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  1. Article ; Online: Sex, Gender, and Cardiovascular Disease in Chronic Kidney Disease.

    Yi, Tae Won / Levin, Adeera

    Seminars in nephrology

    2022  Volume 42, Issue 2, Page(s) 197–207

    Abstract: This review on sex, gender, and cardiovascular diseases in chronic kidney disease attempts to summarize what we know and what we do not know about the effects of sex and gender on cardiovascular disease in chronic kidney disease. We discuss and define ... ...

    Abstract This review on sex, gender, and cardiovascular diseases in chronic kidney disease attempts to summarize what we know and what we do not know about the effects of sex and gender on cardiovascular disease in chronic kidney disease. We discuss and define the terminology of sex and gender, and the underlying physiology for differences observed. We explore how sex and gender affect specific cardiovascular diseases such as coronary artery disease, congestive heart failure, arrhythmias, cardiovascular mortality, and pre-eclampsia. We conclude with a review of recent randomized controlled trials and highlight the pharmacokinetic and pharmacodynamic differences in both sexes.
    MeSH term(s) Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/etiology ; Coronary Artery Disease ; Female ; Humans ; Male ; Pre-Eclampsia ; Pregnancy ; Renal Insufficiency, Chronic/complications
    Language English
    Publishing date 2022-06-16
    Publishing country United States
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 604652-6
    ISSN 1558-4488 ; 0270-9295
    ISSN (online) 1558-4488
    ISSN 0270-9295
    DOI 10.1016/j.semnephrol.2022.04.009
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  2. Article ; Online: Evidence-Based Decision Making 4: Clinical Practice Guidelines.

    Yi, Tae Won / Donnellan, Sine / Levin, Adeera

    Methods in molecular biology (Clifton, N.J.)

    2021  Volume 2249, Page(s) 455–466

    Abstract: Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioners and patient to reach appropriate health-care decisions. The synthesis and translation of a large amount of evidence into practice recommendations should ... ...

    Abstract Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioners and patient to reach appropriate health-care decisions. The synthesis and translation of a large amount of evidence into practice recommendations should ultimately reduce the use of unnecessary or harmful interventions, help patients to achieve maximum benefit, and minimize risk, all at an acceptable cost.In the past, CPGs were developed based on expert opinion, and using consensus methodology either formally or informally. Over the last 30 years, the evolution of increasingly transparent and robust methodology has led to more "evidence-based" recommendations. Clinical practice guidelines should be developed within the principles of bias minimization, systematic evidence retrieval and review, and a focus on patient relevant outcomes. Multiple nationally based and international groups now have published specific guidance for the development, dissemination, and evaluation of CPG.This chapter describes the key principles of CPG development, including the importance of updating, disseminating, and evaluating the impact of CPG , and attempts to differentiate CPG intended for populations of patients from "evidence-based decision making" for individual patients, recognizing that the fundamental principles are the same.
    MeSH term(s) Bias ; Clinical Decision-Making/methods ; Evidence-Based Medicine/methods ; Humans ; Patient Outcome Assessment ; Practice Guidelines as Topic ; Systematic Reviews as Topic ; Treatment Outcome
    Language English
    Publishing date 2021-04-19
    Publishing country United States
    Document type Journal Article
    ISSN 1940-6029
    ISSN (online) 1940-6029
    DOI 10.1007/978-1-0716-1138-8_24
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  3. Article ; Online: Digital health technologies to support medication adherence in chronic kidney disease.

    O'Hara, Daniel V / Yi, Tae Won / Lee, Vincent W / Jardine, Meg / Dawson, Jessica

    Nephrology (Carlton, Vic.)

    2022  Volume 27, Issue 12, Page(s) 917–924

    Abstract: Non-adherence to medications is a critical challenge in the management of people with chronic kidney disease (CKD). This review explores the complexities of adherence in this population, the unique barriers and enablers of good adherence behaviours, and ... ...

