ORCID Profile
0000-0002-9589-0071
Current Organisation
University of Tasmania
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Geology | Geochronology | Tectonics | Geomorphology and Regolith and Landscape Evolution | Isotope Geochemistry | Basin Analysis |
ANZSRC Socio-Economic Objective (SEO)
Expanding Knowledge in the Earth Sciences | Oil and Gas Exploration | Climate Change Models | Mineral Exploration not elsewhere classified | Natural Hazards in Mountain and High Country Environments | Titanium Minerals, Zircon, and Rare Earth Metal Ore (e.g. Monazite) Exploration
Related Links
Publications
Chronic kidney disease and automatic reporting of estimated glomerular filtration rate: new developments and revised recommendations
Publisher: AMPCo
Date: 08-2012
DOI: 10.5694/MJA11.11329
Abstract: The publication of the Australasian Creatinine Consensus Working Group's position statements in 2005 and 2007 resulted in automatic reporting of estimated glomerular filtration rate (eGFR) with requests for serum creatinine concentration in adults, facilitated the unification of units of measurement for creatinine and eGFR, and promoted the standardisation of assays. New advancements and continuing debate led the Australasian Creatinine Consensus Working Group to reconvene in 2010. The working group recommends that the method of calculating eGFR should be changed to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula, and that all laboratories should report eGFR values as a precise figure to at least 90 mL/min/1.73 m(2). Age-related decision points for eGFR in adults are not recommended, as although an eGFR < 60 mL/min/1.73 m(2) is very common in older people, it is nevertheless predictive of significantly increased risks of adverse clinical outcomes, and should not be considered a normal part of ageing.If using eGFR for drug dosing, body size should be considered, in addition to referring to the approved product information. For drugs with a narrow therapeutic index, therapeutic drug monitoring or a valid marker of drug effect should be used to in idualise dosing. The CKD-EPI formula has been validated as a tool to estimate GFR in some populations of non-European ancestry living in Western countries. Pending publication of validation studies, the working group also recommends that Australasian laboratories continue to automatically report eGFR in Aboriginal and Torres Strait Islander peoples. The working group concluded that routine calculation of eGFR is not recommended in children and youth, or in pregnant women. Serum creatinine concentration (preferably using an enzymatic assay for paediatric patients) should remain as the standard test for kidney function in these populations.
Chronic Kidney Disease in Tasmania: Protocol for a Data Linkage Study
Publisher: JMIR Publications Inc.
Date: 17-09-2020
DOI: 10.2196/20160
Abstract: Chronic kidney disease (CKD) is a significant and growing health burden globally. Tasmania has the highest state prevalence for non-Indigenous Australians and it has consistently had the lowest incidence and prevalence of dialysis in Australia. To examine the gap between the high community prevalence of CKD in Tasmania and the low use of dialysis. This is a retrospective cohort study using linked data from 5 health and 2 pathology data sets from the island state of Tasmania, Australia. The study population consists of any person (all ages including children) who had a blood measurement of creatinine with the included pathology providers between January 1, 2004, and December 31, 2017. This study population (N=460,737) includes within it a CKD cohort, which was detected via pathology or documentation of kidney replacement therapy (KRT dialysis or kidney transplant). Kidney function (estimated glomerular filtration rate [eGFR]) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. In iduals with 2 measures of eGFR mL/min/1.73 m2, at least 90 days apart, were identified as having CKD and were included in the CKD cohort. In iduals treated with dialysis or transplant were identified from the Australia and New Zealand Dialysis and Transplant Registry. The study population consisted of 460,737 people (n=245,573 [53.30%] female, mean age 47.4 years) who were Tasmanian residents aged 18 years and older and were followed for a median of 7.8 years. During the later 5 years of the study period, 86.79% (355,622/409,729) of Tasmanian adults were represented. The CKD cohort consisted of 56,438 people (ie, 12.25% of the study population 53.87% (30,405/56,438) female, mean age 69.9 years) followed for a median of 10.4 years with 56,039 detected via eGFR and 399 people detected via documentation of KRT. Approximately half (227,433/460,737, 49.36%) of the study population and the majority of the CKD cohort (41,448/56,438, 73.44%) had an admission episode. Of the 55,366 deaths recorded in the study population, 45.10% (24,970/55,366) had CKD. Whole-of-population approaches to examine CKD in the community can be achieved by data linkage. Over this 14-year period, CKD affected 12.25% (56,438/460,737) of Tasmanian adult residents and was present in 45.10% (24,970/55,366) of deaths. DERR1-10.2196/20160
Mesozoic reactivation of the Beishan, southern Central Asian Orogenic Belt: Insights from low-temperature thermochronology
Publisher: Elsevier BV
Date: 03-2017
Identifying new-onset conditions and pre-existing conditions using lookback periods in Australian health administrative datasets
Publisher: Oxford University Press (OUP)
Date: 20-11-2021
Abstract: The condition onset flag (COF) variable was introduced into the hospitalization coding practice in 2008 to help distinguish between the new and pre-existing conditions. However, Australian datasets collected prior to 2008 lack the COF, potentially leading to data waste. The aim of this study was to determine if an algorithm to lookback across the previous admissions could make this distinction. All patients requiring kidney replacement therapy (KRT) identified in the Australia and New Zealand Dialysis and Transplant Registry in New South Wales, South Australia and Tasmania between July 2008 and December 2015 were linked with hospital admission datasets using probabilistic linkage. Three different lookback periods entailing either one, two or three admissions prior to the index admission were investigated. Conditions identified in an index admission but not in the lookback periods were classified as a new-onset condition. Conditions identified in both the index admission and the lookback period were deemed to be pre-existing. The degrees of agreement were determined using the kappa statistic. Conditions examined for new onset were myocardial infarction, pulmonary embolism and pneumonia. Conditions examined for prior existence were diabetes mellitus, hypertension and kidney failure. Secondary analyses evaluated whether the conditions identified as pre-existing using COF were captured consistently in the subsequent admissions. 11 140 patients on KRT with 69 403 admissions were analysed. Lookback over a single admission interval (Period 1) provided the highest rates of true positives with COF for all three new-onset conditions, ranging from 89% to 100%. The levels of agreement were almost perfect for all conditions (k = 0.94–1.00). This was consistent across the different time eras. All lookback periods identified additional new-onset conditions that were not classified by COF: Lookback Period 1 picked up a further 474 myocardial infarction, 84 pulmonary embolism and 1092 pneumonia episodes. Lookback Period 1 had the highest percentage of true positives when identifying the pre-existing conditions (64–80%). The level of agreement was moderate to strong and was similar across the time eras. Secondary analysis showed that not all pre-existing conditions identified using COF carried forward to the subsequent admission (61–82%) but increased when looking forward across & admission (87–95%). The described algorithm using a lookback period is a pragmatic, reliable and robust means of identifying the new-onset and pre-existing patient conditions, thereby enriching the existing datasets predating the availability of the COF. The findings also highlight the value of concatenating a series of hospital patient admissions to more comprehensively adjudicate the pre-existing conditions, rather than assessing the index admission alone.
Study protocol for The GOAL Trial: comprehensive geriatric assessment for frail older people with chronic kidney disease to increase attainment of patient-identified goals—a cluster randomised controlled trial
Publisher: Springer Science and Business Media LLC
Date: 30-05-2023
DOI: 10.1186/S13063-023-07363-4
Abstract: An increasing number of older people are living with chronic kidney disease (CKD). Many have complex healthcare needs and are at risk of deteriorating health and functional status, which can adversely affect their quality of life. Comprehensive geriatric assessment (CGA) is an effective intervention to improve survival and independence of older people, but its clinical utility and cost-effectiveness in frail older people living with CKD is unknown. The GOAL Trial is a pragmatic, multi-centre, open-label, superiority, cluster randomised controlled trial developed by consumers, clinicians, and researchers. It has a two-arm design, CGA compared with standard care, with 1:1 allocation of a total of 16 clusters. Within each cluster, study participants ≥ 65 years of age (or ≥ 55 years if Aboriginal or Torres Strait Islander (First Nations Australians)) with CKD stage 3–5/5D who are frail, measured by a Frailty Index (FI) of 0.25, are recruited. Participants in intervention clusters receive a CGA by a geriatrician to identify medical, social, and functional needs, optimise medication prescribing, and arrange multidisciplinary referral if required. Those in standard care clusters receive usual care. The primary outcome is attainment of self-identified goals assessed by standardised Goal Attainment Scaling (GAS) at 3 months. Secondary outcomes include GAS at 6 and 12 months, quality of life (EQ-5D-5L), frailty (Frailty Index – Short Form), transfer to residential aged care facilities, cost-effectiveness, and safety (cause-specific hospitalisations, mortality). A process evaluation will be conducted in parallel with the trial including whether the intervention was delivered as intended, any issue or local barriers to intervention delivery, and perceptions of the intervention by participants. The trial has 90% power to detect a clinically meaningful mean difference in GAS of 10 units. This trial addresses patient-prioritised outcomes. It will be conducted, disseminated and implemented by clinicians and researchers in partnership with consumers. If CGA is found to have clinical and cost-effectiveness for frail older people with CKD, the intervention framework could be embedded into routine clinical practice. The implementation of the trial’s findings will be supported by presentations at conferences and forums with clinicians and consumers at specifically convened workshops, to enable rapid adoption into practice and policy for both nephrology and geriatric disciplines. It has potential to materially advance patient-centred care and improve clinical and patient-reported outcomes (including quality of life) for frail older people living with CKD. ClinicalTrials.gov NCT04538157. Registered on 3 September 2020.
Thermochronological insights into the structural contact between the Tian Shan and Pamirs, Tajikistan
Publisher: Wiley
Date: 24-01-2018
DOI: 10.1111/TER.12313
A case of de novo diagnosis anti‐neutrophil cytoplasmic antibody‐negative pauci‐immune necrotising glomerulonephritis in pregnancy
Publisher: Wiley
Date: 05-2017
DOI: 10.1111/IMJ.13405
Thermal and exhumation history of Sakhalin Island (Russia) constrained by apatite U-Pb and fission track thermochronology
Publisher: Elsevier BV
Date: 08-2017
Structural control on Meso-Cenozoic tectonic reactivation and denudation in the Siberian Altai: Insights from multi-method thermochronometry
Publisher: Elsevier BV
Date: 05-2012
Tryptophan metabolism, its relation to inflammation and stress markers and association with psychological and cognitive functioning: Tasmanian Chronic Kidney Disease pilot study
Publisher: Springer Science and Business Media LLC
Date: 10-11-2016
Childhood cardiorespiratory fitness and the early markers of kidney disease in middle age: A population-based cohort study.
Publisher: Elsevier BV
Date: 06-2022
DOI: 10.1016/J.JSAMS.2022.03.005
Abstract: To investigate the relationship of childhood cardiorespiratory fitness with early markers of chronic kidney disease, glomerular hyperfiltration and albuminuria, in midlife. Prospective cohort study. This study included 1371 participants aged 36-49 years who participated in the 1985 Australian Schools Health and Fitness Survey when they were 7-15 years of age. Childhood cardiorespiratory fitness was estimated by the time taken to complete a 1.6- km run. Blood and urine s les were collected at follow-up. Log-binomial regression was used to determine the associations of childhood cardiorespiratory fitness with glomerular hyperfiltration [estimated glomerular filtration rate (mL/min/1.73 m Compared with women with high childhood cardiorespiratory fitness, those with lower childhood cardiorespiratory fitness had a higher risk of glomerular hyperfiltration in midlife after adjusting for childhood age, the duration of follow-up, and midlife smoking status [adjusted relative risk = 2.86, 95% confidence interval, 1.04-7.86 for in iduals with moderate childhood cardiorespiratory fitness (P = 0.04), and adjusted relative risk = 3.38, 95% confidence interval, 1.13-10.14 for in iduals with low childhood cardiorespiratory fitness (P = 0.03)]. Further adjustment for childhood and midlife body mass index resulted in a slightly attenuated and statistically non-significant association. No significant associations were found with glomerular hyperfiltration in males or albuminuria in either males or females. Low cardiorespiratory fitness in childhood may increase the risk of glomerular hyperfiltration in midlife in females, possibly via a path through adult cardiorespiratory fitness.
The role of macrophages in allograft rejection
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 27-12-2005
DOI: 10.1097/01.TP.0000173903.26886.20
Abstract: Macrophage accumulation has long been recognized as a feature of allograft rejection, yet the role of macrophages in rejection remains underappreciated. Macrophages contribute to both the innate and acquired arms of the alloimmune response and thus may be involved in all aspects of acute and chronic allograft rejection. Recent advances in macrophage biology have allowed a better understanding of the mechanisms of macrophage accumulation, their state of activation and the pleuripotent roles they play in allograft rejection. Therapeutic attention to macrophages, in addition to T lymphocytes, may lead to improved outcomes in organ transplantation.
Low-temperature thermal history of the McArthur Basin: Influence of the Cambrian Kalkarindji Large Igneous Province on hydrocarbon maturation
Publisher: Petroleum Exploration Society of Australia (PESA)
Date: 30-08-2022
DOI: 10.36404/OVUF8939
Abstract: The greater McArthur Basin of the North Australian Craton is one of the very few places on Earth where extensive hydrocarbons are preserved that were generated from Mesoproterozoic source rocks, prior to the development of extensive multicellular life (e.g. Cox et al., 2022). It is, however, unclear precisely when hydrocarbons from these source rocks matured, and if this occurred as a singular event or multiple phases (e.g. Crick et al., 1988 Dutkiewicz et al., 2007). In this study we present new apatite fission track data from a combination of outcrop and sub-surface s les from the McArthur Basin (Figure 1) to investigate the post depositional thermal history of the basin, and explore the timing of potential hydrocarbon maturation.
Genetic Kidney Disease in Southern Tasmania
Publisher: Elsevier BV
Date: 04-2020
Tectonic history of the Irtysh shear zone (NE Kazakhstan): New constraints from zircon U/Pb dating, apatite fission track dating and palaeostress analysis
Publisher: Elsevier BV
Date: 02-2012
Crustal root of the Eastern Dharwar Craton: Zircon U–Pb age and Lu–Hf isotopic evolution of the East Salem Block, southeast India
Publisher: Elsevier BV
Date: 08-2014
Medication Adherence, Burden and Health-Related Quality of Life in Adults with Predialysis Chronic Kidney Disease: A Prospective Cohort Study
Publisher: MDPI AG
Date: 06-01-2020
Abstract: This study examines the associations between medication adherence and burden, and health-related quality of life (HRQOL) in predialysis chronic kidney disease (CKD). A prospective study targeting adults with advanced CKD (estimated glomerular filtration rate (eGFR) 30 mL/min/1.73 m2) and not receiving renal replacement therapy was conducted in Tasmania, Australia. The actual medication burden was assessed using the 65-item Medication Regimen Complexity Index, whereas perceived burden was self-reported using a brief validated questionnaire. Medication adherence was assessed using a four-item Morisky-Green-Levine Scale (MGLS) and the Tool for Adherence Behaviour Screening (TABS). The Kidney Disease and Quality of Life Short-Form was used to assess HRQOL. Of 464 eligible adults, 101 participated in the baseline interview and 63 completed a follow-up interview at around 14 months. Participants were predominantly men (67%), with a mean age of 72 (SD 11) years and eGFR of 21 (SD 6) mL/min/1.73 m2. Overall, 43% and 60% of participants reported medication nonadherence based on MGLS and TABS, respectively. Higher perceived medication burden and desire for decision-making were associated with nonadherent behaviour. Poorer HRQOL was associated with higher regimen complexity, whereas nonadherence was associated with a decline in physical HRQOL over time. Medication nonadherence, driven by perceived medication burden, was prevalent in this cohort, and was associated with a decline in physical HRQOL over time.
