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Article ; Online: New Directions in Phosphorus Management in Dialysis.

Dwyer, Jamie P / Kelepouris, Ellie

Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation

2022 Volume 33, Issue 1, Page(s) 12–16

Abstract: Current phosphate management strategies in end-stage renal disease (dietary phosphate restriction, dialysis, and phosphate binders) are inadequate to maintain target phosphate levels in most patients. Dietary phosphate restriction is challenging due to " ... ...

Abstract	Current phosphate management strategies in end-stage renal disease (dietary phosphate restriction, dialysis, and phosphate binders) are inadequate to maintain target phosphate levels in most patients. Dietary phosphate restriction is challenging due to "hidden phosphates" in processed foods, and dialysis and phosphate binders are insufficient to match average dietary phosphate intake. As phosphate binders must be taken with each meal, patients need to ingest many, large pills several times a day, negatively impacting quality of life. Recent advances in our understanding of phosphate absorption pathways have led to the development of new nonbinder therapies that block phosphate absorption. This review describes the limitations of current phosphate management strategies and discusses new therapies in development that inhibit phosphate absorption pathways. These new therapies present an opportunity to rethink phosphate management, potentially by prescribing phosphate absorption inhibitors as a primary therapy and adding phosphate binders if needed.
MeSH term(s)	Humans ; Renal Dialysis ; Phosphorus ; Quality of Life ; Kidney Failure, Chronic/therapy ; Kidney Failure, Chronic/metabolism ; Phosphates/metabolism ; Hyperphosphatemia/drug therapy ; Hyperphosphatemia/etiology
Chemical Substances	Phosphorus (27YLU75U4W) ; Phosphates
Language	English
Publishing date	2022-05-18
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1080003-7
ISSN	1532-8503 ; 1051-2276
ISSN (online)	1532-8503
ISSN	1051-2276
DOI	10.1053/j.jrn.2022.04.006
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Article: Medical Costs in Patients with Hyperkalemia on Long-Term Sodium Zirconium Cyclosilicate Therapy: The RECOGNIZE II Study.

Agiro, Abiy / Dwyer, Jamie P / Oluwatosin, Yemisi / Desai, Pooja

ClinicoEconomics and outcomes research : CEOR

2023 Volume 15, Page(s) 691–702

Abstract: Purpose: Hyperkalemia, defined as abnormally high serum potassium levels of ≥5.1 mmol/L, is associated with increased medical costs. This real-world study evaluated the impact of long-term sodium zirconium cyclosilicate (SZC) therapy on medical costs in ...

Abstract	Purpose: Hyperkalemia, defined as abnormally high serum potassium levels of ≥5.1 mmol/L, is associated with increased medical costs. This real-world study evaluated the impact of long-term sodium zirconium cyclosilicate (SZC) therapy on medical costs in patients with hyperkalemia. Patients and methods: This retrospective, comparative study used claims data from IQVIA PharMetrics Results: Each cohort included 661 matched patients. Mean per-patient hyperkalemia-related medical costs were reduced by 49.5% ($3728.47) for the SZC versus non-SZC cohort ($3798.04 vs $7526.51; Conclusion: This study demonstrated that long-term (>3 months) outpatient treatment with SZC was associated with medical cost savings compared with no SZC therapy.
Language	English
Publishing date	2023-09-21
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2520698-9
ISSN	1178-6981
ISSN	1178-6981
DOI	10.2147/CEOR.S420217
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Article ; Online: Short-term costs in patients with chronic kidney disease treated with dapagliflozin: a retrospective cohort study.

Dwyer, Jamie P / Agiro, Abiy / Desai, Pooja / Cremisi, Henry

Expert review of pharmacoeconomics & outcomes research

2023 Volume 23, Issue 9, Page(s) 1057–1066

Abstract: Objectives: This real-world study evaluated the impact of dapagliflozin on short-term medical costs in patients with stage 3 chronic kidney disease (CKD).: Methods: This retrospective, observational cohort study used medical and pharmacy claims data ... ...