    Abstract Non-adherence to medications is a critical challenge in the management of people with chronic kidney disease (CKD). This review explores the complexities of adherence in this population, the unique barriers and enablers of good adherence behaviours, and the role of emerging digital health technologies in bridging the gap between evidence-based treatment plans and the real-world standard of care. We present the current evidence supporting the use of digital health interventions among CKD populations, identifying the key research questions that remain unanswered, and providing practical strategies for clinicians to support medication adherence in a digital age.
    MeSH term(s) Humans ; Medication Adherence ; Renal Insufficiency, Chronic/diagnosis ; Renal Insufficiency, Chronic/drug therapy
    Language English
    Publishing date 2022-10-06
    Publishing country Australia
    Document type Journal Article ; Review
    ZDB-ID 1303661-0
    ISSN 1440-1797 ; 1320-5358
    ISSN (online) 1440-1797
    ISSN 1320-5358
    DOI 10.1111/nep.14113
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  4. Article: Identifying Barriers and Facilitators for Increasing Uptake of Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors in British Columbia, Canada, using the Consolidated Framework for Implementation Research.

    Yi, Tae Won / O'Hara, Daniel V / Smyth, Brendan / Jardine, Meg J / Levin, Adeera / Morton, Rachael L

    Canadian journal of kidney health and disease

    2023  Volume 11, Page(s) 20543581231217857

    Abstract: Background: Care gaps remain in modern health care despite the availability of robust, evidence-based medications. Although sodium-glucose cotransporter-2 (SGLT2) inhibitors have demonstrated profound benefits in improving both cardiovascular and kidney ...

    Abstract Background: Care gaps remain in modern health care despite the availability of robust, evidence-based medications. Although sodium-glucose cotransporter-2 (SGLT2) inhibitors have demonstrated profound benefits in improving both cardiovascular and kidney outcomes in patients, the uptake of these medications remain suboptimal, and the causes have not been systematically explored.
    Objective: The purpose of this study was to use the Consolidated Framework for Implementation Research (CFIR) to describe the barriers and facilitators faced by clinicians in British Columbia, Canada, when prescribing an SGLT2 inhibitor. To achieve this, we conducted semistructured interviews using the CFIR with practicing family physicians, nephrologists, endocrinologists, and cardiologists in British Columbia.
    Design: Semistructured interviews.
    Setting: British Columbia, Canada.
    Participants: Actively practicing family physicians, nephrologists, endocrinologists, and cardiologists in British Columbia.
    Methods: Twenty-one clinicians were interviewed using questions derived from the CFIR. The audio recordings were transcribed verbatim, and each transcription was individually analyzed in duplicate using thematic analysis. The analysis focused on identifying barriers and facilitators to using SGLT2 inhibitors in clinical practice and coded using the CFIR constructs. Once the transcriptions were coded, overarching themes were created.
    Results: Five overarching themes were identified to the barriers and facilitators to using SGLT2 inhibitors: current perceptions and beliefs, clinician factors, patient factors, medication factors, and health care system factors. The current perceptions and beliefs were that SGLT2 inhibitors are efficacious and have distinct advantages over other agents but are underutilized in British Columbia. Clinician factors included varying levels of knowledge of and comfort in prescribing SGLT2 inhibitors, and patient factors included intolerable adverse events and additional pill burden, but many were enthusiastic about potential benefits. Multiple SGLT2 inhibitor related adverse events like mycotic infections and euglycemic diabetic ketoacidosis and the difficulty in obtaining reimbursement for these medications were also identified as a barrier to prescribing these medications. Facilitators for the use of SGLT2 inhibitors included consensus among colleagues, influential leaders, and peers in support of their use, and endorsement by national guidelines.
    Limitations: The experience from the clinicians regarding costs and the reimbursement process is limited to British Columbia as each province has its own procedures. There may be responder bias as clinicians were approached through purposive sampling.
    Conclusion: This study highlights different themes to the barriers and facilitators of using SGLT2 inhibitors in British Columbia. The identification of these barriers provides a specific target for improvement, and the facilitators can be leveraged for the increased use of SGLT2 inhibitors. Efforts to address and optimize these barriers and facilitators in a systematic approach may lead to an increase in the use of these efficacious medications.
    Language English
    Publishing date 2023-12-29
    Publishing country England
    Document type Journal Article
    ZDB-ID 2765462-X
    ISSN 2054-3581
    ISSN 2054-3581
    DOI 10.1177/20543581231217857
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  5. Article: Kidney Failure Risk Equation in vascular access planning: a population-based study supporting value in decision making.