Survival of indigenous australians receiving renal replacement therapy: Closing the gap?
Publisher: AMPCo
Date: 03-2015
DOI: 10.5694/MJA14.00664
Abstract: To compare mortality rates for Indigenous and non-Indigenous Australians commencing renal replacement therapy (RRT) over time and by categories of remoteness of place of residence. An observational cohort study of Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data on Indigenous and non-Indigenous Australians registered with ANZDATA who commenced RRT from 1 January 1995 to 31 December 2009 and were followed until 31 December 2011. Five-year all-cause mortality for Indigenous and non-Indigenous patients in three cohorts (1995-1999, 2000-2004 and 2005-2009) and five remoteness (of place of residence) categories. Indigenous patients were younger, more likely to have diabetes, be referred late and be from a more remote area than non-Indigenous patients. Age and comorbid conditions increased with successive cohorts for both groups. Unadjusted analysis (using the log-rank test) showed an increased risk of death for Indigenous patients in the 1995-1999 (P = 0.02) and 2000-2004 (P = 0.03) cohorts, but not for the 2005-2009 cohort (P = 0.7). However, a Cox proportional hazards model adjusted for covariates (age, sex, late referral and comorbid conditions [diabetes, coronary artery disease, peripheral vascular disease, cerebrovascular disease, lung disease], and body mass index 30 kg/m(2)) showed the following Indigenous:non-Indigenous hazard ratios (with 95% CIs) for major capital cities: 1995-1999, 1.47 (1.21-1.79) 2000-2004, 1.35 (1.12-1.63) and 2005-2009, 1.37 (1.14-1.66). Although unadjusted analysis suggests that the survival gap between Indigenous and non-Indigenous patients receiving RRT has closed, there remains a significant disparity in survival after adjusting for the variables considered in our study.
Dialysis outcomes of elderly Indigenous and non-Indigenous Australians
Publisher: Wiley
Date: 27-09-2014
DOI: 10.1111/NEP.12317
Abstract: Whilst increasing numbers of elderly people in Australia are commencing dialysis, few Indigenous patients are aged ≥ 65 years and their outcomes are unknown. We compared the long-term survival, mortality hazards and causes of death between elderly Indigenous and elderly non-Indigenous dialysis patients. This was a retrospective cohort study of adults aged ≥ 65 years who commenced dialysis in Australia from 2001-2011, identified from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Indigenous (n = 263) and non-Indigenous (n = 10,713) patients were followed until death, loss to follow-up, recovery of renal function or 31 December 2011. Mortality was compared using a multivariate Cox proportional-hazards model with age, gender, body mass index, smoking, primary renal disease, comorbidities, late referral and initial treatment modality as predictive variables. Median follow-up was 26.9 months (interquartile range 11.3-48.8 months). Overall 166 Indigenous and 6265 non-Indigenous patients died during the 11-year follow-up period. Mortality rates per 100 patient-years were 23.9 for Indigenous patients and 21.2 for non-Indigenous patients. The overall 1-, 3- and 5-year survival rates were 81%, 49% and 27% for Indigenous patients and 82%, 55% and 35% for non-Indigenous patients respectively. Indigenous patients had a 20% increased risk of mortality compared with non-Indigenous patients (adjusted hazard ratio 1.20, 95% confidence interval, 1.02, 1.41 P = 0.02). 'Social deaths' (predominantly dialysis withdrawal) and cardiac deaths were the main causes of death for both groups. Among elderly dialysis patients in Australia, Indigenous status remains an important factor in predicting survival.
Comparison of equations for dosing of medications in renal impairment
Publisher: Wiley
Date: 21-04-2017
DOI: 10.1111/NEP.12834
Abstract: The aim of this study is to determine the concordance among the Cockcroft-Gault, the Modification of Diet in Renal Disease and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in hypothetical dosing of renally cleared medications. A total of 2163 patients prescribed at least one of the 31 renally cleared drugs under review were included in the study. Kidney function was estimated using the three equations. We compared actual prescribed dosages of the same drug with recommended dosages based on the kidney function as calculated by each of the equations and applying dosing recommendations in the Australian Medicines Handbook. There was a significant difference in the kidney function values estimated from the three equations (P < 0.001). Despite the good overall agreement in renal drug dosing, we found selected but potentially important discrepancies among the doses rendered from the equations. The CKD-EPI equation non-normalized for body surface area had a greater rate of concordance with the Cockcroft-Gault equation than the Modification of Diet in Renal Disease equation for renal drug dosing. There is need for a long-term multi-centre study in a erse population to define the clinical effects of the discrepancies among the equations for drug dosing. Given the greater concordance of the non-normalized CKD-EPI equation with the Cockcroft-Gault equation for dosing, the recommendation by Kidney Health Australia and the United States National Kidney Disease Education Program that 'dosing based on either eCrCl or an eGFR with body surface area normalization removed are acceptable' seems suitable and practicable for the purpose of dosing of non-critical drugs in the primary care setting.
Hypercalcaemia preceding diagnosis of Pneumocystis jirovecii pneumonia in renal transplant recipients
Publisher: Oxford University Press (OUP)
Date: 23-06-2017
DOI: 10.1093/CKJ/SFX044
Island medicine: using data linkage to establish the kidney health of the population of Tasmania, Australia.
Publisher: Swansea University
Date: 03-08-2021
Abstract: ObjectiveTo report (using linked laboratory data) the incidence, prevalence and geographic variation of chronic kidney disease (CKD) across the whole island population of Tasmania, Australia. MethodsA retrospective cohort study (the Tasmanian Chronic Kidney Disease study (CKD.TASlink)) using linked data from five health and two pathology datasets from the island state of Tasmania, Australia between 1/1/2004 and 31/12/2017. We used data on 460,737 Tasmanian adults (aged 18 years and older, representing 86.8% of the state's population) who had a serum creatinine measured during the study period. We defined CKD as per Kidney Disease Outcomes Quality Initiative, requiring two measures of estimated glomerular filtration rate (eGFR) mL/min/1.73m2, at least three months apart. Kidney replacement therapy (KRT) included dialysis or kidney transplantation. ResultsWe identified 56,438 Tasmanians with CKD during the study period, equating to an age-standardised annual incidence of 1.0% and a prevalence of 6.5%. These figures were higher in women, older Tasmanians and people living in the North-West region of Tasmania. Testing for urinary albumin:creatinine ratio is increasing, with 28.5% of women and 30.8% of men with stage 3 CKD having both an eGFR and uACR in 2017. Use of KRT was consistently seen in % of Tasmanians with eGFR mL/min/1.73m2. ConclusionThere is geographic and gender variation in the incidence and prevalence of CKD, but it is reassuring to see that the majority of people with end-stage kidney failure are actually receiving treatment with dialysis or transplantation.
Medication Prescribing Quality in Australian Primary Care Patients with Chronic Kidney Disease
Publisher: MDPI AG
Date: 13-03-2020
DOI: 10.3390/JCM9030783
Abstract: Background: Australian patients with chronic kidney disease (CKD) are routinely managed in general practices with multiple medications. However, no nationally representative study has evaluated the quality of prescribing in these patients. The objective of this study was to examine the quality of prescribing in patients with CKD using nationally representative primary care data obtained from the NPS MedicineWise’s dataset, MedicineInsight. Methods: A cross-sectional analysis of general practice data for patients aged 18 years or older with CKD was performed from 1 February 2016 to 1 June 2016. The study examined the proportion of patients with CKD who met a set of 16 published indicators in two categories: (1) potentially appropriate prescribing of antihypertensives, renin-angiotensin system (RAS) inhibitors, phosphate binders, and statins and (2) potentially inappropriate prescribing of nephrotoxic medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), at least two RAS inhibitors, triple therapy (an NSAID, a RAS inhibitor and a diuretic), high-dose digoxin, and metformin. The proportion of patients meeting each quality indicator was stratified using clinical and demographic characteristics. Results: A total of 44,259 patients (24,165 (54.6%) female 25,562 (57.8%) estimated glomerular filtration (eGFR) 45–59 mL/1.73 m2) with CKD stages 3–5 were included. Nearly one-third of patients had diabetes and were more likely to have their blood pressure and albumin-to-creatinine ratio monitored than those without diabetes. Potentially appropriate prescribing of antihypertensives was achieved in 79.9% of hypertensive patients with CKD stages 4–5. The prescribing indicators for RAS inhibitors in patients with microalbuminuria and diabetes and in patients with macroalbuminuria were achieved in 69.9% and 62.3% of patients, respectively. Only 40.8% of patients with CKD and aged between 50 and 65 years were prescribed statin therapy. The prescribing of a RAS inhibitor plus a diuretic was less commonly achieved, with the indicator met in 20.6% for patients with microalbuminuria and diabetes and 20.4% for patients with macroalbuminuria. Potentially inappropriate prescribing of NSAIDs, metformin, and at least two RAS inhibitors were apparent in 14.3%, 14.1%, and 7.6%, respectively. Potentially inappropriate prescribing tended to be more likely in patients aged ≥65 years, living in regional or remote areas, or with socio-economic indexes for areas (SEIFA) score ≤ 3. Conclusions: We identified areas for possible improvement in the prescribing of RAS inhibitors and statins, as well as deprescribing of NSAIDs and metformin in Australian general practice patients with CKD.
Tectonic history of the Kyrgyz South Tien Shan (Atbashi-Inylchek) suture zone: The role of inherited structures during deformation-propagation
Publisher: American Geophysical Union (AGU)
Date: 12-2011
DOI: 10.1029/2011TC002949
The CARI guidelines. Calcineurin inhibitors in renal transplantation: adverse effects
Publisher: Wiley
Date: 02-2007
Inherited structure as a control on late Paleozoic and Mesozoic exhumation of the Tarbagatai Mountains, southeastern Kazakhstan
Publisher: Geological Society of London
Date: 04-06-2021
DOI: 10.1144/JGS2020-121
Pyridine levels in ceftazidime - peritoneal dialysis admixtures stored at body temperature.
Publisher: SAGE Publications
Date: 17-01-2020
Abstract: For the treatment of peritoneal dialysis-associated peritonitis (PDAP), ceftazidime is routinely admixed with peritoneal dialysis (PD) solutions before its intraperitoneal administration. One of the major degradation products of ceftazidime is pyridine, a potentially toxic compound. Depending on the type of PD solution, ceftazidime is exposed to an environment with acidic or basic pH, and depending on the type of dosing and in idual unit practices related to preparation and storage, ceftazidime can be at body temperature for 4–10 h, resulting in potentially varying rates of degradation to pyridine by-product. No study has investigated whether the amount of generated pyridine exceeds the maximum daily exposure limit of 2 mg when ceftazidime-PD admixtures are kept at body temperature. Therefore, the current study aimed to determine the levels of pyridine generated in PD-ceftazidime admixtures kept at 37°C for various time points. Ceftazidime was admixed with 2 L Dianeal (1.5%, 2.5% and 4.25% dextrose) and 2 L Physioneal (1.36%, 2.27% and 3.86% glucose) PD solutions to obtain a concentration of 125 mg/L (continuous dosing model) or 500 mg/L (intermittent dosing model). A total of 36 PD admixtures (3 bags for each type of PD solution and 3 bags for each type of dosing) were prepared and stored at 37°C for 10 h. An aliquot was withdrawn at time 0 (baseline) and after 2, 6, 8 and 10 h of storage. The withdrawn s les were then analysed to determine the concentrations of ceftazidime and pyridine using high-performance liquid chromatography. With the intermittent dosing model (500 mg/L), ceftazidime was found to be stable for only 2 and 6 h when admixed with 3.86% and 2.27% glucose Physioneal PD solutions, respectively. While ceftazidime (500 mg/L) retained more than 90% of its initial concentration in the three types of Dianeal and 1.36% dextrose Physioneal solutions for 10 and 8 h, respectively, the generated amount of pyridine ranged between approximately 290% and 371% more than the daily recommended limit. With the continuous dosing model (125 mg/L), ceftazidime was found to be stable for 6 h in all three types of Physioneal PD solutions, but the total amount of generated pyridine with four daily exchanges (6 h each) was estimated to be 170–360% over the daily recommended limit. Ceftazidime (125 mg/L) was chemically stable when admixed with three types of Dianeal PD solutions and stored at 37°C for 10 h, and the levels of pyridine were estimated to be less than the maximum recommended daily limit. Until the outcomes of this in vitro study are confirmed by appropriate in vivo studies, continuous dosing of ceftzadime–Dianeal admixtures for the treatment of PDAP may be preferred over continuous dosing of ceftazidime–Physioneal admixtures, and intermittent dosing of ceftazidime–Physioneal and ceftazidime–Dianeal admixtures, as ceftazidime remains stable and the generated levels of pyridine are below the maximum recommended daily exposure.
The thermo-tectonic evolution of the southern Congo Craton margin as determined from apatite and muscovite thermochronology
Publisher: Elsevier BV
Date: 09-2019
Peritoneal dialysis practice in Australia and New Zealand: A call to sustain the action
Publisher: Wiley
Date: 22-06-2016
DOI: 10.1111/NEP.12731
Abstract: This paper updates a previous 'Call to Action' paper (Nephrology 2011 16: 19-29) that reviewed key outcome data for Australian and New Zealand peritoneal dialysis patients and made recommendations to improve care. Since its publication, peritonitis rates have improved significantly, although they have plateaued more recently. Peritoneal dialysis patient and technique survival in Australian and New Zealand have also improved, with a reduction in the proportion of technique failures attributed to 'social reasons'. Despite these improvements, technique survival rates overall remain lower than in many other parts of the world. This update includes additional practical recommendations based on published evidence and emerging initiatives to further improve outcomes.
Middle–late Mesoproterozoic tectonic geography of the North Australia Craton: U–Pb and Hf isotopes of detrital zircon grains in the Beetaloo Sub-basin, Northern Territory, Australia
Publisher: Geological Society of London
Date: 09-05-2019
DOI: 10.1144/JGS2018-159
Stability of ampicillin and amoxicillin in peritoneal dialysis solutions
Publisher: Oxford University Press (OUP)
Date: 2015
DOI: 10.2146/AJHP130717
Thermochronological insights into reactivation of a continental shear zone in response to Equatorial Atlantic rifting (northern Ghana)
Publisher: Springer Science and Business Media LLC
Date: 09-11-2018
DOI: 10.1038/S41598-018-34769-X
Abstract: West Africa was subjected to deformation and exhumation in response to Gondwana break-up. The timing and extent of these events are recorded in the thermal history of the margin. This study reports new apatite fission track (AFT) data from Palaeoproterozoic basement along the primary NE-SW structural trend of the Bole-Nangodi shear zone in northwestern Ghana. The results display bimodality in AFT age (populations of ~210-180 Ma and ~115-105 Ma) and length distributions (populations of 12.2 ± 1.6 and 13.1 ± 1.4 µm), supported by differences in apatite chemistry (U concentrations). The bimodal AFT results and associated QTQt thermal history models provide evidence for multiple cooling phases. Late Triassic – Early Jurassic cooling is interpreted to be related with thermal relaxation after the emplacement of the Central Atlantic Magmatic Province (CAMP). Early to middle Cretaceous cooling is thought to be associated with exhumation during the Cretaceous onset of rifting between West Africa and Brazil. Late Cretaceous – Cenozoic cooling can be related with exhumation of the Ivory Coast – Ghana margin and NNW-SSE shortening through western Africa. Furthermore, our data record differential exhumation of the crust with respect to the Bole-Nangodi shear zone, preserving older (CAMP) cooling ages to the south and younger (rifting) cooling ages to the north of the shear zone, respectively. This suggests that the Palaeoproterozoic BN shear zone was reactivated during the Cretaceous as a result of deformation in the Equatorial Atlantic region of Africa.