Abstract	Objectives: This real-world study evaluated the impact of dapagliflozin on short-term medical costs in patients with stage 3 chronic kidney disease (CKD). Methods: This retrospective, observational cohort study used medical and pharmacy claims data from IQVIA PharMetrics Plus. Patients aged ≥18 years with a filled dapagliflozin prescription after stage 3 CKD diagnosis between September 2020 and December 2021 were 1:1 propensity score matched with patients with stage 3 CKD who did not receive dapagliflozin. The primary endpoint was cardiorenal medical costs to payers over 6 months; all-cause medical and pharmacy costs were also analyzed. Within the overall population, there was a new-user subgroup of patients with no sodium-glucose co-transporter-2 use during baseline. Results: The new-user subgroup included 503 matched patients per cohort. Mean per-patient cardiorenal medical costs were reduced by 49.0% in the dapagliflozin versus non-dapagliflozin cohort ($3172.15 vs $6219.50; Conclusion: This study showed dapagliflozin was associated with reduced cardiorenal medical costs over 6 months compared with no dapagliflozin treatment in patients with stage 3 CKD, demonstrating real-world medical cost savings.
MeSH term(s)	Humans ; Adolescent ; Adult ; Retrospective Studies ; Costs and Cost Analysis ; Renal Insufficiency, Chronic/complications ; Cohort Studies ; Health Care Costs ; Benzhydryl Compounds ; Glucosides
Chemical Substances	dapagliflozin (1ULL0QJ8UC) ; Benzhydryl Compounds ; Glucosides
Language	English
Publishing date	2023-08-04
Publishing country	England
Document type	Observational Study ; Journal Article
ZDB-ID	2208481-2
ISSN	1744-8379 ; 1473-7167
ISSN (online)	1744-8379
ISSN	1473-7167
DOI	10.1080/14737167.2023.2237679
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Zs.A 6194: Show issues

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Article ; Online: Impact of Sodium Zirconium Cyclosilicate Plus Renin-Angiotensin-Aldosterone System Inhibitor Therapy on Short-Term Medical Costs in Hyperkalemia: OPTIMIZE II Real-World Study.

Dwyer, Jamie P / Agiro, Abiy / Desai, Pooja / Oluwatosin, Yemisi

Advances in therapy

2023 Volume 40, Issue 11, Page(s) 4777–4791

Abstract: Introduction: Patients receiving cardiorenal-protective renin-angiotensin-aldosterone system inhibitors (RAASis) are at increased risk of developing hyperkalemia, which is associated with increased medical costs. The aim of this study was to evaluate ... ...

Abstract	Introduction: Patients receiving cardiorenal-protective renin-angiotensin-aldosterone system inhibitors (RAASis) are at increased risk of developing hyperkalemia, which is associated with increased medical costs. The aim of this study was to evaluate the impact of adding sodium zirconium cyclosilicate (SZC) therapy on 3-month medical costs in patients who experienced hyperkalemia while receiving RAASi therapy. Methods: The retrospective OPTIMIZE II study used medical and pharmacy claims data from IQVIA PharMetrics Results: In the Continue RAASi + SZC (n = 467) versus Discontinue RAASi + no SZC (n = 467) cohort, there were significant reductions in mean per-patient hyperkalemia-related medical costs (reduction of $2216.07; p = 0.01) and all-cause medical costs (reduction of $6102.43; p < 0.001); mean hyperkalemia-related inpatient medical costs and all-cause inpatient and emergency department medical costs were significantly reduced. The reduction in all-cause medical cost in the Continue RAASi + SZC cohort offset an increase in the mean per-patient all-cause pharmacy cost (increase of $3117.71; p < 0.001). Conclusion: RAASi therapy has well-established cardiorenal benefits. In OPTIMIZE II, management of RAASi-induced hyperkalemia with SZC was associated with lower hyperkalemia-related and all-cause medical costs than RAASi discontinuation without SZC, demonstrating medical cost savings with maintaining RAASi therapy with SZC.
MeSH term(s)	Humans ; Hyperkalemia/drug therapy ; Hyperkalemia/chemically induced ; Renin-Angiotensin System ; Potassium/adverse effects ; Angiotensin-Converting Enzyme Inhibitors/adverse effects ; Aldosterone/adverse effects ; Retrospective Studies ; Antihypertensive Agents/adverse effects
Chemical Substances	sodium zirconium cyclosilicate (D652ZWF066) ; Potassium (RWP5GA015D) ; Angiotensin-Converting Enzyme Inhibitors ; Aldosterone (4964P6T9RB) ; Antihypertensive Agents
Language	English
Publishing date	2023-08-22
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	632651-1
ISSN	1865-8652 ; 0741-238X
ISSN (online)	1865-8652
ISSN	0741-238X
DOI	10.1007/s12325-023-02631-w
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Zs.A 2101: Show issues

