between October 1, 2004, and September 30, 2006, with follow-up through June 30, 2018, we examined the association of incident diuretic use (overall, and separately by thiazide, loop, and potassium-sparing diuretics) with subsequent risk of incident bone fractures using multivariable Cox regression models while minimizing confounding by indication using a target trial emulation approach. Results: Patients were 63.3±12.9 years old; 93.5% (n=807,180) were male; and 27.1% (n=233,996) were diabetic. Their baseline estimated glomerular filtration rate was 84.4±16.5 mL/min per 1.73 m Conclusion: Incident use of diuretics, particularly loop diuretics, was independently associated with higher risk of incident bone fractures. Our findings suggest distinct pathophysiologic contributions of diuretics to bone metabolism and the need for careful attention to skeletal outcomes when initiating diuretics.
Language	English
Publishing date	2024-04-03
Publishing country	England
Document type	Journal Article
ZDB-ID	124027-4
ISSN	1942-5546 ; 0025-6196
ISSN (online)	1942-5546
ISSN	0025-6196
DOI	10.1016/j.mayocp.2023.09.018
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Article: Association of long-term aspirin use with kidney disease progression.

Lu, Jun Ling / Shrestha, Prabin / Streja, Elani / Kalantar-Zadeh, Kamyar / Kovesdy, Csaba P

Frontiers in medicine

2023 Volume 10, Page(s) 1283385

Abstract: Background: Chronic microinflammation contributes to the progression of chronic kidney disease (CKD). Aspirin (ASA) has been used to treat inflammation for centuries. The effects of long-term low-dose ASA on CKD progression are unclear.: Methods: We ... ...

Abstract	Background: Chronic microinflammation contributes to the progression of chronic kidney disease (CKD). Aspirin (ASA) has been used to treat inflammation for centuries. The effects of long-term low-dose ASA on CKD progression are unclear. Methods: We examined the association of long-term use of newly initiated low-dose ASA (50-200 mg/day) with all-cause mortality using Cox proportional hazard models; with cardiovascular/cerebrovascular (CV) mortality and with end stage kidney disease (ESKD) using Fine and Gray competing risk regression models; with progression of CKD defined as patients' eGFR slopes steeper than -5 mL/min/1.73m Results: In the matched cohort, over a 4.9-year median follow-up period, 11,846 (40.2%) patients (6,017 vs. 5,829 ASA users vs. non-users) died with 25.8% CV deaths, and 934 (3.2%) patients (476 vs. 458) reached ESKD. ASA users had a higher risk of faster decline of kidney functions, i.e., steeper slopes (OR 1.30 [95%CI: 1.18, 1.44], Conclusion: Chronic low-dose ASA use was associated with faster kidney function deterioration, and no association was observed with mortality or risk of ESKD.
Language	English
Publishing date	2023-12-04
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2775999-4
ISSN	2296-858X
ISSN	2296-858X
DOI	10.3389/fmed.2023.1283385
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Article ; Online: Medical Faculty and Medical Student Opinions on the Utility of Questions to Teach and Evaluate in the Clinical Environment.

Rucker, Lloyd / Rucker, Garrett / Nguyen, Angelica / Noel, Maria / Marroquin, Maria / Streja, Elani / Hennrikus, Eileen

Medical science educator

2023 Volume 33, Issue 3, Page(s) 669–678

Abstract: Objectives: We sought to report medical student and faculty perceptions of the purpose and utility of questions on clinical rounds.: Methods: We developed and administered a survey to third and fourth-year medical students and teaching physicians. ... ...

Abstract	Objectives: We sought to report medical student and faculty perceptions of the purpose and utility of questions on clinical rounds. Methods: We developed and administered a survey to third and fourth-year medical students and teaching physicians. The survey elicited attitudes about using questions to teach on rounds in both benign and malignant learning environments. Results: Ninety-seven percent of faculty and 85% of students predicted they will use questions to teach. Nine percent of students described learning-impairing stress during benign bedside teaching. Fifty-nine percent of faculty felt questions were mostly for teaching; 74% of students felt questions were mostly for evaluation. Forty-six percent of students felt questions underestimated their knowledge. Students felt questions were more effective for classroom teaching than bedside teaching. Faculty and students agreed that a malignant environment detrimentally affected learning and performance. Conclusions: Students and faculty supported the use of questions to teach and evaluate, especially in benign teaching environments. Many students described stress severe enough to affect their learning and performance, even when questioned in benign teaching environments. Faculty underestimated the degree to which students experience stress-related learning impairment and the degree to which students see questions as evaluation rather than teaching. Nearly half of students felt that questions underestimated their own knowledge. Students feel more stress and less learning when questioned with a patient present. Faculty must realize that even in the best learning environment some students experience stress-impaired learning and performance, perhaps because of the conflict between learning and evaluation.
Language	English
Publishing date	2023-04-11
Publishing country	United States
Document type	Journal Article
ISSN	2156-8650
ISSN (online)	2156-8650
DOI	10.1007/s40670-023-01780-5
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Article ; Online: Comparing the Fried frailty phenotype versus the Veterans Affairs frailty index among dialysis dependent patients.