Potentially Inappropriate Prescribing of Renally Cleared Drugs in Elderly Patients in Community and Aged Care Settings
Publisher: Springer Science and Business Media LLC
Date: 30-04-2015
DOI: 10.1007/S40266-015-0261-1
Abstract: Limited data are available on the prevalence of inappropriate prescribing of renally cleared drugs in elderly patients in Australia. To quantify and compare the extent of inappropriate prescribing (defined as at least one drug prescribed in an excessive dose or when contraindicated with respect to renal function) of renally cleared drugs in elderly patients across the community and aged care settings, and to determine factors associated with patients being prescribed one or more potentially inappropriate renally cleared drugs. This retrospective study examined de-identified Home Medicines Review (HMR) and Residential Medication Management Review (RMMR) cases pertaining to 30,898 patients aged 65 years and over. Only 25 % (n = 7625) of these patients had documented information on their renal function. Among them, 4035 patients were prescribed at least one of the 31 renally cleared drugs examined in this study. For these patients, details including demographics, medications, medical conditions and pathology test results were extracted. Creatinine clearance was estimated using the Cockcroft-Gault formula, and the prevalence of inappropriate prescribing of the 31 drugs was examined on the basis of conformity with the recommendations in the Australian Medicines Handbook. Multivariate logistic regression was performed to determine the factors associated with patients being prescribed one or more potentially inappropriate renally cleared drugs. The mean (± standard deviation) ages of the HMR patients (n = 3315 59 % female) and RMMR patients (n = 720 68 % female) were 78.3 ± 7.2 and 86 ± 7.3 years, respectively. Over one quarter of the patients (n = 1135 out of 4035 28.1 %) prescribed the renally cleared drugs examined in this study had evidence of inappropriate prescribing of at least one of the drugs, with respect to their renal function. The drugs/drug classes most commonly prescribed inappropriately were perindopril, fenofibrate, glibenclamide, gliptins, metformin, olmesartan, bisphosphonates and strontium. The factors independently associated with patients being prescribed one or more potentially inappropriate renally cleared drugs were advancing age [odds ratio (OR) 1.06 per year increase, 95 % confidence interval (CI) 1.05-1.07 P < 0.001], the total number of renally cleared drugs prescribed (OR 1.44 per unit increase, 95 % CI 1.29-1.61 P < 0.001), presence of diabetes (OR 1.51, 95 % CI 1.30-1.76 P < 0.001), presence of heart failure (OR 1.38, 95 % CI 1.13-1.69 P < 0.005) and living in aged care facilities (OR 1.28, 95 % CI 1.06-1.5 P < 0.05). Inappropriate prescribing of renally cleared drugs is common in older Australians. Intervention studies to improve prescribing of renally cleared drugs in the elderly appear to be warranted.
Heparin leak from a hemodialysis catheter causing major bleeding, ultimately leading to transplant rejection and death
Publisher: Wiley
Date: 10-2008
DOI: 10.1111/J.1542-4758.2008.00306.X
Abstract: Leakage of hemodialysis catheter-locking solutions into the circulation has been reported in in vitro and in vivo studies, although there have been few reports of serious clinical adverse events. We describe a case of heparin leak from a hemodialysis catheter, which caused significant clinical bleeding requiring multiple transfusions and may have ultimately been responsible for the patient's death after transplantation.
Geology, Apatite Geochronology, and Geochemistry of the Ernest Henry Inter-lens: Implications for a Re-Examined Deposit Model
Publisher: MDPI AG
Date: 13-09-2018
DOI: 10.3390/MIN8090405
Abstract: The Ernest Henry Iron-Oxide-Copper-Gold deposit is the largest known Cu-Au deposit in the Eastern Succession of the Proterozoic Mount Isa Inlier, NW Queensland. Cu-Au mineralization is hosted in a K-feldspar altered breccia, bounded by two major pre-mineralization shear zones. Previous research suggests that Cu-Au mineralization and the ore-bearing breccia formed simultaneously through an eruption style explosive/implosive event, facilitated by the mixing of fluids at ~1530 Ma. However, the preservation of a highly deformed, weakly mineralized, pre-mineralization feature (termed the Inter-lens) within the orebody indicates that this model must be re-examined. The paragenesis of the Inter-lens is broadly consistent with previous studies on the deposit, and consists of albitization an apatite-calcite-quartz-garnet assemblage biotite-magnetite ± garnet alteration K-feldspar ± hornblende alteration Cu-Au mineralization and post-mineralization alteration and veining. Apatite from the paragenetically early apatite-calcite-quartz-garnet assemblage produce U–Pb ages of 1584 ± 22 Ma and 1587 ± 22 Ma, suggesting that the formation of apatite, and the maximum age of the Inter-lens is synchronous with D2 deformation of the Isan Orogeny and regional peak-metamorphic conditions. Apatite rare earth element-depletion trends display: (1) a depletion in rare earth elements evenly, corresponding with an enrichment in arsenic and (2) a selective light rare earth element depletion. Exposure to an acidic NaCl and/or CaCl2-rich sedimentary-derived fluid is responsible for the selective light rare earth element-depletion trend, while the exposure to a neutral to alkaline S, Na-, and/or Ca-rich magmatic fluid resulted in the depletion of rare earth elements in apatite evenly, while producing an enrichment in arsenic. We suggest the deposit experienced at least two hydrothermal events, with the first event related to peak-metamorphism (~1585 Ma) and a subsequent event related to the emplacement of the nearby (~1530 Ma) Williams–Naraku Batholiths. Brecciation resulted from competency contrasts between ductile metasedimentary rocks of the Inter-lens and surrounding shear zones against the brittle metavolcanic rocks that comprise the ore-bearing breccia, providing permeable pathways for the subsequent ore-bearing fluids.
Late Palaeogene emplacement and late Neogene–Quaternary exhumation of the Kuril island-arc root (Kunashir island) constrained by multi-method thermochronometry
Publisher: Elsevier BV
Date: 03-2016
Serum levels of macrophage-colony stimulating factor (M-CSF): a marker of kidney allograft rejection
Publisher: Oxford University Press (OUP)
Date: 18-05-2004
DOI: 10.1093/NDT/GFH257
Enabling good outcomes in older adults on dialysis: a qualitative study
Publisher: Springer Science and Business Media LLC
Date: 29-01-2020
DOI: 10.1186/S12882-020-1695-1
Abstract: Older patients on dialysis may not have optimal outcomes, particularly with regards to quality of life. Existing research is focused mainly on survival, with limited information about other outcomes. Such information can help in shared decision-making around dialysis initiation it can also be used to improve outcomes in patients established on dialysis. We used qualitative research methods to explore patient perspectives regarding their experience and outcomes with dialysis. Semi-structured interviews with participants aged ≥70, receiving dialysis at a regional Australian hospital, were recorded and transcribed. From participants’ responses, we identified descriptive themes using a phenomenological approach, with verification by two researchers. Factors affecting outcomes were derived reflexively from these themes. Seventeen interviews were analysed prior to saturation of themes. Participants (12 on haemodialysis, 5 on peritoneal dialysis) had spent an average of 4.3 years on dialysis. There were 11 males and 6 females, with mean age 76.2 years (range 70 to 83). Experiences of dialysis were described across four domains - the self, the body, effects on daily life and the influences of others yielding themes of (i) responses to loss (of time, autonomy, previous life), (ii) responses to uncertainty (variable symptoms unpredictable future dependence on others), (iii) acceptance / adaptation (to life on dialysis to ageing) and (iv) the role of relationships / support (family, friends and clinicians). Older patients experience the effects of dialysis across multiple domains in their lives. They endure feelings of loss and persistent uncertainty, but may also adapt successfully to their new circumstances, aided by the support they receive from family, health professionals and institutions. From these insights, we have suggested practical measures to improve outcomes in older patients .
Clinicians’ perspectives on equity of access to dialysis and kidney transplantation for rural people in Australia: a semistructured interview study
Publisher: BMJ
Date: 02-2022
DOI: 10.1136/BMJOPEN-2021-052315
Abstract: People with chronic kidney disease requiring dialysis or kidney transplantation in rural areas have worse outcomes, including an increased risk of hospitalisation and mortality and encounter many barriers to accessing kidney replacement therapy. We aim to describe clinicians’ perspectives of equity of access to dialysis and kidney transplantation in rural areas. Qualitative study with semistructured interviews. Twenty eight nephrologists, nurses and social workers from 19 centres across seven states in Australia. We identified five themes: the tyranny of distance (with subthemes of overwhelming burden of travel, minimising relocation distress, limited transportation options and concerns for patient safety on the roads) supporting navigation of health systems (reliance on local ch ions, variability of health literacy, providing flexible models of care and frustrated by gatekeepers) disrupted care (without continuity of care, scarcity of specialist services and fluctuating capacity for dialysis) pervasive financial distress (crippling out of pocket expenditure and widespread socioeconomic disadvantage) and understanding local variability (lacking availability of safe and sustainable resources for dialysis, sensitivity to local needs and dependence on social support). Clinicians identified geographical barriers, dislocation from homes and financial hardship to be major challenges for patients in accessing kidney replacement therapy. Strategies such as telehealth, outreach services, increased service provision and patient navigators were suggested to improve access.
Evaluation of a young adult renal and transplant transition clinic in a regional setting: Supporting young adults and parents' transition to self‐management
Publisher: Wiley
Date: 16-01-2021
DOI: 10.1111/AJR.12683
Macrophages act as effectors of tissue damage in acute renal allograft rejection
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-10-2003
Epidemiology of chronic kidney disease in Australian general practice: National Prescribing Service MedicineWise MedicineInsight dataset
Publisher: Wiley
Date: 13-12-2018
DOI: 10.1111/NEP.13537
Blockade of Macrophage Colony-Stimulating Factor Reduces Macrophage Proliferation and Accumulation in Renal Allograft Rejection
Publisher: Elsevier BV
Date: 03-2003
DOI: 10.1034/J.1600-6143.2003.00068.X
Abstract: Macrophage accumulation within an acutely rejecting allograft occurs by recruitment and local proliferation. To determine the importance of M-CSF in driving macrophage proliferation during acute rejection, we blocked the M-CSF receptor, c-fms, in a mouse model of acute renal allograft rejection. C57BL/6 mouse kidneys (allografts, n = 20) or BALB/c kidneys (isografts, n = 5) were transplanted into BALB/c mice. Anti-c-fms antibody (AFS98) or control Ig (50 mg/kg/day, i.p.) was given daily to allografts from days 0-5. All mice were killed day 6 postoperatively. Expression of the M-CSF receptor, c-fms, was restricted to infiltrating CD68+ macrophages. Blockade of c-fms reduced proliferating (CD68+/BrdU+) macrophages by 82% (1.1 v 6.2%, p < 0.001), interstitial CD68+ macrophage accumulation by 53% (595 v 1270/mm2, p < 0.001), and glomerular CD68+ macrophage accumulation by 71% (0.73 V 2.48 CD68+ cells per glomerulus, p < 0.001). Parameters of T-cell involvement (intragraft CD4+, CD8+ and CD25+ lymphocyte numbers) were not affected. The severity of tubulointerstitial rejection was reduced in the treatment group as shown by decreased tubulitis and tubular cell proliferation. Macrophage proliferation during acute allograft rejection is dependent on the interaction of M-CSF with its receptor c-fms. This pathway plays a significant and specific role in the accumulation of macrophages within a rejecting renal allograft.
Incremental healthcare expenditure attributable to diabetes mellitus: A cost of illness study in Tasmania, Australia.
Publisher: Wiley
Date: 28-02-2022
DOI: 10.1111/DME.14817
Abstract: To quantify the incremental direct medical costs in people with diabetes from the healthcare system perspective and to identify trends in the incremental costs. This was a matched retrospective cohort study based on a linked data set developed for investigating chronic kidney disease in Tasmania, Australia. Using propensity score matching, 51,324 people with diabetes were matched on age, sex and residential area with 102,648 people without diabetes. Direct medical costs (Australian dollars 2020–2021) due to hospitalisation, Emergency Department visits and pathology tests were included. The incremental costs and cost ratios between mean annual costs of people with diabetes and their controls were calculated. On average, people with diabetes had healthcare costs that were almost double their controls ($2427 [95% CI 2322–2543] ratio 1.87 [95% CI 1.85–1.91] pooled from 2007–2017). While in the first year of follow‐up, the costs of a person with diabetes were $1643 (95% CI 1489–1806) ratio 1.83 (95% CI 1.76–1.92) more than their control, this increased to $2480 (95% CI 2265–2680) ratio 1.69 (95% CI 1.62–1.77) in the final year. Although the incremental costs were higher in older age groups (e.g., ≥70: $2498 [95% CI 2265–2754] 40–49: $2117 [95% CI 1887–2384]), the cost ratios were higher in younger age groups (≥70: 1.52 [95% CI 1.48–1.56] 40–49: 2.37 [95% CI 2.25–2.61]). Given the increasing burden that diabetes imposes, our findings will support policymakers in future planning for diabetes and enable targeting sub‐groups with higher long‐term costs for possible cost savings for the Tasmanian healthcare system.
Ex vivo lymphocyte proliferative function is severely inhibited in renal transplant patients on mycophenolate mofetil treatment
Publisher: Elsevier BV
Date: 06-2004
Meso‐Cenozoic Tectonic History of the Altai: New Insights From Apatite U‐Pb and Fission Track Thermochronology for the Fuyun Area (Xinjiang, China)
Publisher: American Geophysical Union (AGU)
Date: 04-2023
DOI: 10.1029/2022TC007692
Abstract: The Altai is an enigmatic, relatively young mountain belt with sharp relief (up to 4,500 m high) that developed thousands of kilometers away from the nearest current plate margins. The Fuyun area, at the interface between the southern margin of the Chinese Altai and the Junggar Basin, represents a key locality for understanding the Meso‐Cenozoic deformation and exhumation history of the Altai. The complex structural architecture of the Fuyun area suggests that multiple deformation events affected the area, which ultimately led to the exhumation of the Altai. Furthermore, the area hosts orogenic‐type mineralization, suggesting a history of fluid alteration. However, in contrast to the well‐constrained Palaeozoic history, the timing of Meso‐Cenozoic deformation, metasomatism and exhumation has not been comprehensively studied. This study presents new apatite U‐Pb, trace element and fission track data for the Fuyun area and integrates these with previous studies for the Altai to shed more light on the Meso‐Cenozoic tectonic history. The apatite U‐Pb dates, associated with LREE‐depleted trace element profiles, suggest that a phase of Middle–Late Jurassic (∼170–160 Ma) metasomatism affected the Keketuohai area, which is potentially linked to the timing of rare‐metal mineralization. The apatite fission track results and thermal history models reveal rapid early Late Cretaceous (∼100–75 Ma) cooling linked to tectonic exhumation throughout the Chinese Altai, associated with distant plate‐margin processes. In addition, s les taken in vicinity to the frontal thrusts of the Altai record evidence for Cenozoic partial resetting of the apatite fission track system.