    Atiquzzaman, Mohammad / Zhu, Bingyue / Romann, Alexandra / Er, Lee / Djurdjev, Ognjenka / Bevilacqua, Micheli / Wong, Michelle M Y / Birks, Peter / Yi, Tae Won / Singh, Anurag / Tangri, Navdeep / Levin, Adeera

    Clinical kidney journal

    2024  Volume 17, Issue 2, Page(s) sfae008

    Abstract: Background: The Kidney Failure Risk Equation (KFRE) can play a better role in vascular access (VA) planning in patients with chronic kidney disease (CKD) requiring hemodialysis (HD). We described the VA creation and utilization pattern under existing ... ...

    Abstract Background: The Kidney Failure Risk Equation (KFRE) can play a better role in vascular access (VA) planning in patients with chronic kidney disease (CKD) requiring hemodialysis (HD). We described the VA creation and utilization pattern under existing estimated glomerular filtration rate (eGFR)-based referral, and investigated the utility of KFRE score as an adjunct variable in VA planning.
    Methods: Patients with CKD aged ≥18 years with eGFR <20 mL/min/1.73 m
    Results: Study included 2581 patients, median age 71 years, 60% male. Overall, 1562(61%) started HD and 276 (11%) experienced death before HD initiation within 2 years. Compared with current referral, the proportion of patients who started HD on AVF/G was significantly higher when KFRE-2 was considered in addition to current referral (49% vs 58%,
    Conclusions: KFRE in addition to existing eGFR-based referral for VA creation has the potential to improve VA resource utilization by ensuring more patients start HD on AVF/G and may minimize too-early/unnecessary creation. Prospective research is necessary to validate these findings.
    Language English
    Publishing date 2024-01-11
    Publishing country England
    Document type Journal Article
    ZDB-ID 2655800-2
    ISSN 2048-8513 ; 2048-8505
    ISSN (online) 2048-8513
    ISSN 2048-8505
    DOI 10.1093/ckj/sfae008
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  6. Article ; Online: Applications of SGLT2 inhibitors beyond glycaemic control.

    O'Hara, Daniel V / Lam, Carolyn S P / McMurray, John J V / Yi, Tae Won / Hocking, Samantha / Dawson, Jessica / Raichand, Smriti / Januszewski, Andrzej S / Jardine, Meg J

    Nature reviews. Nephrology

    2024  

    Abstract: Sodium-glucose cotransporter 2 (SGLT2) inhibitors were initially developed for their glucose-lowering effects and have shown a modest glycaemic benefit in people with type 2 diabetes mellitus (T2DM). In the past decade, a series of large, robust clinical ...

    Abstract Sodium-glucose cotransporter 2 (SGLT2) inhibitors were initially developed for their glucose-lowering effects and have shown a modest glycaemic benefit in people with type 2 diabetes mellitus (T2DM). In the past decade, a series of large, robust clinical trials of these therapies have demonstrated striking beneficial effects for various care goals, transforming the chronic disease therapeutic landscape. Cardiovascular safety studies in people with T2DM demonstrated that SGLT2 inhibitors reduce cardiovascular death and hospitalization for heart failure. Subsequent trials in participants with heart failure with reduced or preserved left ventricular ejection fraction demonstrated that SGLT2 inhibitors have beneficial effects on heart failure outcomes. In dedicated kidney outcome studies, SGLT2 inhibitors reduced the incidence of kidney failure among participants with or without diabetes. Post hoc analyses have suggested a range of other benefits of these drugs in conditions as diverse as metabolic dysfunction-associated steatotic liver disease, kidney stone prevention and anaemia. SGLT2 inhibitors have a generally favourable adverse effect profile, although patient selection and medication counselling remain important. Concerted efforts are needed to better integrate these agents into routine care and support long-term medication adherence to close the gap between clinical trial outcomes and those achieved in the real world.
    Language English
    Publishing date 2024-04-26
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2490366-8
    ISSN 1759-507X ; 1759-5061
    ISSN (online) 1759-507X
    ISSN 1759-5061
    DOI 10.1038/s41581-024-00836-y
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  7. Article: A Provincial Survey of the Contemporary Management of Autosomal Dominant Polycystic Kidney Disease.

