A5066861138- Dialysis and Renal Disease Management
- Central Venous Catheters and Hemodialysis
- Acute Ischemic Stroke Management
- Chronic Kidney Disease and Diabetes
- Blood Pressure and Hypertension Studies
- Vascular Procedures and Complications
- Renal and Vascular Pathologies
- Health Systems, Economic Evaluations, Quality of Life
- Acute Kidney Injury Research
- Potassium and Related Disorders
- Peripheral Artery Disease Management
- Muscle and Compartmental Disorders
- Hemodynamic Monitoring and Therapy
- demographic modeling and climate adaptation
- Cardiac, Anesthesia and Surgical Outcomes
- Healthcare Policy and Management
- Renal Diseases and Glomerulopathies
- Cardiovascular Health and Disease Prevention
- Venous Thromboembolism Diagnosis and Management
- Neurological Complications and Syndromes
- Parathyroid Disorders and Treatments
- Intracerebral and Subarachnoid Hemorrhage Research
- Neurological and metabolic disorders
- Atrial Fibrillation Management and Outcomes
- Healthcare cost, quality, practices
North Bristol NHS Trust
2015-2024
Southmead Hospital
2016-2024
Cardiff University
2024
The Royal Free Hospital
2024
Roland Hill (United Kingdom)
2024
University College London
2024
Government of the United Kingdom
2023
University of Otago
2020
Imperial College London
1989-2018
University of Bristol
2018
The growing burden of chronic kidney disease (CKD) places substantial financial pressures on patients, healthcare systems, and society. An understanding the costs attributed to CKD replacement therapy (KRT) is essential for evidence-based policy making.
Background and objectives: During the past decade, nephrogenic systemic fibrosis (NSF) has been reported in patients who have severe renal impairment exposed to a gadolinium (Gd)-based contrast agent during magnetic resonance imaging (MRI). As result of positive reporting bias, many suitable with chronic kidney disease (CKD) are being denied highly important form investigation that can be safely undertaken. We analyzed safety Gd-MRI CKD varying levels estimated GFR (eGFR). Design, setting,...
We evaluated the effect of hernias and their surgical or conservative management on peritoneal dialysis (PD) technique survival residual renal function.This 10-year single-center retrospective case-control study (January 2001 - January 2011) compared patient survival, PD function in patients with a history abdominal control cohort matched for age vintage.Of 73 identified 63 (mean age: 55 years; 63% men), umbilical were most frequent (40%), followed by inguinal (33%), incisional, epigastric...
Abstract Background More than a third of the 65,000 people living with kidney failure in UK attend dialysis unit 2–5 times week to have their blood cleaned for 3–5 h. In haemodialysis (HD), toxins are removed by diffusion, which can be enhanced using high-flux dialyser. This augmented convection, as occurs haemodiafiltration (HDF), and improved outcomes been reported who able achieve high volumes convection. study compares clinical- cost-effectiveness high-volume HDF compared HD treatment...
Treatment without catheter replacement (catheter salvage) has been described for bacteremia associated with tunneled venous catheters in hemodialysis patients, but few data are available on which to base an estimation of the likelihood treatment success.In a prospective cohort study, all cases catheter-associated that occurred large dialysis center were identified during 12-mo period. Catheter salvage was attempted according standard protocol favorable early response antibiotic therapy seen,...
Vascular access for haemodialysis is achieved by tunnelled central venous catheter (CVC) in at least 23% of prevalent patients the UK, Canada and USA. Use CVCs associated with an increased incidence stenosis that can progressively limit future vascular routes. Lack conventional routes mandates use alternative strategies such as translumbar approach.We retrospectively analysed our centre requiring inferior vena caval (TesioCath) period 1999-2008. Written electronic records capturing dialysis...
<b><i>Background:</i></b> Renal impairment is a potent risk factor for stroke, which remains leading cause of death and disability. Thrombolysis acute ischemic stroke has transformed patient outcomes, although the safety efficacy this approach remain poorly characterized in patients with renal dysfunction, who manifest higher bleeding due to uremia. We therefore examined impact on clinical outcomes thrombolysis within current 4.5-hour therapeutic window....
<b><i>Background:</i></b> Systematic collection and analysis of global hemodialysis patient data may help to improve outcomes. <b><i>Methods:</i></b> The MONitoring Dialysis Outcomes (MONDO) initiative comprises from eight dialysis providers worldwide. Data are combined into one repository. Extensive procedures employed merge across countries providers. <b><i>Results:</i></b> MONDO database longitudinal currently 128,000...