Improving equity in access to kidney transplantation: implementing targeted models of care focused on improving timely access to waitlisting
Publisher: Wiley
Date: 15-10-2023
DOI: 10.5694/MJA2.52099
Chronic kidney disease in Tasmania
Publisher: Wiley
Date: 30-11-2009
DOI: 10.1111/J.1440-1797.2009.01198.X
Abstract: Chronic kidney disease (CKD) is a progressive disease which is becoming a major public health issue due to its high rate of premature death, poor quality of life and expensive end-stage treatment (dialysis or transplantation). The burden of this chronic condition in a community setting was examined. Data were obtained from 369,098 Tasmanian adults (aged >or=18 years) and included 1,640,687 measurements of creatinine taken between 1995 and 2007. In 2007 alone, testing comprised 25.5% of the state's adult population. A modelled estimate of CKD prevalence was developed. For those at risk of CKD (aged >50 years), 50.6%, 70.2% and 82% had a measured creatinine (and reported estimated glomerular filtration rate (eGFR)) during the last 1, 2 and 3 years respectively. However, only 9.4% of people with eGFR of less than 60 mL/min per 1.73 m(2) had albuminuria formally measured. Estimated prevalence of stage III or greater CKD (eGFR <60 mL/min per 1.73 m(2)) was at least 11.4% of women and 8.6% of men during 2007. Detection of low eGFR increased significantly over the last 13 years. There was a large geographic variation throughout Tasmania and high relative mortality with lower eGFR. There is a broad gap between the number of people with eGFR of less than 15 mL/min per 1.73 m(2) (stage V CKD) and those receiving dialysis treatment. The number of people identified with low eGFR has increased significantly since 1995 with a large geographic variation. Despite this, testing for kidney disease (by measuring serum creatinine and albuminuria) in people at risk is still suboptimal.
Unravelling the Neoproterozoic accretionary history of Oman, using an array of isotopic systems in zircon
Publisher: Geological Society of London
Date: 22-11-2019
DOI: 10.1144/JGS2018-125
Medication Regimen Complexity and Adherence in Haemodialysis Patients: An Exploratory Study
Publisher: S. Karger AG
Date: 2016
DOI: 10.1159/000446450
Abstract: b i Background: /i /b The impact of medication regimen complexity on adherence in hemodialysis patients is unknown. We investigated regimen complexity, perceived burden of medicines (PBM) and health-related quality of life (HR-QoL) as potential predictors of adherence. b i Methods: /i /b Adult (≥18 years) hemodialysis patients were included. Data on medication regimen complexity index (MRCI), self-reported and objective adherence, comorbidity index, PBM and HR-QoL were obtained using established measures. Sociodemographic and clinical characteristics were collected during interviews and by reviewing medical records. Predictors of adherence were determined using logistic regression. b i Results: /i /b Fifty-three out of 70 hemodialysis patients participated (response rate 75% male 58.5% age 67.9 ± 11.5 years). The mean MRCI, HR-QoL and PBM scores were 27.0 ± 10.9, 0.70 ± 0.13 and 1.7 ± 0.6, respectively. Based on self-reports, 43.4% (n = 23) were adherent, whereas for a subset of patients analyzed using objective measure (n = 33), much lower adherence rate was observed (27.3%, n = 9). The self-reported and objective measures were significantly correlated (r = 0.43, p = 0.01). Older age was the only significant predictor of self-reported adherence (OR 1.05 95% CI 1.00-1.11) whereas older age (OR 1.10 95% CI 1.00-1.21), higher comorbidity (OR 1.58 95% CI 1.03-2.42) and MRCI (OR 1.14 95% CI 1.02-1.27) were independent predictors of objective adherence. b i Conclusions: /i /b The findings of this exploratory study suggest that older patients with high comorbidities and highly complex regimen are more likely to be adherent based on an objective measure. Future research is needed using objective measures of adherence suitable for all patients and reflecting all medications.
Psychosocial factors in adults with chronic kidney disease: characteristics of pilot participants in the Tasmanian Chronic Kidney Disease study
Publisher: Springer Science and Business Media LLC
Date: 12-04-2013
Impending challenges of the burden of end-stage kidney disease in Australia
Publisher: Wiley
Date: 10-2019
DOI: 10.5694/MJA2.50354
Abstract: Sex and age-specific incidence rates of patients with treated end-stage kidney disease (ESKD) in Australia are comparable to those in European countries, but substantially lower compared with those in the United States, Canada and many Asian countries. The incidence rates of treated ESKD in Australia increase with advancing age however, the incidence of ESKD is likely to be underestimated because a proportion of patients with ESKD (about 50%) remain untreated. Late referral to nephrologists has reduced over the past decade, temporally associated with improved ESKD recognition. However, late referral still occurs in one in five Australians with ESKD. One in two Australians with ESKD has diabetes, with up to 35% of cases directly attributed to diabetes. Mortality rates for patients with ESKD remain substantially higher compared with the age-matched general population, although there has been a significant improvement in survival over time. Cardiovascular disease and cancer are the two most common causes of death in patients with ESKD.
The kidney failure risk equation predicts kidney failure: Validation in an Australian cohort
Publisher: Wiley
Date: 19-04-2023
DOI: 10.1111/NEP.14160
Abstract: Predicting progression to kidney failure for patients with chronic kidney disease is essential for patient and clinicians' management decisions, patient prognosis, and service planning. The Tangri et al Kidney Failure Risk Equation (KFRE) was developed to predict the outcome of kidney failure. The KFRE has not been independently validated in an Australian Cohort. Using data linkage of the Tasmanian Chronic Kidney Disease study (CKD.TASlink) and the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), we externally validated the KFRE. We validated the 4, 6, and 8‐variable KFRE at both 2 and 5 years. We assessed model fit (goodness of fit), discrimination (Harell's C statistic), and calibration (observed vs predicted survival). There were 18 170 in the cohort with 12 861 participants with 2 years and 8182 with 5 years outcomes. Of these 2607 people died and 285 progressed to kidney replacement therapy. The KFRE has excellent discrimination with C statistics of 0.96–0.98 at 2 years and 0.95–0.96 at 5 years. The calibration was adequate with well‐performing Brier scores (0.004–0.01 at 2 years, 0.01–0.03 at 5 years) however the calibration curves, whilst adequate, indicate that predicted outcomes are systematically worse than observed. This external validation study demonstrates the KFRE performs well in an Australian population and can be used by clinicians and service planners for in idualised risk prediction.
Removal of Hg interferences for common Pb correction when dating apatite and titanite by LA-ICP-MS/MS
Publisher: Royal Society of Chemistry (RSC)
Date: 2020
DOI: 10.1039/D0JA00224K
Abstract: Improved 204 Pb common Pb correction by LA-ICP-MS/MS for apatite and titanite U-Pb dating.
Dose adjustment guidelines for medications in patients with renal impairment: how consistent are drug information sources?
Publisher: Wiley
Date: 2014
DOI: 10.1111/IMJ.12291
Abstract: It is known that patients with renal disease are often administered inappropriate dosages of drugs. A lack of quantitative data in the available drug information sources and inconsistency in dosing information may augment the problem of dosing error. To determine the concordance among five drug information sources regarding the dosing recommendations provided for drugs considered problematic in patients with renal impairment and to determine the consistency among the sources regarding the definition of renal impairment and categorisation of chronic kidney disease. Five standard drug information sources were reviewed for 61 drugs recommended to be used with caution in renal impairment. Information on recommendations for dosage adjustment in renal impairment was extracted and analysed. Further, the definition and classification of renal impairment were recorded. The recommendation for each drug was coded into six different categories and the intersource reliability was calculated. Only slight agreement was observed among the sources (Fleiss Kappa: 0.3). Qualitative data were not well defined, and there was a lack of consistency in quantitative values. Some drugs marked as contraindicated in one source were not mentioned as such in others. Also, drugs considered as not requiring dosage adjustment in one source had explicit recommendations in other sources. The definition and classification of renal impairment differed among the five information sources. There should be an evidence-based approach to drug dosage adjustment in order to bring uniformity to the recommendations. Regular updating of the content of the drug information sources is also important.
Medication-Related Factors and Hospital Readmission in Older Adults with Chronic Kidney Disease
Publisher: MDPI AG
Date: 21-03-2019
DOI: 10.3390/JCM8030395
Abstract: This study aimed to examine the association between medication-related factors and risk of hospital readmission in older patients with chronic kidney disease (CKD). A retrospective analysis was conducted targeting older CKD (n = 204) patients admitted to an Australian hospital. Medication appropriateness (Medication Appropriateness Index MAI), medication regimen complexity (number of medications and Medication Regimen Complexity Index MRCI) and use of selected medication classes were exposure variables. Outcomes were occurrence of readmission within 30 and 90 days, and time to readmission within 90 days. Logistic and Cox hazards regression were used to identify factors associated with readmission. Overall, 50 patients (24%) were readmitted within 30 days, while 81 (40%) were readmitted within 90 days. Mean time to readmission within 90 days was 66 (SD 34) days. Medication appropriateness and regimen complexity were not independently associated with 30- or 90-day hospital readmissions in older adults with CKD, whereas use of renin‒angiotensin blockers was associated with reduced occurrence of 30-day (adjusted OR 0.39 95% CI 0.19–0.79) and 90-day readmissions (adjusted OR 0.45 95% CI 0.24–0.84) and longer time to readmission within 90 days (adjusted HR 0.52 95% CI 0.33–0.83). This finding highlights the importance of considering the potential benefits of in idual medications during medication review in older CKD patients.
Neoproterozoic tectonic geography of the south-east Congo Craton in Zambia as deduced from the age and composition of detrital zircons
Publisher: Elsevier BV
Date: 11-2019
New chronological constrains on the tectonic affinity of the Alxa Block, NW China
Publisher: Elsevier BV
Date: 09-2017
Final Subduction Processes of the Paleo-Asian Ocean in the Alxa Tectonic Belt (NW China): Constraints From Field and Chronological Data of Permian Arc-Related Volcano-Sedimentary Rocks
Publisher: American Geophysical Union (AGU)
Date: 06-2018
DOI: 10.1029/2017TC004919
Retention of knowledge and perceived relevance of basic sciences in an integrated case-based learning (CBL) curriculum
Publisher: Springer Science and Business Media LLC
Date: 08-10-2013
Macrophage colony-stimulating factor expression and macrophage accumulation in renal allograft rejection1
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2002
DOI: 10.1097/00007890-200204270-00022
Abstract: Studies of infiltrating cells from acutely rejecting renal allografts show that a high proportion of these cells are macrophages, and early macrophage infiltration is a poor prognostic sign for transplant survival. Macrophage colony-stimulating factor (M-CSF), produced by tubular and mesangial cells, has been associated with macrophage infiltration and proliferation in experimental and human kidney diseases. We investigated the expression of M-CSF in a model of acute rejection. Lewis rats underwent bilateral nephrectomies and received an orthotopic Dark Agouti allograft or Lewis isograft. Animals received cyclosporine (10 mg/kg/day) from day 0 to day 3 and were killed at days 4, 8, or 14 after transplantation. Macrophages (ED1+) and T cells (W3-13+) were identified by immunohistochemistry, and M-CSF expression was identified by Northern blotting and in situ hybridization. Isografts had normal renal function without histological evidence of rejection. Allografts exhibited a moderate infiltrate at day 4 but progressed to severe rejection at day 14, with elevated serum creatinine level and severe tubulointerstitial damage. Macrophages and T cells were present in equal proportion in the infiltrate at day 4. At day 14, the number of macrophages increased fivefold (2580/mm2), although T cells were unchanged (380/mm2). Proliferating macrophages (ED1+, BrdU+) increased from day 4 (4%) to day 14 (10%). M-CSF mRNA expression was strongly up-regulated in allografts compared with isografts and normal rat. In situ hybridization demonstrated M-CSF expression by resident and infiltrating cells. Renal tubular expression was minimally increased at day 4 but strongly up-regulated at day 14 (more than 50% of tubules positive), particularly in areas of tubular damage. Tubular M-CSF expression colocalized with areas of intense macrophage infiltration and proliferation. Serial sections with double labeling demonstrated that T cells were the dominant source of M-CSF at day 4, yet later in the rejection (day 14) the predominant sites of production were both renal tubular cells and interstitial macrophages. Renal production of M-CSF by graft-infiltrating (macrophages and T lymphocytes) and resident (tubular) cells was up-regulated during acute rejection. M-CSF promotes macrophage recruitment and proliferation and may thereby play a pathogenic role in acute rejection. The kinetics of M-CSF production during acute rejection suggest that local macrophage proliferation may be initiated by T cells and perpetuated by both renal tubular and autocrine release.
Quality Use Of Medicines In Patients With Chronic Kidney Disease
Publisher: Research Square Platform LLC
Date: 19-05-2020
Abstract: Background: Chronic kidney disease (CKD) affects drug elimination and patients with CKD require appropriate adjustment of renally cleared medications to ensure safe and effective pharmacotherapy. The main objective of this study was to determine the extent of potentially inappropriate prescribing (PIP defined as the use of a contraindicated medication or inappropriately high dose according to the kidney function) of renally-cleared medications commonly prescribed in Australian primary care, based on two measures of kidney function. A secondary aim was to assess agreement between the two measures. Methods Retrospective analysis of routinely collected de-identified Australian general practice patient data (NPS MedicineWise MedicineInsight from January 1, 2013, to June 1, 2016 collected from 329 general practices). All adults (aged ≥18 years) with CKD presenting to general practices across Australia were included in the analysis. Patients were considered to have CKD if they had two or more estimated glomerular filtration rate (eGFR) recorded values mL/min/1.73m 2 , and/or two urinary albumin/creatinine ratios ≥3.5 mg/mmol in females (≥2.5 mg/mmol in males) at least 90 days apart. PIP was assessed for 49 commonly prescribed medications using the Cockcroft-Gault (CG) equation/eGFR as per the instructions in the Australian Medicines Handbook. Results: A total of 48,731 patients met the Kidney Health Australia (KHA) definition for CKD and had prescriptions recorded within 90 days of measuring serum creatinine (SCr)/estimated glomerular filtration rate (eGFR). Overall, 28,729 patients were prescribed one or more of the 49 medications of interest. Approximately 35% (n=9,926) of these patients had at least one PIP based on either the Cockcroft-Gault (CG) equation or eGFR (CKD-EPI CKD-Epidemiology Collaboration Equation). There was good agreement between CG and eGFR while determining the appropriateness of medications, with approximately 97% of the medications classified as appropriate by eGFR also being considered appropriate by the CG equation. Conclusion: This study highlights that PIP commonly occurs in primary care patients with CKD and the need for further research to understand why and how this can be minimised. The findings also show that the eGFR provides clinicians a potential alternative to the CG formula when estimating kidney function to guide drug appropriateness and dosing.
Randomized trial investigating the safety and efficacy of influenza vaccination in patients with antineutrophil cytoplasmic antibody‐associated vasculitis
Publisher: Wiley
Date: 15-04-2015
DOI: 10.1111/NEP.12416
Abstract: This study evaluated the safety and efficacy of influenza vaccination in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis. Thirty-one patients who were in remission were randomized to receive either a trivalent influenza vaccine or no vaccine. Vaccine efficacy was assessed at 28 days. Patients were followed for 6 months for signs of reactivation of disease. In addition, 67 healthy in iduals were randomized to receive either the influenza vaccine or no vaccine to assess its potential for triggering the formation of autoantibodies. Compared with patients who did not receive the vaccine, vaccinated patients achieved effective responses to all three influenza vaccine antigens. There was no significant change in levels of anti-neutrophil cytoplasmic antibody post-vaccination. There was no significant change in disease activity in vaccinated patients compared with non-vaccinated patients. Among vaccinated healthy in iduals, we did not observe any significant change in the level of autoantibodies measured. This study shows that the administration of influenza vaccine to patients in remission with anti-neutrophil cytoplasmic antibody-associated vasculitis is both safe and modestly efficacious.