    Yi, Tae Won / Levin, Adeera / Bevilacqua, Micheli / Canney, Mark

    Canadian journal of kidney health and disease

    2020  Volume 7, Page(s) 2054358120948294

    Abstract: Background: Recent years have witnessed an encouraging expansion of knowledge and management tools in the care of patients with autosomal dominant polycystic kidney disease (ADPKD), including measurement of total kidney volume as a biomarker of disease ... ...

    Abstract Background: Recent years have witnessed an encouraging expansion of knowledge and management tools in the care of patients with autosomal dominant polycystic kidney disease (ADPKD), including measurement of total kidney volume as a biomarker of disease progression, stringent blood pressure targets to slow cyst growth, and targeted treatments such as tolvaptan.
    Objectives: We sought to evaluate clinicians' familiarity with, and usage of, novel evidence-based management tools for ADPKD.
    Design: On-line survey.
    Setting: British Columbia, Canada.
    Participants: Nephrologists in academic and community practice (excluding clinicians who practice exclusively in transplantation).
    Measurements: Participants answered multiple-choice questions in 6 domains: sources of information, self-identified needs for optimal care delivery, prognostication, imaging tests, blood pressure targets, and use of tolvaptan.
    Methods: An online survey was developed and disseminated via email to 65 nephrologists engaged in current clinical practice in British Columbia.
    Results: A total of 29 nephrologists (45%) completed the questionnaire. The most popular source of information was the primary literature (83% of respondents). While 86% of respondents reported assessing the risk of disease progression before the onset of kidney function decline, most were using traditional metrics such as blood pressure and proteinuria rather than validated prediction tools such as the Mayo Classification. Although 90% of respondents obtained additional imaging after diagnosis in some or all of their ADPKD patients, only 1 in 5 reported being confident in their ability to interpret kidney size. The recommended blood pressure (BP) target of <110/75 mmHg was sought by 17% of respondents. All respondents reported being familiar with the literature regarding tolvaptan; however, only half were confident in their ability to identify suitable patients for treatment. The top 3 needs identified by clinicians were better access to medications (69%), clear management protocols (66%), and easier access to imaging tests (59%).
    Limitations: Funding mechanisms for tolvaptan can vary; therefore, clinicians' experience with the drug may not be generalizable. Although the response rate was acceptable, the survey is nonetheless subject to responder bias.
    Conclusion: This survey indicates that there is substantial variability in the usage of, and familiarity with, evidence-based ADPKD management tools among contemporary nephrologists, contributing to incomplete translation of evidence into clinical practice. Providing greater access to tolvaptan or imaging tests is unlikely to improve patient care without enhancing knowledge translation and education.
    Trial registration: Not applicable as this was a survey.
    Language English
    Publishing date 2020-09-03
    Publishing country England
    Document type Journal Article
    ZDB-ID 2765462-X
    ISSN 2054-3581
    ISSN 2054-3581
    DOI 10.1177/2054358120948294
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  8. Article ; Online: Effects of canagliflozin on cardiovascular and kidney events in patients with chronic kidney disease with and without peripheral arterial disease: Integrated analysis from the CANVAS Program and CREDENCE trial.