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Article ; Online: We Give Too Much Intravenous Iron.

Dwyer, Jamie P

Seminars in dialysis

2016 Volume 29, Issue 4, Page(s) 309–311

Abstract: Dialysis patients have absolute and functional iron deficiencies. Traditionally, oral iron preparations have been insufficient to maintain iron stores to support erythropoiesis, especially in the setting of the ubiquitous use of erythropoiesis- ... ...

Abstract	Dialysis patients have absolute and functional iron deficiencies. Traditionally, oral iron preparations have been insufficient to maintain iron stores to support erythropoiesis, especially in the setting of the ubiquitous use of erythropoiesis-stimulating agents. This has led to the widespread adoption of intravenous iron protocols designed to maintain iron stores at levels that are much higher than for patients not on dialysis. These protocols are often developed by dialysis providers and may be largely independent of the treating nephrologist. Concerns about multiple risks associated with the use of intravenous iron persist. Despite this, mean ferritin levels in the United States have risen, partly due to more intravenous iron use and partly due to reduced erythropoiesis-stimulating agent use. Questions about the relationship of intravenous iron to infection, cardiac, and hepatobiliary risks remain. The failure of oral iron preparations to maintain iron stores continues to prompt the use of intravenous iron. Recently, studies with oral ferric citrate as a phosphate binder have shown improved iron stores and maintenance of hemoglobin, and studies with soluble ferric pyrophosphate added to dialysate have shown both maintenance of iron stores and hemoglobin. With new iron options that affect iron stores in dialysis patients, the use of intravenous iron and its potential risks may wane.
Language	English
Publishing date	2016-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	1028193-9
ISSN	1525-139X ; 0894-0959
ISSN (online)	1525-139X
ISSN	0894-0959
DOI	10.1111/sdi.12509
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Zs.A 2879: Show issues

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Article ; Online: Assessment of Blood Pressure: Techniques and Implications From Clinical Trials.

Waguespack, Dia R / Dwyer, Jamie P

Advances in chronic kidney disease

2019 Volume 26, Issue 2, Page(s) 87–91

Abstract: Hypertension is a global health problem and without adequate diagnosis and treatment is a risk factor for morbidity and mortality. Proper assessment of blood pressure is key to diagnosis and management of hypertension. Different methods of measurement ... ...

Abstract	Hypertension is a global health problem and without adequate diagnosis and treatment is a risk factor for morbidity and mortality. Proper assessment of blood pressure is key to diagnosis and management of hypertension. Different methods of measurement are available for use and varying techniques are applied to patient care. Understanding the proper methods of blood pressure measurement both in and out of the physician's office is crucial for providing appropriate care to an individual patient. In addition, understanding the techniques used in research, on which current guidelines are based, is critical for proper application to daily practice. In this article, we review the types of blood pressure measurement techniques, discuss the benefits and limitations to each, explore future technological advances in measurement devices, and provide insight into research techniques, which ultimately guide our practice.
MeSH term(s)	Automation ; Blood Pressure Determination/methods ; Blood Pressure Monitoring, Ambulatory/methods ; Blood Pressure Monitors ; Humans ; Hypertension/diagnosis ; Hypertension/therapy ; Sphygmomanometers
Language	English
Publishing date	2019-04-26
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ISSN	1548-5609 ; 1548-5595
ISSN (online)	1548-5609
ISSN	1548-5595
DOI	10.1053/j.ackd.2019.02.002
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Zs.A 4627: Show issues

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Article ; Online: Hyperkalemia Recurrence Following Medical Nutrition Therapy in Patients with Stage 3-4 Chronic Kidney Disease: The REVOLUTIONIZE I Real-World Study.