BMI Trajectories from Childhood to Midlife are Associated with Subclinical Kidney Damage in Midlife
Publisher: Wiley
Date: 16-04-2021
DOI: 10.1002/OBY.23145
Low‐Temperature Thermochronology of the Chatkal‐Kurama Terrane (Uzbekistan‐Tajikistan): Insights Into the Meso‐Cenozoic Thermal History of the Western Tian Shan
Publisher: American Geophysical Union (AGU)
Date: 10-2018
DOI: 10.1029/2017TC004878
Psychosocial factors in people with chronic kidney disease prior to renal replacement therapy
Publisher: Wiley
Date: 26-08-2013
DOI: 10.1111/NEP.12138
Abstract: Increasing evidence implicates psychosocial factors including depression, anxiety, perceived social support and health-related quality of life in the pathophysiology of various chronic diseases. Research examining the psychosocial aspects of kidney disease has focussed predominantly on depressive disorders in dialysis patients where they are independently associated with increased risk of mortality and poor health-related quality of life. In contrast, studies examining the influence of psychosocial factors in people with chronic kidney disease (CKD) prior to the initiation of renal replacement therapy are sparse. Limited data indicate that clinical depression and depressive symptoms are common and may independently predict progression to dialysis, hospitalization and death. In contrast, the influence of anxiety disorders, lower perceived social support and impaired health-related quality of life on the clinical course of CKD have received little attention. Large-scale prospective cohort studies are needed to clarify the burden and prognostic impact of these factors in this vulnerable population. Given the escalating burden of CKD worldwide examining the role of these potentially modifiable risk factors is crucial. Identifying and implementing targeted interventions in order to prevent or delay the progression of CKD and improve quality of life will be a major challenge.
Gender differences in the dialysis treatment of Indigenous and non-Indigenous Australians
Publisher: Elsevier BV
Date: 02-2017
Abstract: Access to dialysis treatment and the types of treatments employed in Australia differs by Indigenous status. We examined whether dialysis treatment utilisation in Indigenous and non-Indigenous Australians also differs by gender. Using registry data we evaluated 21,832 incident patients (aged ≥18 years) commencing dialysis, 2001-2013. Incidence rates were calculated and multivariate regression modelling used to examine differences in dialysis treatment (modality, location and vascular access creation) by race and gender. Dialysis incidence was consistently higher in Indigenous women compared to all other groups. Compared to Indigenous women, both non-Indigenous women and men were more likely to receive peritoneal dialysis as their initial treatment (non-Indigenous women RR=1.91, 95%CI 1.55-2.35 non-Indigenous men RR=1.73, 1.40-2.14) and were more likely to commence initial treatment at home (non-Indigenous women RR=2.07, 1.66-2.59 non-Indigenous men RR=1.95, 1.56-2.45). All groups were significantly more likely than Indigenous women to receive their final treatment at home. Contemporary dialysis treatment in Australia continues to benefit the dominant non-Indigenous population over the Indigenous population, with non-Indigenous men being particularly advantaged. Implications for Public Health: Treatment guidelines that incorporate a recognition of gender-based preferences and dialysis treatment options specific to Indigenous Australians may assist in addressing this disparity.
Targeted Education ApproaCH to improve Peritoneal Dialysis Outcomes (TEACH-PD): A feasibility study
Publisher: SAGE Publications
Date: 17-01-2020
Abstract: There is substantial variation in peritonitis rates across peritoneal dialysis (PD) units globally. This may, in part, be related to the wide variability in the content and delivery of training for PD nurse trainers and patients. The aim of this study was to test the feasibility of implementing the Targeted Education ApproaCH to improve Peritoneal Dialysis Outcomes (TEACH-PD) curriculum in real clinical practice settings. This study used mixed methods including questionnaires and semi-structured interviews (pretraining and post-training) with nurse trainers and patients to test the acceptability and usability of the PD training modules implemented in two PD units over 6 months. Quantitative data from the questionnaires were analysed descriptively. Interviews were analysed using thematic analysis. Ten PD trainers and 14 incident PD patients were included. Mean training duration to complete the modules were 10.9 h (range 6–17) and 24.9 h (range 15–35), for PD trainers and patients, respectively. None of the PD patients experienced PD-related complications at 30 days follow-up. Three (21%) patients were transferred to haemodialysis due to non-PD–related complications. Ten trainers and 14 PD patients participated in the interviews. Four themes were identified including use of adult learning principles (trainers), comprehension of online modules (trainers), time to complete the modules (trainers) and patient usability of the manuals (patient). This TEACH-PD study has demonstrated feasibility of implementation in a real clinical setting. The outcomes of this study have informed refinement of the TEACH-PD modules prior to rigorous evaluation of its efficacy and cost-effectiveness in a large-scale study.
Post-accretionary exhumation of the Meguma terrane relative to the Avalon terrane in the Canadian Appalachians
Publisher: Elsevier BV
Date: 11-2018
Methods of analysing patterns of multimorbidity using network analysis: a scoping review.
Publisher: Springer Science and Business Media LLC
Date: 21-01-2023
Renal drug dosing recommendations: evaluation of product information for brands of the same drug
Publisher: Wiley
Date: 06-2014
DOI: 10.1111/IMJ.12446
Abstract: To review the product information (PI) for various brands of the same generic drugs and investigate the extent to which information is currently available on dosing in renal impairment and the concordance between the dosing recommendations for the same generic drug. The Monthly Index of Medical Specialities (MIMS) was examined for 28 generic drugs recommended to be used with caution in renal impairment. For each generic drug all available brands listed as having solid oral dosage form were recorded. For each identified brand, the current PI was consulted and data referring to renal impairment was collated. The dissimilarity between these PI regarding the renal dosage recommendation was determined. There was generally a lack of detailed information in the PI on the use of drugs in patients with renal impairment. The majority of PI documents (88 of 155 PI 57%) provided quantitative dosage recommendations, but this was often not detailed enough to help users to make an informed decision. For 37 PI documents (24%), an altered dosage regimen was proposed without a quantifiable measure of renal function reported in the dose recommendation. The renal function severity category terms used and the associated quantitative values were also not consistent. It was observed that the recommendations varied among different brands of hydromorphone, morphine, oxycodone, tramadol, metformin and topiramate. The reporting of renal function quantification methods, and associated dosage recommendations, in PI requires standardisation to ensure optimal drug dosing. Regularly updating of PI is also necessary.
Evaluation of a chronic kidney disease risk assessment service in community pharmacies
Publisher: Wiley
Date: 27-02-2019
DOI: 10.1111/NEP.13247
Abstract: Targeted 'opportunistic' screening might be a sustainable approach for the early detection of people with undiagnosed chronic kidney disease (CKD). The aim of this study was to implement and evaluate a CKD risk assessment service in the community pharmacy setting. Twenty-four pharmacies in Tasmania, Australia participated in this study. Targeted people were aged between 50 and 74 years, with at least one CKD risk factor. The QKidney risk calculator was used to estimate the participants' 5-year percentage risk of developing moderate-severe CKD. Participants identified with ≥3% risk were referred to their general practitioner (GP) and followed-up after 9 months. Laboratory data was collected from a pathology provider. The main outcome measures were rates of GP referral uptake and of participants who underwent estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (ACR) measurement. We analyzed data for 389 screened participants, of whom 203 (52.1%) had ≥3% 5-year risk of developing moderate-severe CKD and were referred to their GP. Follow-up was successful for 126 participants and showed low (27%) GP referral uptake. Analysis of the pathology data revealed suboptimal kidney testing in participants with ≥3% risk, with eGFR and ACR tests performed for only 52.7% and 25.1% of these participants, respectively. There is significant scope for improving early detection of CKD via implementation of a community pharmacy-based CKD risk assessment service. However, a healthcare system that encourages inter-professional collaboration between community pharmacists and GPs, and provides a robust referral pathway is needed to optimize the effectiveness of this service.
Laser ablation (in situ) Lu-Hf dating of magmatic fluorite and hydrothermal fluorite-bearing veins
Publisher: Elsevier BV
Date: 11-2023
Quality use of medicines in patients with chronic kidney disease
Publisher: Springer Science and Business Media LLC
Date: 05-06-2020
DOI: 10.1186/S12882-020-01862-1
Abstract: Chronic kidney disease (CKD) affects drug elimination and patients with CKD require appropriate adjustment of renally cleared medications to ensure safe and effective pharmacotherapy. The main objective of this study was to determine the extent of potentially inappropriate prescribing (PIP defined as the use of a contraindicated medication or inappropriately high dose according to the kidney function) of renally-cleared medications commonly prescribed in Australian primary care, based on two measures of kidney function. A secondary aim was to assess agreement between the two measures. Retrospective analysis of routinely collected de-identified Australian general practice patient data (NPS MedicineWise MedicineInsight from January 1, 2013, to June 1, 2016 collected from 329 general practices). All adults (aged ≥18 years) with CKD presenting to general practices across Australia were included in the analysis. Patients were considered to have CKD if they had two or more estimated glomerular filtration rate (eGFR) recorded values 60 mL/min/1.73m 2 , and/or two urinary albumin/creatinine ratios ≥3.5 mg/mmol in females (≥2.5 mg/mmol in males) at least 90 days apart. PIP was assessed for 49 commonly prescribed medications using the Cockcroft-Gault (CG) equation/eGFR as per the instructions in the Australian Medicines Handbook. A total of 48,731 patients met the Kidney Health Australia (KHA) definition for CKD and had prescriptions recorded within 90 days of measuring serum creatinine (SCr)/estimated glomerular filtration rate (eGFR). Overall, 28,729 patients were prescribed one or more of the 49 medications of interest. Approximately 35% ( n = 9926) of these patients had at least one PIP based on either the Cockcroft-Gault (CG) equation or eGFR (CKD-EPI CKD-Epidemiology Collaboration Equation). There was good agreement between CG and eGFR while determining the appropriateness of medications, with approximately 97% of the medications classified as appropriate by eGFR also being considered appropriate by the CG equation. This study highlights that PIP commonly occurs in primary care patients with CKD and the need for further research to understand why and how this can be minimised. The findings also show that the eGFR provides clinicians a potential alternative to the CG formula when estimating kidney function to guide drug appropriateness and dosing.
Plasma levels of enoxaparin oligosaccharides, antifactor-Xa and thrombin generation in patients undergoing haemodialysis
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2020
Variation in Documenting Diagnosable Chronic Kidney Disease in General Medical Practice: Implications for Quality Improvement and Research
Publisher: SAGE Publications
Date: 2019
Abstract: Background: National health surveys indicate that chronic kidney disease (CKD) is an increasingly prevalent condition in Australia, placing a significant burden on the health budget and on the affected in iduals themselves. Yet, there are relatively limited data on the prevalence of CKD within Australian general practice patients. In part, this could be due to variation in the terminology used by general practitioners (GPs) to identify and document a diagnosis of CKD. This project sought to investigate the variation in terms used when recording a diagnosis of CKD in general practice. Methods: A search of routinely collected de-identified Australian general practice patient data (NPS MedicineWise MedicineInsight from January 1, 2013, to June 1, 2016 collected from 329 general practices) was conducted to determine the terms used. Manual searches were conducted on coded and on “free-text” or narrative information in the medical history, reason for encounter, and reason for prescription data fields. Results: From this data set, 61 102 patients were potentially diagnosable with CKD on the basis of pathology results, but only 14 172 (23.2%) of these had a term representing CKD in their electronic record. Younger patients with pathology evidence of CKD were more likely to have documented CKD compared with older patients. There were a total of 2090 unique recorded documentation terms used by the GPs for CKD. The most commonly used terms tended to be those included as “pick-list” options within the various general practice software packages’ standard “classifications,” accounting for 84% of use. Conclusions: A diagnosis of CKD was often not documented and, when recorded, it was in a variety of ways. While recording CKD with various terms and in free-text fields may allow GPs to flexibly document disease qualifiers and enter patient specific information, it might inadvertently decrease the quality of data collected from general practice records for clinical audit or research purposes.
Stability of the Combination of Ceftazidime and Cephazolin in Icodextrin or PH Neutral Peritoneal Dialysis Solution
Publisher: SAGE Publications
Date: 03-2013
Abstract: The objective of this study was to investigate the stability of ceftazidime and cephazolin in a 7.5% icodextrin or pH neutral peritoneal dialysis (PD) solution. Ceftazidime and cephazolin were injected into either a 7.5% icodextrin or pH neutral PD bag to obtain the concentration of 125 mg/L of each antibiotic. A total of nine 7.5% icodextrin or pH neutral PD bags containing ceftazidime and cephazolin were prepared and stored at 1 of 3 different temperatures: 4°C in a domestic refrigerator 25°C at room temperature or 37°C (body temperature) in an incubator. An aliquot was withdrawn immediately before (0 hour) or after 12, 24, 48, 96, 120, 144, 168 and 336 hours of storage. Each s le was analyzed in duplicate for the concentration of ceftazidime and cephazolin using a stability-indicating high-performance liquid chromatography technique. Ceftazidime and cephazolin were considered stable if they retained more than 90% of their initial concentration. S les were also assessed for pH, colour changes and evidence of precipitation immediately after preparation and on each day of analysis. Ceftazidime and cephazolin in both types of PD solution retained more than 90% of their initial concentration for 168 and 336 hours respectively when stored at 4°C. Both of the antibiotics lost more than 10% of the initial concentration after 24 hours of storage at 25 or 37°C. There was no evidence of precipitation at any time under the tested storage conditions. Change in the pH and color was observed at 25 and 37°C, but not at 4°C. Premixed ceftazidime and cephazolin in a 7.5% icodextrin or pH neutral PD solution is stable for at least 168 hours when refrigerated. This allows the preparation of PD bags in advance, avoiding the necessity for daily preparation. Both the antibiotics are stable for at least 24 hours at 25 and 37°C, permitting storage at room temperature and pre-warming of PD bags to body temperature prior to its administration.
Plasma cell infiltrates and renal allograft outcomes in indigenous and non‐indigenous people of the Northern Territory of Australia
Publisher: Wiley
Date: 27-10-2011
DOI: 10.1111/J.1440-1797.2011.01487.X
Abstract: Plasma cell-rich rejection is a distinct histological phenomenon associated with poor renal allograft outcomes. Aboriginal and Torres Straight Islander (ATSI) transplant recipients have poorer allograft survival and higher rates of acute rejection. We sought to determine whether a higher incidence of plasma cell-rich infiltrates (PCIR) could account for poorer survival. Renal transplant biopsies performed in recipients from the Northern Territory of Australia between 1985 and 2007 were reviewed and correlated with outcome. Biopsies were designated PCIR positive when plasma cells constituted >10% of the interstitial infiltrate. Four hundred and seventy-seven biopsies from 177 recipients (108 ATSI) were performed. Median graft survival was shorter for recipients with PCIR: 4.0 years (interquartile range 2.18-6.41) versus 5.4 years (2.0-9.99) (P = 0.013). ATSI recipients had higher rates of plasma cell-rich rejection (RR 1.76, 95% CI 1.43-2.17, P 20% (RR 1.29, 95% CI 1.03-1.56, P = 0.025), ≥5 human leukocyte antigen mismatches (RR 1.91, 1.41-2.58, p 10 infections RR 5.11, 1.69-15.5, P = 0.004), and subsequent death from septicaemia (RR 1.6, 1.17-2.18, P = 0.003). PCIR is associated with infection and markers of chronic immunological stimulation but does not independently contribute to inferior renal allograft outcomes, even in ATSI recipients.