    Yi, Tae Won / Wong, Michelle M Y / Neuen, Brendon L / Arnott, Clare / Poirier, Paul / Seufert, Jochen / Slee, April / Rapattoni, Wally / Ang, Fernando G / Wheeler, David C / Mahaffey, Kenneth W / Perkovic, Vlado / Levin, Adeera

    Diabetes, obesity & metabolism

    2023  Volume 25, Issue 7, Page(s) 2043–2047

    MeSH term(s) Humans ; Canagliflozin/therapeutic use ; Kidney ; Cardiovascular System ; Renal Insufficiency, Chronic/complications ; Renal Insufficiency, Chronic/drug therapy ; Renal Insufficiency, Chronic/chemically induced ; Peripheral Arterial Disease/complications ; Peripheral Arterial Disease/drug therapy ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/drug therapy ; Diabetes Mellitus, Type 2/chemically induced ; Cardiovascular Diseases/complications ; Cardiovascular Diseases/drug therapy ; Cardiovascular Diseases/prevention & control
    Chemical Substances Canagliflozin (0SAC974Z85)
    Language English
    Publishing date 2023-04-24
    Publishing country England
    Document type Letter ; Research Support, Non-U.S. Gov't
    ZDB-ID 1454944-x
    ISSN 1463-1326 ; 1462-8902
    ISSN (online) 1463-1326
    ISSN 1462-8902
    DOI 10.1111/dom.15065
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  9. Article ; Online: Digital health and artificial intelligence in kidney research: a report from the 2020 Kidney Disease Clinical Trialists (KDCT) meeting.

    Yi, Tae Won / Laing, Chris / Kretzler, Matthias / Nkulikiyinka, Richard / Legrand, Matthieu / Jardine, Meg / Rossignol, Patrick / Smyth, Brendan

    Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

    2021  Volume 37, Issue 4, Page(s) 620–627

    Abstract: The exponential growth in digital technology coupled with the global coronavirus disease 2019 pandemic is driving a profound change in the delivery of medical care and research conduct. The growing availability of electronic monitoring, electronic health ...

    Abstract The exponential growth in digital technology coupled with the global coronavirus disease 2019 pandemic is driving a profound change in the delivery of medical care and research conduct. The growing availability of electronic monitoring, electronic health records, smartphones and other devices and access to ever greater computational power provides not only new opportunities, but also new challenges. Artificial intelligence (AI) exemplifies the potential of this digital revolution, which also includes other tools such as mobile health (mHealth) services and wearables. Despite digital technology becoming commonplace, its use in medicine and medical research is still in its infancy, with many clinicians and researchers having limited experience with such tools in their usual practice. This article, derived from the 'Digital Health and Artificial Intelligence' session of the Kidney Disease Clinical Trialists virtual workshop held in September 2020, aims to illustrate the breadth of applications to which digital tools and AI can be applied in clinical medicine and research. It highlights several innovative projects incorporating digital technology that range from streamlining medical care of those with acute kidney injury to the use of AI to navigate the vast genomic and proteomic data gathered in kidney disease. Important considerations relating to any new digital health project are presented, with a view to encouraging the further evolution and refinement of these new tools in a manner that fosters collaboration and the generation of robust evidence.
    MeSH term(s) Artificial Intelligence ; COVID-19 ; Humans ; Kidney ; Kidney Diseases/therapy ; Proteomics
    Language English
    Publishing date 2021-11-09
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 90594-x
    ISSN 1460-2385 ; 0931-0509
    ISSN (online) 1460-2385
    ISSN 0931-0509
    DOI 10.1093/ndt/gfab320
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  10. Article ; Online: Kidney and Cardiovascular Effects of Canagliflozin According to Age and Sex: A Post Hoc Analysis of the CREDENCE Randomized Clinical Trial.