Hamiduzzaman, Anum / Wu, Ruoxue / Murray, Victoria / Kalantar-Zadeh, Kamyar / Streja, Elani / Sy, John

Hemodialysis international. International Symposium on Home Hemodialysis

2023 Volume 27, Issue 4, Page(s) 444–453

Abstract: Introduction: Frailty in dialysis patients is a modifiable disease state which can increase mortality if left untreated but remains underdiagnosed as frailty evaluations can be arduous or time consuming. We evaluate the agreement between a clinical ... ...

Abstract	Introduction: Frailty in dialysis patients is a modifiable disease state which can increase mortality if left untreated but remains underdiagnosed as frailty evaluations can be arduous or time consuming. We evaluate the agreement between a clinical frailty construct (Fried frailty phenotype, FFP) against and an electronic health record-based Veterans Affairs Frailty Index (VAFI) and their association with mortality. Methods: A retrospective cohort analysis of 764 participants from the ACTIVE/ADIPOSE study was performed. Frailty as measured by VAFI and FFP was obtained and Kappa statistic estimating concordance between the two scores were calculated. Differences in mortality risk were analyzed according to presence or absence of frailty. Findings: When assessing agreement between the VAFI and FFP, the kappa statistic was 0.09 (95% confidence interval [CI] 0.02-0.16) suggesting a low level of agreement. Frailty was independently associated with higher mortality risk (hazards ratio [HR] 1.40-1.42 in fully adjusted models depending upon frailty construct). Discordantly frail patients by construct had a higher risk of mortality though this was not statistically significant after adjustment. However, concordantly frail patients had much higher mortality risk compared to concordantly nonfrail (adjusted HR 2.08, 95% CI 1.44-3.01). Discussion: Poor agreement between constructs is likely reflective of the multifactorial definition of frailty. While further longitudinal studies are needed to determine if the VAFI would be beneficial in the reassessment of frailty, it may be beneficial as a cue for further frailty testing (e.g., with FFP) with the combination of multiple frail constructs providing improved prognostic information.
MeSH term(s)	Humans ; Aged ; Frailty/complications ; Frailty/diagnosis ; Renal Dialysis ; Frail Elderly ; Retrospective Studies ; Veterans ; Phenotype
Language	English
Publishing date	2023-06-15
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2192458-2
ISSN	1542-4758 ; 1492-7535
ISSN (online)	1542-4758
ISSN	1492-7535
DOI	10.1111/hdi.13101
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Article ; Online: Anti-Tumor Necrosis Factor Therapy and Risk of Kidney Function Decline and Mortality in Inflammatory Bowel Disease.

Sumida, Keiichi / Shrestha, Prabin / Mallisetty, Yamini / Thomas, Fridtjof / Gyamlani, Geeta / Streja, Elani / Kalantar-Zadeh, Kamyar / Kovesdy, Csaba P

JAMA network open

2024 Volume 7, Issue 4, Page(s) e246822

Abstract: Importance: Inflammatory bowel disease (IBD) is associated with adverse clinical outcomes, including chronic kidney disease and mortality, due in part to chronic inflammation. Little is known about the effects of anti-tumor necrosis factor (TNF) therapy ...