Blockade of Macrophage Migration Inhibitory Factor Does Not Prevent Acute Renal Allograft Rejection
Publisher: Elsevier BV
Date: 09-2003
DOI: 10.1034/J.1600-6143.2003.00188.X
Abstract: Macrophage migration inhibitory factor (MIF) is a pro-inflammatory molecule involved in cell-mediated immunity and delayed-type hypersensitivity (DTH). We inhibited systemic and local MIF production to determine its contribution to acute rejection (AR). Skin DTH response and acute rejection of skin and kidney allografts were examined using MIF gene knockout (MIF -/-) and wild-type mice (MIF +/+) with anti-MIF or control antibody. MIF-Ab reduced skin DTH by 60% (p < 0.01), but absence of the MIF gene (MIF -/-) had no effect. Local absence of MIF had no effect on the survival of skin grafted onto BALB/c recipients. Similarly MIF +/+ and MIF -/- kidneys transplanted into BALB/c recipients showed a similar degree of histological rejection, graft dysfunction and cellular infiltrate suggesting that AR is not dependent on local MIF production. To investigate the influence of systemic MIF, BALB/c donor skin was grafted onto MIF +/+ and MIF -/- mice. The tempo of AR was not altered by systemic absence of MIF (MIF-Ab or MIF -/-). BALB/c kidneys transplanted into MIF +/+ (with or without MIF-Ab) and MIF -/- mice showed similar parameters of rejection. MIF blockade reduces the DTH response however, neither local nor systemic MIF are required for the rejection of fully mismatched skin and renal allografts.
Infectious complications in the Southern Tasmanian kidney transplant population.
Publisher: Wiley
Date: 25-04-2019
DOI: 10.1111/NEP.13482
Abstract: Examine the incidence of suspected and proven infections, the range of infections, antimicrobial use and hospital admissions in kidney transplant recipients (KTx) in southern Tasmania. An audit of the medical records of KTx managed by the Royal Hobart Hospital for the period 1 January 2015 to 31 December 2016. Data were collected on positive microbiological investigations, antimicrobial use and hospital admissions. Of the 151 evaluable KTx, there were 339 episodes of suspected infection in 95 (63%) patients with a preponderance of urinary tract infections. Overall, these 95 KTx received a total of 249 courses of antimicrobials, with predominantly monotherapy (n = 101, 65%). There were 11 vaccine preventable infections, including herpes zoster (n = 7), Influenza A (n = 3) and invasive pneumococcal disease (n = 1). Hospitalization was required for 50 infectious episodes, for a total of 227 admitted bed days (median 4 interquartile range 2-7 range 1-18 days). In conclusion, episodes of infection, hospitalization, antimicrobial use and development of multi-resistant organisms are common following kidney transplantation in this southern Tasmanian cohort. This study has identified several areas of focus for improved patient care including antimicrobial management of urinary tract infections, implementation of programmes to vaccinate KTx prior to transplantation, and development of transplantation specific antimicrobial stewardship programmes.
Tectono-thermal evolution of the southwestern Alxa Tectonic Belt, NW China: Constrained by apatite U-Pb and fission track thermochronology
Publisher: Elsevier BV
Date: 2018
Association of continuity of care with blood pressure control in patients with chronic kidney disease and hypertension
Publisher: The Royal Australian College of General Practitioners
Date: 05-2019
A web-based training program to support chronic kidney disease screening by community pharmacists
Publisher: Springer Science and Business Media LLC
Date: 21-06-2016
DOI: 10.1007/S11096-016-0330-5
Abstract: Background Community pharmacists' role in screening of several chronic diseases has been widely explored. The global health burden of chronic kidney disease is high however, the progression and adverse outcomes can be prevented or delayed by detecting and treating the disease in its initial stages 1-3. Therefore, a web-based training program was developed to enhance pharmacists' knowledge and skills required to perform a chronic kidney disease screening service in a community setting. Objective The aim of this study was to evaluate the impact of a web-based training program on community pharmacists' knowledge and skills associated with chronic kidney disease screening. As secondary aim, pharmacists' satisfaction with the training program was assessed. Setting Community pharmacy practice. Method A web-based training program was developed by four pharmacists and a nephrologist. Quantitative data was collected by employing a self-administered, web-based questionnaire, which comprised a set of five multiple-choice knowledge questions and one clinical vignette to assess skills. A nine-item Likert scale was used to determine pharmacists' satisfaction with the training program. Main outcome measure Pharmacists' knowledge and skills scores at pre and post-training, reliability of the Likert scale, and the proportion of responses to the in idual nine items of the satisfaction survey. Results Fifty pharmacists participated in the pre-questionnaire and 38 pharmacists completed the web-based training and post-questionnaire. Significant differences were observed in the knowledge scores (p < 0.001) and skills scores (p < 0.001) at pre- and post-training. Cronbach's alpha for the nine-item satisfaction scale was 0.73 and the majority pharmacists (92.1-100 %) were satisfied with the various aspects of the training program. Conclusion The web-based training program positively enhanced pharmacists' knowledge and skills associated with chronic kidney disease screening. These findings support further development and widespread implementation of the training program to facilitate health promotion and early identification of chronic kidney disease in a community setting.
Evaluating data quality in the Australian and New Zealand dialysis and transplant registry using administrative hospital admission datasets and data-linkage
Publisher: SAGE Publications
Date: 11-06-2022
DOI: 10.1177/18333583221097724
Abstract: Background: Clinical quality registries provide rich and useful data for clinical quality monitoring and research purposes but are susceptible to data quality issues that can impact their usage. Objective: This study assessed the concordance between comorbidities recorded in the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry and those in state-based hospital admission datasets. Method: All patients in New South Wales, South Australia, Tasmania, Victoria and Western Australia recorded in ANZDATA as requiring chronic kidney replacement therapy (KRT) between 01/07/2000 and 31/12/2015 were linked with state-based hospital admission datasets. Coronary artery disease, diabetes mellitus, cerebrovascular disease, chronic lung disease and peripheral vascular disease recorded in ANZDATA at each annual census date were compared overall, over time and between different KRT modalities to comorbidities recorded in hospital admission datasets, as defined by the International Classification of Diseases (ICD-10-AM), using both the kappa statistic and logistic regression analysis. Results: 29, 334 patients with 207,369 hospital admissions were identified. Comparison was made at census date for every patient comparison. Overall agreement was “very good” for diabetes mellitus (92%, k = 0.84) and “poor” to “fair” (21–61%, k = 0.02–0.22) for others. Diabetes mellitus recording had the highest accuracy (sensitivity 93% (±SE 0.2) and specificity 93% (±SE 0.2)), and cerebrovascular disease had the lowest (sensitivity 54% (±SE 0.2) and specificity 21% (±SE 0.3)). The false positive rates for cerebrovascular disease, peripheral vascular disease and chronic airway disease ranged between 18 and 33%. The probability of a false positive was lowest for kidney transplant patients for all comorbidities and highest for patients on haemodialysis. Conclusions and Implications: Agreement between the clinical quality registry and hospital admission datasets was variable, with the prevalence of comorbidities being higher in ANZDATA.
Thermal history of the northern Olympic Domain, Gawler Craton; correlations between thermochronometric data and mineralising systems
Publisher: Elsevier BV
Date: 04-2018
Effects of allopurinol on the progression of chronic kidney disease
Publisher: Massachusetts Medical Society
Date: 25-06-2020
Temporal changes and risk factors for death from early withdrawal within 12 months of dialysis initiation - a cohort study
Publisher: Oxford University Press (OUP)
Date: 27-06-2022
DOI: 10.1093/NDT/GFAB207
Abstract: Mortality risk is high soon after dialysis initiation in patients with kidney failure, and dialysis withdrawal is a major cause of early mortality, attributed to psychosocial or medical reasons. The temporal trends and risk factors associated with cause-specific early dialysis withdrawal within 12 months of dialysis initiation remain uncertain. Using data from the Australia and New Zealand Dialysis and Transplant Registry, we examined the temporal trends and risk factors associated with mortality attributed to early psychosocial and medical withdrawals in incident adult dialysis patients in Australia between 2005 and 2018 using adjusted competing risk analyses. Of 32 274 incident dialysis patients, 3390 (11%) experienced death within 12 months post-dialysis initiation. Of these, 1225 (36%) were attributed to dialysis withdrawal, with 484 (14%) psychosocial withdrawals and 741 (22%) medical withdrawals. These patterns remained unchanged over the past two decades. Factors associated with increased risk of death from early psychosocial and medical withdrawals were older age, dialysis via central venous catheter, late referral and the presence of cerebrovascular disease obesity and Asian ethnicity were associated with decreased risk. Risk factors associated with early psychosocial withdrawals were underweight and higher socioeconomic status. Presence of peripheral vascular disease, chronic lung disease and cancers were associated with early medical withdrawals. Death from dialysis withdrawal accounted for & % of early deaths in kidney failure patients initiated on dialysis and remained unchanged over the past two decades. Several shared risk factors were observed between mortality attributed to early psychosocial and medical withdrawals.
A systematic review of cost-effectiveness analyses of continuous versus intermittent renal replacement therapy in acute kidney injury
Publisher: Informa UK Limited
Date: 02-05-2021
DOI: 10.1080/14737167.2021.1916471
Abstract: Though cost-effectiveness analyses (CEAs) have evaluated continuous renal replacement therapy (RRTs) and intermittent RRTs in acute kidney injury (AKI) patients it is yet to establish which RRT technique is most cost-effective. We systematically reviewed the current evidence from CEAs of CRRT versus IRRT in patients with AKI. PubMed, EMBASE, and Cochrane databases searched for CEAs comparing two RRTs. Overall, seven CEAs, two from Brazil and one from US, Canada, Colombia, Belgium, and Argentina were included. Five CEAs used Markov model, three reported following CHEERS, none accounted indirect costs. Time horizon varied from 1-year-lifetime. Marginal QALY gain with CRRT compared to IRRT was reported across CEAs. Older CEAs found CRRT to be costlier and not cost-effective than IRRT (ICER 2019 US$: 152,671$/QALY) latest CEAs (industry-sponsored) reported CRRT to be cost-saving versus IRRT (-117,614$/QALY). Risk of mortality, dialysis dependence, and incidence of renal recovery were the key drivers of cost-effectiveness. CEAs of RRTs for AKI show conflicting findings with secular trends. Latest CEAs suggested CRRT to be cost-effective versus IRRT with dialysis dependence rate as major driver of cost-effectiveness. Future CEAs, preferably non-industry sponsored, may account for indirect costs to improve the generalizability of CEAs.
An apatite U–Pb thermal history map for the northern Gawler Craton, South Australia
Publisher: Elsevier BV
Date: 09-2018
In situ Lu–Hf phosphate geochronology: Progress towards a new tool for space exploration
Publisher: Elsevier BV
Date: 05-2022
Use of Patient-Reported Outcome Measures and Patient-Reported Experience Measures in Renal units in Australia and New Zealand: a Cross-sectional Survey Study
Publisher: Wiley
Date: 05-2019
DOI: 10.1111/NEP.13577
Abstract: Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are increasingly used in research to quantify how patients feel and function, and their experiences of care, however, knowledge of their utilization in routine nephrology is limited. The Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) PROMs working group conducted a prospective cross-sectional survey of PROMs/PREMs use among renal 'parent hospitals'. One survey per hospital was completed (August-November 2017). Descriptive statistics reported type and frequency of measures used and purpose of use. Survey response rate was 100%. Fifty-five of 79 hospitals (70%) used at least one PROMs or PREMs for specific patient groups. PROMs were more likely to be collected from patients receiving comprehensive conservative care (45% of hospitals) than dialysis patients (32%, 31% and 28% of hospitals for home haemodialysis, peritoneal dialysis and facility dialysis, respectively). Few renal transplanting hospitals (3%) collected PROMs. The Integrated Palliative Outcome Scale-Renal (IPOS-Renal) (40% of units), and the Euro-Qol (EQ-5D-5 L) (25%), were most frequently used. The main reason for collecting PROMs was to inform clinical care (58%), and for PREMs was to fulfil private dialysis/hospital provider requirements (25%). The most commonly reported reason for not using PROMs in 24 hospitals was insufficient staff resources (79%). Sixty-two hospitals (78%) expressed interest in participating in a registry-based PROMs trial. Many renal hospitals in Australia and New Zealand collect PROMs and/or PREMs as part of clinical care with use varying by treatment modality. Resources are a key barrier to PROMs use.
Intracontinental Fault Reactivation in High Heat Production Areas of Central Australia: Insights From Apatite Fission Track Thermochronology
Publisher: American Geophysical Union (AGU)
Date: 12-2022
DOI: 10.1029/2022GC010559
Abstract: Pervasive intracontinental orogenesis during the Paleozoic has been widely recognized in the metamorphic and structural records of the Aileron Province and Amadeus Basin in central Australia, commonly attributed to the Ordovician–Carboniferous Alice Springs Orogeny. Comparatively less clear, however, is the magnitude and geographic expression of this event elsewhere in the North Australian Craton. This study presents new apatite fission track thermochronology data from central Australia which demonstrate considerable Paleozoic reactivation across the continental interior. Both the Tennant region and Murphy Province exhibit low‐temperature cooling coeval with the Alice Springs Orogeny (ca. 450–320 Ma), although Triassic reactivation in the Aileron Province correlates with the timing of the Hunter‐Bowen Orogeny (ca. 265–230 Ma) in eastern Australia. High heat production and metasomatism within the Aileron Province has made the region highly susceptible to reactivation, rendering it more vulnerable to subsequent reactivation in response to far‐field stresses during the progressive Tasmanides development.
Emplacement and exhumation of the Kuznetsk-Alatau basement (Siberia): Implications for the tectonic evolution of the Central Asian Orogenic Belt and sediment supply to the Kuznetsk, Minusa and West Siberian Basins
Publisher: Wiley
Date: 31-05-2011
Formation and palaeozoic evolution of the gorny-altai-altai-mongolia suture zone (south siberia): Zircon u/pb constraints on the igneous record
Publisher: Elsevier BV
Date: 09-2011
Acute kidney injury, stroke and death after cardiopulmonary bypass surgery: the role of perfusion flow and pressure
Publisher: SAGE Publications
Date: 09-06-2020
Abstract: Acute kidney injury after cardiopulmonary bypass surgery is associated with morbidity and mortality. This study aims to evaluate the role of low perfusion flow and pressure in the development of cardiopulmonary bypass–associated acute kidney injury, stroke and death, using multicentre registry data. We identified patients from the Australian and New Zealand Collaborative Perfusion Registry who underwent coronary artery bypass grafting and/or valvular surgery between 2008 and 2018. Primary predictor variables were the length of time the perfusion flow was .6 L/min/m 2 and the length of time perfusion pressure was 50mmHg. The primary outcome was new postoperative acute kidney injury defined by the risk-injury-failure-loss-end stage criteria. Secondary outcomes were stroke and in-hospital death. The influence of perfusion flow and pressure during cardiopulmonary bypass on the primary and secondary outcomes was estimated using separate multivariate models. A total of 16,356 patients were included. The mean age was 66 years and 75% were male. Acute kidney injury was observed in 1,844 patients (11%), stroke in 204 (1.3%) and in-hospital death in 286 (1.8%). Neither the duration of the time spent for perfusion flow ( .6 L/minute/m 2 ) nor the duration of the time spent for perfusion pressure ( mmHg) was associated with postoperative acute kidney injury, stroke or death in adjusted models. Neither low perfusion pressure nor low perfusion flow during cardiopulmonary bypass were predictive of postoperative acute kidney injury, stroke or death.