    Yi, Tae Won / Smyth, Brendan / Di Tanna, Gian Luca / Arnott, Clare / Cardoza, Kathryn / Kang, Amy / Pollock, Carol / Agarwal, Rajiv / Bakris, George / Charytan, David M / de Zeeuw, Dick / Heerspink, Hiddo J L / Neal, Bruce / Wheeler, David C / Cannon, Christopher P / Zhang, Hong / Zinman, Bernard / Perkovic, Vlado / Levin, Adeera /
    Mahaffey, Kenneth W / Jardine, Meg

    American journal of kidney diseases : the official journal of the National Kidney Foundation

    2023  Volume 82, Issue 1, Page(s) 84–96.e1

    Abstract: Rationale & objective: It is unclear whether the effect of canagliflozin on adverse kidney and cardiovascular events in those with diabetic kidney disease varies by age and sex. We assessed the effects of canagliflozin among age group categories and ... ...

    Abstract Rationale & objective: It is unclear whether the effect of canagliflozin on adverse kidney and cardiovascular events in those with diabetic kidney disease varies by age and sex. We assessed the effects of canagliflozin among age group categories and between sexes in the Canagliflozin and Renal Endpoints in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) study.
    Study design: Secondary analysis of a randomized controlled trial.
    Setting & participants: Participants in the CREDENCE trial.
    Intervention: Participants were randomly assigned to receive canagliflozin 100mg/d or placebo.
    Outcomes: Primary composite outcome of kidney failure, doubling of serum creatinine concentration, or death due to kidney or cardiovascular disease. Prespecified secondary and safety outcomes were also analyzed. Outcomes were evaluated by age at baseline (<60, 60-69, and≥70 years) and sex in the intention-to-treat population using Cox regression models.
    Results: The mean age of the cohort was 63.0±9.2 years, and 34% were female. Older age and female sex were independently associated with a lower risk of the composite of adverse kidney outcomes. There was no evidence that the effect of canagliflozin on the primary outcome (a composite of kidney failure, a doubling of serum creatinine concentration, or death from kidney or cardiovascular causes) differed between age groups (HRs, 0.67 [95% CI, 0.52-0.87], 0.63 [0.48-0.82], and 0.89 [0.61-1.29] for ages<60, 60-69, and≥70 years, respectively; P=0.3for interaction) or sexes (HRs, 0.71 [95% CI, 0.54-0.95] and 0.69 [0.56-0.84] in women and men, respectively; P=0.8for interaction). No differences in safety outcomes by age group or sex were observed.
    Limitations: This was a post hoc analysis with multiple comparisons.
    Conclusions: Canagliflozin consistently reduced the relative risk of kidney events in people with diabetic kidney disease in both sexes and across age subgroups. As a result of greater background risk, the absolute reduction in adverse kidney outcomes was greater in younger participants.
    Funding: This post hoc analysis of the CREDENCE trial was not funded. The CREDENCE study was sponsored by Janssen Research and Development and was conducted collaboratively by the sponsor, an academic-led steering committee, and an academic research organization, George Clinical.
    Trial registration: The original CREDENCE trial was registered at ClinicalTrials.gov with study number NCT02065791.
    MeSH term(s) Male ; Female ; Humans ; Middle Aged ; Aged ; Canagliflozin/therapeutic use ; Diabetic Nephropathies/drug therapy ; Diabetic Nephropathies/epidemiology ; Diabetic Nephropathies/complications ; Sodium-Glucose Transporter 2 Inhibitors/adverse effects ; Creatinine ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/drug therapy ; Diabetes Mellitus, Type 2/epidemiology ; Treatment Outcome ; Kidney ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/prevention & control ; Cardiovascular Diseases/drug therapy ; Renal Insufficiency
    Chemical Substances Canagliflozin (0SAC974Z85) ; Sodium-Glucose Transporter 2 Inhibitors ; Creatinine (AYI8EX34EU)
    Language English
    Publishing date 2023-03-07
    Publishing country United States
    Document type Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 604539-x
    ISSN 1523-6838 ; 0272-6386
    ISSN (online) 1523-6838
    ISSN 0272-6386
    DOI 10.1053/j.ajkd.2022.12.015
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