Abstract Background The aim was to carry out phase 4 international field-testing of the European Organisation for Research and Treatment Cancer (EORTC) breast reconstruction (BRECON) module. primary objective finalization its scale structure. Secondary objectives were evaluation reliability, validity, responsiveness, acceptability interpretability in patients with cancer undergoing mastectomy reconstruction. Methods EORTC module development guidelines followed. Patients recruited from 28...
The incidence of subdural haematoma (SDH) is high in haemodialysis (HD), with data suggesting an increasing over time. prognosis remains poor 40% mortality at 30 days. extent this problem non-US populations has not been described the literature.We conducted a retrospective, single-centre UK study non-traumatic SDH patients established on maintenance HD between 1 January 2002 and June 2009.The prevalence was 0.4% our centre overall annual 189 per 100 000 patients. associated increased patient...
Kidney transplant patients in our regional centre travel long distances to attend routine hospital follow-up appointments. Patients incur costs and productivity losses as well adverse environmental impacts. A significant proportion of these patients, who may not require physical examination, could potentially be managed through telephone consultations (tele-clinic). We adopted a Quality Improvement approach with iterative Plan–Do–Study–Act (PDSA) cycles test the introduction tele-clinic...
Urinary albumin-to-creatinine ratio (uACR) is an independent predictor of chronic kidney disease (CKD) progression. However there limited evidence on the burden CKD according to uACR categories at population level. This study estimates future clinical and financial using Inside microsimulation. The model individual patient level microsimulation that emulates national populations based demographic, epidemiological, economic data. analysis outcomes over time Kidney Disease: Improving Global...
<b><i>Background:</i></b> Commencing hemodialysis (HD) using a catheter is associated with higher risk of adverse outcomes, and early conversion from central-venous (CVC) to arteriovenous fistula/graft (non-CVC) improves outcomes. We investigated CVC prevalence conversion, their effects on outcomes during the first year HD in multinational cohort elderly patients. <b><i>Methods:</i></b> Patients ≥70 years MONDO Initiative who commenced between...
Dialysis providers frequently collect detailed longitudinal and standardized patient data, providing valuable registries of routine care. However, even large organizations are restricted to certain regions, limiting their ability separate effects local practice from the pathophysiology shared by most dialysis patients. To overcome this limitation, MONDO (MONitoring Outcomes) research consortium has created a platform for joint analysis data almost 200,000 patients worldwide.We examined...
<b><i>Background:</i></b> Low serum sodium (SNa) is associated with an increased mortality in chronic hemodialysis (HD) patients. Dialysis patients are thought to have individual pre-dialysis SNa set-point, yet there evidence for variability of patient. In this study, we explored the association several metrics all-cause a large patient population from international MONitoring Outcomes (MONDO) Initiative. <b><i>Methods:</i></b> All adult...
In February 1994, an outbreak of vancomycin-resistant Enterococcus faecium (VREM) occurred in the oncology unit a Dublin hospital. Between and July VREM was isolated from 18 patients, one staff member 14 environmental sites within unit. The isolates also had high-level aminoglycoside penicillin resistance. Three pulsed-field gel electrophoresis (PFGE) types were identified, two them multiple patients sites. Plasmid typing allowed subdivision PFGE types. A retrospective study enterococci...
Corticosteroid use after transplantation is associated with an increased incidence of cardiovascular events and death. Cerebrovascular disease a common cause morbidity mortality post-renal transplantation; however, dedicated analysis cerebrovascular in recipients steroid sparing protocol has not been reported. The aim this study was to examine the incidence, risk factors, outcomes CVA transplant receiving protocol. We retrospectively analyzed 1237 patients who received kidney alone or...
Hypotension commonly occurs during hemodialysis (HD). can result from an absolute reduction in plasma volume following excessive ultrafiltration or a vascular tone. We hypothesized that changes tone could occur dialysis. Aortic pulse wave velocity (aPWV) was measured 197 HD patients, mean age 63.3 ± 16.6 years, 62% male, 49% diabetic, single session. aPWV did not change (9.6 2.2 vs. 9.6 m/s) with HD. Systolic blood pressure (SBP) declined 151 31 to 147 32 after 20 min and 140 36 mm Hg on...
Intracranial arterial calcification (IAC) is associated with ischemic stroke in the general population but this relationship has not been examined hemodialysis patients. We factors IAC and its acute population. retrospectively studied 490 head computed tomographic scans from 2225 patients presenting neurological symptoms at our center (October 2005-May 2009). was graded using a validated scoring system. Multivariate regression used to examine presence of IAC, severity, ability predict...