In-situ calcite U-Pb geochronology of hydrothermal veins in Thailand: New constraints on Indosinian and Cenozoic deformation
Publisher: Elsevier BV
Date: 02-2021
Fatal Dialysis Vascular Access Hemorrhage
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1053/J.AJKD.2017.05.014
Abstract: Bleeding from dialysis vascular access (arteriovenous fistulas, arteriovenous grafts, and vascular catheters) is uncommon. Death from these bleeds is rare and likely to be under-reported, with incident rates of fewer than 1 episode for every 1,000 patient-years on dialysis, meaning that dialysis units may experience this catastrophic event only once a decade. There is an opportunity to learn from (and therefore prevent) these bleeding deaths. We reviewed all reported episodes of death due to vascular access bleeding in Australia and New Zealand over a 14-year period together with in idual dialysis units' root cause analyses on each event. In this perspective, we provide a clinically useful summary of the evidence and knowledge gained from these rare events. Our conclusion is that death due to dialysis vascular access hemorrhage is an uncommon, catastrophic, but potentially preventable event if the right policies and procedures are put in place.
Exhumation history of the Peake and Denison Inliers: insights from low-temperature thermochronology
Publisher: Informa UK Limited
Date: 02-10-2016
Thermal history and differential exhumation across the Eastern Musgrave Province, South Australia: Insights from low-temperature thermochronology
Publisher: Elsevier BV
Date: 04-2017
Chronic kidney disease monitoring in Australian general practice
Publisher: The Royal Australian College of General Practitioners
Date: 03-2019
Older patient considering treatment for advanced renal disease: protocol for a scoping review of the information available for shared decision-making
Publisher: BMJ
Date: 12-2016
Northern Australian kidney transplant unit: A viable option?
Publisher: Wiley
Date: 07-05-2007
DOI: 10.1111/J.1440-1797.2007.00798.X
Abstract: Kidney transplant units in Australia are confined to large hospitals in major metropolitan areas, yet this may limit access and diminish outcomes in people who do not live in these large centres. The authors examined the viability of a kidney transplant unit located in northern Australia (NA), with particular emphasis on recipient outcomes and the number of donors. 'Northern Australia' was arbitrarily defined as 'north of the tropic of Capricorn' for Queensland and Western Australia and included the entire Northern Territory. Data on donors and transplant recipients were provided by ANZDATA and ANZOD registries, identified by postcode. Between 1998 and 2004 in NA there were 163 deceased donor kidneys and 97.5% of available organs were transplanted. There were no Aboriginal/Torres Strait Islander (ATSI) donors from NA. Recipients from NA in this time included 55 patients receiving living grafts and 156 receiving deceased donor grafts, of whom 36% were ATSI, making up half of the total ATSI transplanted in Australia during this time period. Compared with the rest of Australia, NA recipients were older, waited longer on dialysis, had longer ischaemic times and a greater number of human leucocyte antigen mismatches, and were more likely to be diabetic and obese. Despite the longer cold ischaemic time in NA recipients, no difference in immediate graft function was seen. ATSI recipients in NA, when compared with their southern Australian counterparts, had poorer patient survival (HR=3.19, 95% CI 1.44-7.08, P<0.001), but equivalent graft survival (HR=1.67, 95% CI 0.95-2.95, P=not significant) on multivariate analysis. Key factors that would influence feasibility of a Northern Australian transplant unit include adequate staffing, and support services in addition to currently available resources. Current donor numbers in NA are adequate for past recipients of kidney transplant, but may not cover future needs without a significant increase in donor rate. A transplant unit situated in northern Australian would require significant resources to ensure long-term viability and its effect on outcomes is uncertain.
Symptoms and their recognition in adult haemodialysis patients: Interactions with quality of life
Publisher: Wiley
Date: 16-02-2017
DOI: 10.1111/NEP.12754
Abstract: We investigated the symptom burden in adults on haemodialysis, the recognition of symptoms by nurses and nephrologists, and the relationship between symptoms and quality of life. In this cross-sectional observational study, symptoms and quality of life in haemodialysis patients were determined using validated surveys. Nurses and nephrologists independently estimated their patients' symptoms, and these estimates were compared with patient responses (sensitivity kappa values for interrater agreement). Associations between symptoms and quality of life were assessed using multi-level regression. Forty-three patients, 18 nurses and 3 nephrologists participated. The commonest symptoms (95%CI) reported by patients were weakness, 69% (53 to 82) poor mobility, 44% (29 to 60) and drowsiness, 44% (29 to 60). Sensitivity less than 50% was seen towards 11 of 17 symptoms in nurse ratings compared with 15 of 17 in nephrologist ratings. Agreement with patient symptom ratings was mostly 'fair' (0.21-0.4), with nurses' scores showing greater agreement than nephrologists'. Physical, mental and kidney disease component summary scores of quality of life were negatively associated with total symptom score and the number of 'major' symptoms (r Symptom burden worsened quality of life scores in haemodialysis patients. Clinician recognition of symptom burden was inaccurate, although nurses were more accurate than nephrologists. Using patient-completed surveys or including dialysis nurse feedback in routine outpatient settings may help improve symptom recognition by nephrologists.
Stability of Tigecycline in Different Types of Peritoneal Dialysis Solutions
Publisher: SAGE Publications
Date: 07-2016
Abstract: Intraperitoneal tigecycline is a potential option for the treatment of peritoneal dialysis (PD)-associated peritonitis caused by microorganisms resistant to commonly used antibiotics. However, the stability of tigecycline must be assessed in the PD solution before evaluating its safety and therapeutic efficacy in PD-associated peritonitis. The objective of this study was to investigate the stability of tigecycline in 3 types of PD solutions at different temperatures for various time points. A total of 27 PD bags (9 PD bags for each type of PD solution 1.5% glucose, 7.5% icodextrin, and 1.5% glucose pH neutral) containing 2 μg/mL of tigecycline were prepared and stored at either 4, 25, or 37°C. An aliquot was withdrawn immediately before (0 hour) and after pre-defined time points. Each s le was analyzed in duplicate for the concentration of tigecycline using a stability-indicating high-performance liquid chromatography (HPLC) technique. S les were also assessed for pH, color changes, and evidence of precipitation immediately after preparation and on each day of analysis. Tigecycline in all 3 types of PD solutions retained more than 90% of its initial concentration for at least 216, 72, and 8 hours at 4, 25, and 37°C, respectively. There was no evidence of precipitation at any time under the tested storage conditions. The pH and color of tigecycline admixed PD solutions stored at 4, 25, and 37°C remained essentially unchanged for 336, 96, and 48 hours respectively. The results obtained from the study provide a platform for future clinical studies aiming to determine the safety and therapeutic efficacy of intraperitoneally administered tigecycline for the treatment of PD-associated peritonitis.
Chronic Kidney Disease in Tasmania: Protocol for a Data Linkage Study (Preprint)
Publisher: JMIR Publications Inc.
Date: 12-05-2020
Abstract: hronic kidney disease (CKD) is a significant and growing health burden globally. Tasmania has the highest state prevalence for non-Indigenous Australians and it has consistently had the lowest incidence and prevalence of dialysis in Australia. o examine the gap between the high community prevalence of CKD in Tasmania and the low use of dialysis. his is a retrospective cohort study using linked data from 5 health and 2 pathology data sets from the island state of Tasmania, Australia. The study population consists of any person (all ages including children) who had a blood measurement of creatinine with the included pathology providers between January 1, 2004, and December 31, 2017. This study population (N=460,737) includes within it a CKD cohort, which was detected via pathology or documentation of kidney replacement therapy (KRT dialysis or kidney transplant). Kidney function (estimated glomerular filtration rate [eGFR]) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. In iduals with 2 measures of eGFR& mL/min/1.73 m sup /sup , at least 90 days apart, were identified as having CKD and were included in the CKD cohort. In iduals treated with dialysis or transplant were identified from the Australia and New Zealand Dialysis and Transplant Registry. he study population consisted of 460,737 people (n=245,573 [53.30%] female, mean age 47.4 years) who were Tasmanian residents aged 18 years and older and were followed for a median of 7.8 years. During the later 5 years of the study period, 86.79% (355,622/409,729) of Tasmanian adults were represented. The CKD cohort consisted of 56,438 people (ie, 12.25% of the study population 53.87% (30,405/56,438) female, mean age 69.9 years) followed for a median of 10.4 years with 56,039 detected via eGFR and 399 people detected via documentation of KRT. Approximately half (227,433/460,737, 49.36%) of the study population and the majority of the CKD cohort (41,448/56,438, 73.44%) had an admission episode. Of the 55,366 deaths recorded in the study population, 45.10% (24,970/55,366) had CKD. hole-of-population approaches to examine CKD in the community can be achieved by data linkage. Over this 14-year period, CKD affected 12.25% (56,438/460,737) of Tasmanian adult residents and was present in 45.10% (24,970/55,366) of deaths. ERR1-10.2196/20160
A detective duo of apatite and zircon geochronology for East Avalonia, Johnston Complex, Wales
Publisher: Geological Society of London
Date: 05-05-2023
DOI: 10.1144/JGS2022-178
Abstract: The Johnston Complex represents a rare inlier of the Neoproterozoic basement of southern Britain and offers a window into the tectonomagmatic regime of East Avalonia during the assembly of Gondwana. This work presents in situ zircon (U–Pb, Lu–Hf), apatite (U–Pb), and trace element chemistry for both minerals from the complex. Zircon and apatite yield a coeval crystallization age of 570 ± 3 Ma, and a minor antecrystic zircon core component is identified at 615 ± 11 Ma. Zircon Hf data imply a broadly chondritic source, comparable to Nd data from East Avalonia, and T DM 2 model ages of c. 1.5 Ga indicate source extraction during the Mesoproterozoic. Zircon trace element chemistry is consistent with an ensialic calc-alkaline continental arc setting and demonstrates that magmatism was ongoing prior to terrane dispersal at 570 Ma. Apatite trace element chemistry implies a sedimentary component within the melt consistent with voluminous S-type granite production during the formation of Gondwana. The similarity of the ɛHf and geochemistry between both zircon age populations suggest derivation from a uniform source that did not undergo significant modification between 615–570 Ma. Time-constrained apatite–zircon chemistry addresses complexities in dating S-type granitoids (zircon inheritance) and permits inferences on post-magmatic thermal histories. Supplementary material: Zircon U–Pb, Lu–Hf and trace element data, and apatite U–Pb and trace element data are available at 0.6084/m9.figshare.c.6484464
Data analysis of the U–Pb geochronology and Lu–Hf system in zircon and whole-rock Sr, Sm–Nd and Pb isotopic systems for the granitoids of Thailand
Publisher: Elsevier BV
Date: 12-2018
Overview of dialysis in indigenous compared to nonindigenous Australians
Publisher: Dustri-Verlgag Dr. Karl Feistle
Date: 12-2016
DOI: 10.5414/CNP86S119
Calibration methods for laser ablation Rb–Sr geochronology: comparisons and recommendation based on NIST glass and natural reference materials
Publisher: Copernicus GmbH
Date: 12-09-2023
In situ laser ablation Lu–Hf geochronology of garnet across the Western Gneiss Region: campaign-style dating of metamorphism
Publisher: Geological Society of London
Date: 17-12-2021
DOI: 10.1144/JGS2021-094
Abstract: The development of in situ laser ablation Lu–Hf geochronology of apatite, xenotime and garnet has opened avenues to quickly and directly date geological processes. We demonstrate the first use of c aign-style in situ Lu–Hf geochronology of garnet across the high- to ultrahigh-pressure Western Gneiss Region in Norway. Mafic eclogites from this region have been the focus of much work, and were clearly formed during continental subduction during the Caledonian Orogeny. However, abundant quartzofeldspathic and pelitic lithologies record a more complex history, with some preserving polymetamorphic age data, and most containing no indication of high-pressure mineral assemblages formed during subduction. Twenty metapelitic and felsic s les spanning 160 lateral kilometres across the Western Gneiss Region have been analysed using garnet Lu–Hf geochronology. The results reveal Caledonian ages for the majority of the garnets, suggesting that some quartzofeldspathic and metapelitic lithologies were reactive and grew garnet during high- to ultrahigh-pressure metamorphism. However, two ultrahigh-pressure eclogite locations, Verpeneset and Fjørtoft, preserve both Caledonian and Neoproterozoic-aged garnets. Despite significant uncertainties on some of the Lu–Hf geochronological ages, laser ablation Lu–Hf efficiently identifies the polymetamorphic history of parts of the Western Gneiss Region, illustrating the effectiveness of this novel analytical method for rapid mapping of metamorphic ages. Supplementary material: All laser ablation Lu–Hf geochronological data for the garnets analysed in this study are available at 0.6084/m9.figshare.c.5715453 Thematic collection: This article is part of the Caledonian Wilson cycle collection available at: c/caledonian-wilson-cycle
Late Palaeozoic and Meso-Cenozoic tectonic evolution of the southern Kyrgyz Tien Shan: Constraints from multi-method thermochronology in the Trans-Alai, Turkestan-Alai segment and the southeastern Ferghana Basin
Publisher: Elsevier BV
Date: 2012
The thermo-tectonic history of the Song-Kul plateau, Kyrgyz Tien Shan: Constraints by apatite and titanite thermochronometry and zircon U/Pb dating
Publisher: Elsevier BV
Date: 11-2011
Probing into Thailand's basement: New insights from U–Pb geochronology, Sr, Sm–Nd, Pb and Lu–Hf isotopic systems from granitoids
Publisher: Elsevier BV
Date: 11-2018
Spatial and temporal variation in detrital zircon age provenance of the hydrocarbon-bearing upper Roper Group, Beetaloo Sub-basin, Northern Territory, Australia
Publisher: Elsevier BV
Date: 2018
From microanalysis to supercontinents: Insights from the Rio Apa Terrane into the Mesoproterozoic SW Amazonian Craton evolution during Rodinia assembly
Publisher: Wiley
Date: 24-11-2021
DOI: 10.1111/JMG.12641
Abstract: Deciphering the tectono‐metamorphic evolution of Precambrian terranes can be difficult due to reworking by later superimposed events. Whole‐rock elemental and isotopic geochemistry and zircon U–Pb geochronology are often employed in those studies, but these approaches are often not sensitive to the presence of multiple events and medium‐grade metamorphic episodes. The Rio Apa Terrane (RAT), an allochthonous fragment of the Amazonian Craton, is a crustal block with a well‐characterized crustal evolution but with no detailed thermal constraints for its tectono‐metamorphic evolution. In contrast to previous studies, we show the existence of four tectono‐metamorphic events at c . 1,780, c . 1,625, c . 1,420–1,340, and c . 1,300–1,200 Ma on the basis of apatite, titanite, and rutile U–Pb, in situ white‐mica Rb–Sr, and in situ garnet Lu–Hf geochronology combined with mineral chemistry and phase‐equilibria modelling. The c . 1,780 Ma event is recorded in the basement of the Western domain, representing an extensional event coeval with the development of its Eastern domain in response to the retreat stage of the accretionary system. This is followed by juxtaposition of the Western and Eastern domains along a major crustal boundary at c . 1,625 Ma, which is defined by the magnetic profiles and zircon U–Pb–Hf data across the boundary. The third and fourth events correspond to progressive high‐pressure/medium‐temperature (HP/MT) metamorphism, characterized by an anticlockwise P–T path, suggesting a convergent‐to‐collisional tectonic setting. The RAT was accreted to the adjoining Paraguá Terrane at c . 1,420–1,340 Ma under an isobaric P–T evolution spanning ~530°C to 600°C and ~10.0 kbar. Subsequently, the combined Rio Apa and Paraguá terranes collided with the SW Amazonian Craton at c . 1,300–1,200 Ma, reaching P–T conditions of ~560–580°C and ~10.9–11.7 kbar during crustal thickening. This study reveals for the first time the existence of a HP/MT metamorphic evolution related to the growth of the SW Amazonian Craton as part of an accretionary orogenic system during Rodinia assembly in the Palaeoproterozoic to Mesoproterozoic.