Abstract	Importance: Inflammatory bowel disease (IBD) is associated with adverse clinical outcomes, including chronic kidney disease and mortality, due in part to chronic inflammation. Little is known about the effects of anti-tumor necrosis factor (TNF) therapy on kidney disease progression and mortality among patients with new-onset IBD. Objective: To examine the association of incident use of TNF inhibitors with subsequent decline in kidney function and risk of all-cause mortality. Design, setting, and participants: This retrospective cohort study used data from the US Department of Veterans Affairs health care system. Participants were US veterans with new-onset IBD enrolled from October 1, 2004, through September 30, 2019. Data were analyzed from December 2022 to February 2024. Exposures: Incident use of TNF inhibitors. Main outcomes and measures: The main outcomes were at least 30% decline in estimated glomerular filtration rate (eGFR) and all-cause mortality. Results: Among 10 689 patients (mean [SD] age, 67.4 [12.3] years; 9999 [93.5%] male) with incident IBD, 3353 (31.4%) had diabetes, the mean (SD) baseline eGFR was 77.2 (19.2) mL/min/1.73 m2, and 1515 (14.2%) were newly initiated on anti-TNF therapy. During a median (IQR) follow-up of 4.1 (1.9-7.0) years, 3367 patients experienced at least 30% decline in eGFR, and over a median (IQR) follow-up of 5.0 (2.5-8.0) years, 2502 patients died. After multivariable adjustments, incident use (vs nonuse) of TNF inhibitors was significantly associated with higher risk of decline in eGFR (adjusted hazard ratio [HR], 1.34 [95% CI, 1.18-1.52]) but was not associated with risk of all-cause mortality (adjusted HR, 1.02 [95% CI, 0.86-1.21]). Similar results were observed in sensitivity analyses. Conclusions and relevance: In this cohort study of US veterans with incident IBD, incident use (vs nonuse) of TNF inhibitors was independently associated with higher risk of progressive eGFR decline but was not associated with risk of all-cause mortality. Further studies are needed to elucidate potentially distinct pathophysiologic contributions of TNF inhibitor use to kidney and nonkidney outcomes in patients with IBD.
MeSH term(s)	Aged ; Female ; Humans ; Male ; Cohort Studies ; Inflammatory Bowel Diseases/drug therapy ; Kidney ; Necrosis ; Retrospective Studies ; Tumor Necrosis Factor Inhibitors/adverse effects ; Tumor Necrosis Factor Inhibitors/therapeutic use
Chemical Substances	Tumor Necrosis Factor Inhibitors
Language	English
Publishing date	2024-04-01
Publishing country	United States
Document type	Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2024.6822
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Article ; Online: Feasibility and acceptability of a structured quality by design approach to enhancing the rigor of clinical studies at an academic health center.

Moradi, Hamid / Schneider, Margaret / Streja, Elani / Cooper, Dan

Journal of clinical and translational science

2021 Volume 5, Issue 1, Page(s) e175

Abstract: Introduction: Clinical trials are a critical step in the meaningful translation of biomedical discoveries into effective diagnostic and therapeutic interventions. Quality by design (QbD) is a framework for embedding quality into the design, conduct, and ...

Abstract	Introduction: Clinical trials are a critical step in the meaningful translation of biomedical discoveries into effective diagnostic and therapeutic interventions. Quality by design (QbD) is a framework for embedding quality into the design, conduct, and monitoring of clinical trials. Here we report the feasibility and acceptability of a process for implementing QbD in clinical research at an academic health center via multidisciplinary design studios aimed at identifying and prioritizing critical to quality (CTQ) factors. Methods: The Clinical Trial Transformation Initiative's Principles Document served as a guide to identify and categorize key CTQ factors, defined as elements of a clinical trial that are critical to patient safety and data integrity. Individual trials were reviewed in CTQ design studios (CTQ-DS) and the feasibility and acceptability of this intervention was examined through post-meeting interviews and surveys. Results: Eight clinical research protocols underwent the QbD evaluation process. The protocols ranged from multicenter randomized clinical trials to nonrandomized investigator-initiated studies. A developmental evaluation informed the iterative refinement of the CTQ-DS process, and post-meeting surveys revealed that CTQ-DS were highly valued by principal investigators (PIs) and resulted in multiple protocol changes. Conclusions: The present study demonstrated that QbD principles can be implemented to inform the design and conduct of clinical research at an academic health center using multidisciplinary design studios aimed at identifying and prioritizing CTQ elements. This approach was well received by the participants including study PIs. Future research will need to evaluate the effectiveness of this approach in improving the quality of clinical research.
Language	English
Publishing date	2021-08-13
Publishing country	England
Document type	Journal Article
ISSN	2059-8661
ISSN (online)	2059-8661
DOI	10.1017/cts.2021.837
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Article ; Online: Association of long-term aspirin use with kidney disease progression

Jun Ling Lu / Prabin Shrestha / Elani Streja / Kamyar Kalantar-Zadeh / Csaba P. Kovesdy

Frontiers in Medicine, Vol

2023 Volume 10

Abstract: BackgroundChronic microinflammation contributes to the progression of chronic kidney disease (CKD). Aspirin (ASA) has been used to treat inflammation for centuries. The effects of long-term low-dose ASA on CKD progression are unclear.MethodsWe examined ... ...