Rowan, Christopher G / Agiro, Abiy / Chan, K Arnold / Colman, Ellen / White, Katie / Desai, Pooja / Dwyer, Jamie P

Advances in therapy

2024

Abstract: Introduction: The REVOLUTIONIZE I study aimed to characterize the relationships between medical nutrition therapy (MNT) and hyperkalemia recurrence in patients with stage 3-4 chronic kidney disease (CKD) and hyperkalemia who received MNT in real-world ... ...

Abstract	Introduction: The REVOLUTIONIZE I study aimed to characterize the relationships between medical nutrition therapy (MNT) and hyperkalemia recurrence in patients with stage 3-4 chronic kidney disease (CKD) and hyperkalemia who received MNT in real-world clinical practice. Methods: This observational cohort study used de-identified electronic health record data from patients aged ≥ 18 years with stage 3-4 CKD who received MNT between January 2019 and October 2022 and had hyperkalemia (serum potassium > 5.0 mmol/L) within 30 days before MNT. Patients were followed for 6 months or until the first censoring event (death, prescription of outpatient potassium binder, or study end). The primary outcome was the percentage of patients with ≥ 1 hyperkalemia recurrence during follow-up. Secondary outcomes included the number of hyperkalemia recurrences per patient, time to each recurrence, and hyperkalemia-related healthcare resource utilization. Exploratory outcomes included all-cause healthcare resource utilization and mortality. Results: The final cohort comprised 2048 patients; 1503 (73.4%) patients remained uncensored after 6 months. During the 6-month follow-up period, 56.0% of patients had ≥ 1 hyperkalemia recurrence and 37.4% had ≥ 1 recurrence within the first month. Patients with ≥ 1 hyperkalemia recurrence during follow-up had a mean ± standard deviation (SD) of 2.6 ± 2.2 recurrences. The mean ± SD time to first hyperkalemia recurrence was 45 ± 46 days; the time between recurrences decreased with subsequent episodes. Hyperkalemia-related hospitalizations and emergency department visits were recorded for 13.7% and 1.5% of patients, respectively. Sensitivity analyses showed that results were consistent across patient subgroups, including those with comorbid heart failure and patients receiving renin-angiotensin-aldosterone system inhibitor therapy at baseline. Conclusion: Most patients with stage 3-4 CKD had hyperkalemia recurrence, and MNT alone was inadequate to prevent recurrence. These patients may require additional long-term treatment, such as novel potassium binders, to maintain normokalemia and prevent hyperkalemia recurrence following MNT. Infographic available for this article. INFOGRAPHIC.
Language	English
Publishing date	2024-04-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	632651-1
ISSN	1865-8652 ; 0741-238X
ISSN (online)	1865-8652
ISSN	0741-238X
DOI	10.1007/s12325-024-02835-8
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Article ; Online: Ecological performance standards for regenerative urban design

Benyus, Janine / Dwyer, Jamie / El Sayed, Sara / Hayes, Samantha / Baumeister, Dayna / Penick, Clint A.

Sustain Sci. 2022 Nov., v. 17, no. 6 p.2631-2641

2022

Abstract: Ecosystem services encompass the tangible human benefits that ecosystems provide. Past efforts to maintain ecosystem services have focused on conserving and rehabilitating natural ecosystems, but there is growing consensus that the built environment must ...