Abstract	BackgroundChronic microinflammation contributes to the progression of chronic kidney disease (CKD). Aspirin (ASA) has been used to treat inflammation for centuries. The effects of long-term low-dose ASA on CKD progression are unclear.MethodsWe examined the association of long-term use of newly initiated low-dose ASA (50–200 mg/day) with all-cause mortality using Cox proportional hazard models; with cardiovascular/cerebrovascular (CV) mortality and with end stage kidney disease (ESKD) using Fine and Gray competing risk regression models; with progression of CKD defined as patients’ eGFR slopes steeper than −5 mL/min/1.73m2/year using logistic regression models in a nationwide cohort of US Veterans with incident CKD. Among 831,963 patients, we identified 385,457 who either initiated ASA (N = 21,228) within 1 year of CKD diagnosis or never received ASA (N = 364,229). We used propensity score matching to account for differences in key characteristics, yielding 29,480 patients (14,740 in each group).ResultsIn the matched cohort, over a 4.9-year median follow-up period, 11,846 (40.2%) patients (6,017 vs. 5,829 ASA users vs. non-users) died with 25.8% CV deaths, and 934 (3.2%) patients (476 vs. 458) reached ESKD. ASA users had a higher risk of faster decline of kidney functions, i.e., steeper slopes (OR 1.30 [95%CI: 1.18, 1.44], p < 0.01), but did not have apparent benefits on mortality (HR 0.97 [95%CI: 0.94, 1.01], p = 0.17), CV mortality (Sub-Hazard Ratio [SHR]1.06 [95%CI: 0.99–1.14], p = 0.11), or ESKD (SHR1.00 [95%CI: 0.88, 1.13], p = 0.95).ConclusionChronic low-dose ASA use was associated with faster kidney function deterioration, and no association was observed with mortality or risk of ESKD.
Keywords	chronic kidney disease ; microinflammation ; aspirin ; end-stage kidney disease (ESKD) ; eGFR slopes ; Medicine (General) ; R5-920
Language	English
Publishing date	2023-12-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
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Article ; Online: Feasibility and acceptability of a structured quality by design approach to enhancing the rigor of clinical studies at an academic health center

Hamid Moradi / Margaret Schneider / Elani Streja / Dan Cooper

Journal of Clinical and Translational Science, Vol

2021 Volume 5

Abstract: Abstract Introduction: Clinical trials are a critical step in the meaningful translation of biomedical discoveries into effective diagnostic and therapeutic interventions. Quality by design (QbD) is a framework for embedding quality into the design, ... ...

Abstract	Abstract Introduction: Clinical trials are a critical step in the meaningful translation of biomedical discoveries into effective diagnostic and therapeutic interventions. Quality by design (QbD) is a framework for embedding quality into the design, conduct, and monitoring of clinical trials. Here we report the feasibility and acceptability of a process for implementing QbD in clinical research at an academic health center via multidisciplinary design studios aimed at identifying and prioritizing critical to quality (CTQ) factors. Methods: The Clinical Trial Transformation Initiative’s Principles Document served as a guide to identify and categorize key CTQ factors, defined as elements of a clinical trial that are critical to patient safety and data integrity. Individual trials were reviewed in CTQ design studios (CTQ-DS) and the feasibility and acceptability of this intervention was examined through post-meeting interviews and surveys. Results: Eight clinical research protocols underwent the QbD evaluation process. The protocols ranged from multicenter randomized clinical trials to nonrandomized investigator-initiated studies. A developmental evaluation informed the iterative refinement of the CTQ-DS process, and post-meeting surveys revealed that CTQ-DS were highly valued by principal investigators (PIs) and resulted in multiple protocol changes. Conclusions: The present study demonstrated that QbD principles can be implemented to inform the design and conduct of clinical research at an academic health center using multidisciplinary design studios aimed at identifying and prioritizing CTQ elements. This approach was well received by the participants including study PIs. Future research will need to evaluate the effectiveness of this approach in improving the quality of clinical research.
Keywords	Quality by design ; critical to quality ; clinical trials ; patient safety ; implementation ; trial design ; Medicine ; R
Subject code	610
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Cambridge University Press
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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