Abstract	Ecosystem services encompass the tangible human benefits that ecosystems provide. Past efforts to maintain ecosystem services have focused on conserving and rehabilitating natural ecosystems, but there is growing consensus that the built environment must contribute these services as well. The field of regenerative design seeks to create infrastructure that contributes to and enhances local ecosystems, but a key challenge has been the development of baseline standards that reflect ecosystem health as opposed to business-as-usual design. To address this challenge, we draw on work by Biomimicry 3.8 and project partners to outline a framework for ecological performance standards (EPS) that can be applied to regenerative projects. While current sustainability frameworks quantify negative impacts of proposed designs and seek to reduce those impacts, EPS specifies positive-impact performance standards based on local ecosystems. The EPS process involves four steps: (1) identifying a local reference ecosystem, (2) quantifying ecosystem services at the reference ecosystem to develop EPS metrics, (3) designing to meet or exceed EPS metrics at the building site, and (4) implementing and assessing the proposed design. We outline these steps in detail and provide three case studies that highlight implementation successes and challenges at the city, development, and building scale.
Keywords	biomimetics ; ecosystems ; environmental health ; humans ; infrastructure
Language	English
Dates of publication	2022-11
Size	p. 2631-2641.
Publishing place	Springer Japan
Document type	Article ; Online
ZDB-ID	2260333-5
ISSN	1862-4057 ; 1862-4065
ISSN (online)	1862-4057
ISSN	1862-4065
DOI	10.1007/s11625-022-01180-5
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: COVID-19 and the Inpatient Dialysis Unit: Managing Resources during Contingency Planning Pre-Crisis.

Burgner, Anna / Ikizler, T Alp / Dwyer, Jamie P

Clinical journal of the American Society of Nephrology : CJASN

2020 Volume 15, Issue 5, Page(s) 720–722

MeSH term(s)	Betacoronavirus ; COVID-19 ; Coronavirus Infections/prevention & control ; Coronavirus Infections/transmission ; Health Planning ; Humans ; Inpatients ; Medical Staff ; Pandemics/prevention & control ; Pneumonia, Viral/prevention & control ; Pneumonia, Viral/transmission ; Renal Dialysis/methods ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-04-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2226665-3
ISSN	1555-905X ; 1555-9041
ISSN (online)	1555-905X
ISSN	1555-9041
DOI	10.2215/CJN.03750320
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Zs.A 6584: Show issues

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Article ; Online: Decentralized research technology use in multicenter clinical research studies based at U.S. academic research centers.

Cummins, Mollie R / Burr, Jeri / Young, Lisa / Yeatts, Sharon D / Ecklund, Dixie J / Bunnell, Brian E / Dwyer, Jamie P / VanBuren, John M

Journal of clinical and translational science

2023 Volume 7, Issue 1, Page(s) e250

Abstract: Introduction: During the COVID-19 pandemic, research organizations accelerated adoption of technologies that enable remote participation. Now, there's a pressing need to evaluate current decentralization practices and develop appropriate research, ... ...

Abstract	Introduction: During the COVID-19 pandemic, research organizations accelerated adoption of technologies that enable remote participation. Now, there's a pressing need to evaluate current decentralization practices and develop appropriate research, education, and operations infrastructure. The purpose of this study was to examine current adoption of decentralization technologies in a sample of clinical research studies conducted by academic research organizations (AROs). Methods: The setting was three data coordinating centers in the U.S. These centers initiated coordination of 44 clinical research studies during or after 2020, with national recruitment and enrollment, and entailing coordination between one and one hundred sites. We determined the decentralization technologies used in these studies. Results: We obtained data for 44/44 (100%) trials coordinated by the three centers. Three technologies have been adopted across nearly all studies (98-100%): eIRB, eSource, and Clinical Trial Management Systems. Commonly used technologies included e-Signature (32/44, 73%), Online Payments Portals (26/44, 59%), ePROs (23/44, 53%), Interactive Response Technology (22/44, 50%), Telemedicine (19/44, 43%), and eConsent (18/44, 41%). Wearables (7/44,16%) and Online Recruitment Portals (5/44,11%) were less common. Rarely utilized technologies included Direct-to-Patient Portals (1/44, 2%) and Home Health Nurse Portals (1/44, 2%). Conclusions: All studies incorporated some type of decentralization technology, with more extensive adoption than found in previous research. However, adoption may be strongly influenced by institution-specific IT and informatics infrastructure and support. There are inherent needs, responsibilities, and challenges when incorporating decentralization technology into a research study, and AROs must ensure that infrastructure and informatics staff are adequate.
Language	English
Publishing date	2023-11-08
Publishing country	England
Document type	Journal Article
ISSN	2059-8661
ISSN (online)	2059-8661
DOI	10.1017/cts.2023.678
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