Differential Exhumation and Crustal Tilting in the Easternmost Tianshan (Xinjiang, China), Revealed by Low‐Temperature Thermochronology
Publisher: American Geophysical Union (AGU)
Date: 10-2017
DOI: 10.1002/2017TC004574
Peritoneal dialysis practice in Australia and New Zealand: A call to action
Publisher: Wiley
Date: 23-12-2011
DOI: 10.1111/J.1440-1797.2010.01390.X
Abstract: Peritoneal dialysis technique survival in Australia and New Zealand is lower than in other parts of the world. More than two-thirds of technique failures are related to infective complications (predominantly peritonitis) and 'social reasons'. Practice patterns vary widely and more than one-third of peritoneal dialysis units do not meet the International Society of Peritoneal Dialysis minimum accepted peritonitis rate. In many cases, poor peritonitis outcomes reflect significant deviations from international guidelines. In this paper we propose a series of practical recommendations to improve outcomes in peritoneal dialysis patients through appropriate patient selection, prophylaxis and treatment of infectious complications, investigation of social causes of technique failure and a greater focus on patient education and clinical governance.
Chronic kidney disease in the Top End of the Northern Territory of Australia, 2002–2011: a retrospective cohort study using existing laboratory data
Publisher: Springer Science and Business Media LLC
Date: 22-10-2015
Footprints of the Alice Springs Orogeny preserved in far northern Australia: an application of multi-kinetic thermochronology in the Pine Creek Orogen and Arnhem Province
Publisher: Geological Society of London
Date: 17-12-2021
DOI: 10.1144/JGS2020-173
Kidney Transplant Outcomes in the Indigenous Population in the Northern Territory of Australia
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-10-2006
Tracking the Cretaceous transcontinental Ceduna River through Australia: The hafnium isotope record of detrital zircons from offshore southern Australia
Publisher: Elsevier BV
Date: 03-2016
The low-temperature thermo-tectonic evolution of the western Tian Shan, Uzbekistan
Publisher: Elsevier BV
Date: 12-2018
Competing risks of death and kidney failure in a cohort of Australian adults with severe chronic kidney disease
Publisher: Wiley
Date: 05-12-2022
DOI: 10.5694/MJA2.51361
Abstract: To examine the competing risks of death (any cause) and of kidney failure in a cohort of Australian adults with severe chronic kidney disease. Population-based cohort study analysis of linked data from the Tasmanian Chronic Kidney Disease study (CKD.TASlink), 1 January 2004 - 31 December 2017. All adults in Tasmania with incident stage 4 chronic kidney disease (estimated glomerular filtration rate [eGFR], 15-29 mL/min/1.73 m Death or kidney failure (defined as eGFR below 10 mL/min/1.73 m We included data for 6825 adults with incident stage 4 chronic kidney disease (mean age, 79.3 years SD, 11.1 years), including 3816 women (55.9%). The risk of death increased with age - under 65 years: 0.18 (95% CI, 0.15-0.22) 65-74 years: 0.39 (95% CI, 0.36-0.42) 75-84 years, 0.56 (95% CI, 0.54-0.58) 85 years or older: 0.78 (95% CI, 0.77-0.80) - while that of kidney failure declined - under 65 years: 0.39 (95% CI, 0.35-0.43) 65-74 years: 0.12 (95% CI, 0.10-0.14) 75-84 years: 0.05 (95% CI, 0.04-0.06) 85 years or older: 0.01 (95% CI, 0.01-0.02). The risk of kidney failure was greater for people with macroalbuminuria and those whose albumin status had not recently been assessed. The risks of kidney failure and death were greater for men than women in all age groups (except similar risks of death for men and women under 65 years of age). For older Australians with incident stage 4 chronic kidney disease, the risk of death is higher than that of kidney failure, and the latter risk declines with age. Clinical guidelines should recognise these competing risks and include recommendations about holistic supportive care, not just on preparation for dialysis or transplantation.
Anticoagulation for people receiving long-term haemodialysis
Publisher: Wiley
Date: 04-09-2015
Review article: Luminex technology for HLA antibody detection in organ transplantation
Publisher: Wiley
Date: 03-2009
DOI: 10.1111/J.1440-1797.2008.01074.X
Abstract: Since its inception in the early 1960s, the serologically based complement-dependent cytotoxicity (CDC) assay has been the cornerstone technique for the detection of human leucocyte antigen (HLA) antibodies, not only in pre-transplant renal patients, but also in other forms of organ transplantation. Recently, solid phase assays have been developed and introduced for this purpose, and in particular the Flow-based bead assays such as the Luminex system. This latter assay has proved to be far more sensitive than the CDC assay and has revealed pre-sensitization in potential transplant recipients not detected by other methods of HLA antibody detection. However, the clinical implications of this increased sensitivity have not been convincingly demonstrated until recently. This technology for HLA antibody detection permits the evaluation of the clinical importance of antibodies directed at, for ex le, HLA-DPB1 and HLA-DQA1, which has not been possible to date. There are Luminex issues, however, requiring resolution such as the ability to distinguish between complement fixing and non-complement fixing antibodies and determination of their relative clinical significance. Luminex technology will permit a re-evaluation of the role of HLA antibodies in both early and late antibody-mediated rejection.
Associations of a healthy lifestyle score from childhood to adulthood with subclinical kidney damage in midlife: a population-based cohort study.
Publisher: Springer Science and Business Media LLC
Date: 03-01-2022
DOI: 10.1186/S12882-021-02627-0
Abstract: The relationships of healthy lifestyle scores (HLS) of various kinds in adulthood with the risk of chronic kidney disease (CKD) have been reported, but little is known about the association of childhood lifestyle with later life CKD. This study examined the relationship of HLS from childhood to adulthood with subclinical kidney damage (SKD) in midlife, a surrogate measure for CKD. Data were collected in an Australian population-based cohort study with 33 years follow-up. 750 participants with lifestyle information collected in childhood (ages 10–15 years) and midlife (ages 40–50 years), and measures of kidney function in midlife were included. The HLS was generated from the sum scores of five lifestyle factors (body mass index, smoking, alcohol consumption, physical activity, and diet). Each factor was scored as poor (0 point), intermediate (1 point), or ideal (2 points). Log-binomial regression was used to investigate the relationship of HLS in childhood and from childhood to adulthood with SKD defined as either 1) estimated glomerular filtration rate (eGFR) 30–60 mL/min/1.73m 2 or 2) eGFR 60 mL/min/1.73m 2 with urine albumin-creatinine ratio ≥ 2.5 mg/mmol (males) or 3.5 mg/mmol (females), adjusting for socio-demographic factors and the duration of follow-up. The average HLS was 6.6 in childhood and 6.5 in midlife, and the prevalence of SKD was 4.9% ( n = 36). Neither HLS in childhood nor HLS from childhood to adulthood were significantly associated with the risk of SKD in midlife. A HLS from childhood to adulthood did not predict SKD in this middle-aged, population-based Australian cohort.
Late Miocene (10.0∼6.0 Ma) Rapid Exhumation of the Chinese South Tianshan: Implications for the Timing of Aridification in the Tarim Basin
Publisher: American Geophysical Union (AGU)
Date: 10-02-2021
DOI: 10.1029/2020GL090623
Abstract: Cenozoic exhumation in the Tianshan is controlled by a complex interaction between tectonics and climate. However, the timing and magnitude of exhumation of the Tianshan and its contribution to climate change in Central Asia remains debated. In this study, we report new apatite fission track and (U‐Th)/He ages for granite s les from the roof of the South Tianshan that are significantly younger than those published for other parts of the South Tianshan. Inverse and forward modeling reveals two phases of accelerated cooling at 10∼6 Ma and since ∼3 Ma, which can be linked to (1) the reactivation of strike‐slip faults and hot asthenospheric upwelling during India‐Eurasia convergence and (2) the interplay between tectonics and glaciation, respectively. The 10∼6 Ma exhumation phase further corresponds to the timing of climate change, suggesting that this exhumation phase significantly contributed to the enhanced aridification of the Tarim Basin.
Effectiveness of targeted screening for chronic kidney disease in the community setting: a systematic review
Publisher: Springer Science and Business Media LLC
Date: 08-02-2018
DOI: 10.1007/S40620-017-0375-0
Abstract: Targeted screening interventions for chronic kidney disease (CKD) are increasingly being implemented in various community settings. However, the overall success of these programs is uncertain. Therefore, the aim of this review is to determine whether targeted screening is effective in detecting people with undiagnosed CKD. We performed a systematic literature review, and included studies of targeted screening intervention implemented in any community-based setting. Studies were required to have targeted people aged ≥18 years, and multiple CKD risk factors from the following: diabetes, hypertension, cardiovascular disease and family history of kidney disease. The outcome measures were percentages of participants with positive screening test results and diagnosed with CKD at follow-up. Nine studies met the inclusion criteria. Eight studies reported the percentage of participants with positive screening test results, which ranged from 7 to 60.3%. Only two studies repeated the diagnostic tests to detect CKD, and confirmed the chronicity of CKD in 20.5 and 17.1% of screened participants. The most commonly used screening tests were albumin creatinine ratio (≥3.4 mg/mmol), and estimated glomerular filtration rate (eGFR) (<60 ml/min/1.73 m This systematic review found significant variation in the methods that were used to detect CKD, with the majority of studies reporting results based on only single albuminuria or eGFR values. Future targeted screening programs should appropriately use the 2012 KDIGO guidelines in order to detect CKD, which is necessary to determine the benefit of these programs when implemented in community-settings.
Renal sarcoidosis in Christchurch, New Zealand 1970-1998
Publisher: Wiley
Date: 12-1999
DOI: 10.1111/J.1445-5994.1999.TB00778.X
Abstract: To identify patients presenting to a nephrologist in whom a diagnosis of sarcoidosis could be made, to assess the relevant causes of renal involvement and to review treatment and long-term follow-up of this group. A retrospective review of the computer database PROTON for patients given the diagnosis of sarcoidosis, followed by a case note review of identified patients with respect to the mode of presentation, clinical and laboratory features, treatment and subsequent follow-up. Nineteen patients (15 males) were identified, mean age 45 years, all were Caucasian, and follow-up was four months to 26 years (mean 9.3 years). Most common mode of presentation was acute renal failure (11) during spring/summer (14). Evidence for systemic disease was present in all patients. Mean plasma creatinine on presentation was 0.52 mmol/L and calcium 3.01 mmol/L. Hypercalcaemia was present in 60%. Kidney biopsy was performed in seven patients with the predominant findings of tubular atrophy and interstitial fibrosis significant granulomata were present in only two. Treatment in all patients was with corticosteroids with good result. Mean long term plasma creatinine was 0.17 mmol/L at 9.3 years. Steroid withdrawal was attempted in all patients, successful in five, with the mean time to relapse of five months in the remaining 14. Mean steroid dose in this group was 7.6 mg on long term follow-up. Sarcoidosis causes renal dysfunction mainly through altered calcium metabolism. Treatment with corticosteroids is successful in improving renal function, but relapse is common on steroid withdrawal and prolonged treatment is necessary for disease control.
Remote indigenous peritoneal dialysis patients have higher risk of peritonitis, technique failure, all-cause and peritonitis-related mortality.
Publisher: Oxford University Press (OUP)
Date: 07-03-2011
DOI: 10.1093/NDT/GFR070
Abstract: The number of indigenous patients with end-stage kidney disease (ESKD) is increasing in Australia, reflecting a similar trend in other countries. Because many indigenous patients live in remote areas, peritoneal dialysis (PD) is often preferred. Compared to non-indigenous PD patients, indigenous patients have increased complication rates but the effect of residential locations on outcomes remains unclear. The aim of this study is to examine the association between race and PD outcomes stratified by location. Using the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, all adult ESKD patients commencing PD in Australia between 1995 and 2008 were included. Patients were stratified as non-indigenous or indigenous race and were grouped according to their residential location, the latter stratified into metropolitan, regional and remote areas. Outcomes evaluated included peritonitis, technique failure, peritonitis-related and all-cause mortality. Regional and/or remote PD patients generally have a greater risk peritonitis-related complications and/or mortality compared to metropolitan patients. However, remote indigenous PD patients had the greatest risk of all PD-related complications, including all-cause and peritonitis-related mortality. This registry analysis demonstrates that non-metropolitan PD patients, especially remote indigenous patients, have higher complication rates, suggesting that environmental factors are important in determining PD outcomes.
High Pyridine Generation in Ceftazidime-Icodextrin Admixtures Used to Treat Peritoneal Dialysis-associated Peritonitis.
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.CLINTHERA.2019.08.021
Abstract: To investigate the amount of pyridine generated from degradation of ceftazidime in icodextrin peritoneal dialysis (PD) solutions. PD solutions that contained 1 and 1.5 g of ceftazidime were stored at 25 °C for 12 hours and then at 37 °C for 14 hours. An aliquot was withdrawn at predefined time points and analyzed for the concentrations of ceftazidime and pyridine. The amount of pyridine generated was >225% and 400% of its maximum recommended daily exposure in the 1- and 1.5-g ceftazidime-PD admixtures, respectively. Until these results are confirmed with appropriate in vivo studies, intermittent intraperitoneal dosing of ceftazidime admixed with icodextrin should be used with caution and appropriate clinical monitoring or a suitable alternative antibiotic should be used.
Stability of daptomycin in peritoneal dialysis solutions packaged in dual-compartment infusion bags
Publisher: BMJ
Date: 20-08-2015
Detrital apatite Lu–Hf and U–Pb geochronology applied to the southwestern Siberian margin
Publisher: Wiley
Date: 18-02-2022
DOI: 10.1111/TER.12580
Abstract: Apatite is increasingly used in sedimentary provenance studies. However, detrital apatite U–Pb geochronology can be challenging due to the presence of non‐radiogenic Pb, its intermediate closure temperature (~350–550°C) and/or age‐resetting by metamorphic/metasomatic processes. The Lu–Hf system in apatite has a higher closure temperature (~675–750°C) and is, therefore, more robust to thermal resetting. Here we present the first detrital apatite Lu–Hf age spectra. We have developed a laser‐ablation Lu–Hf dating technique, using reaction‐cell mass spectrometry, that allows rapid cost‐effective analysis, required for detrital apatite studies. The method is best suited to Precambrian detritus, permitting greater radiogenic Hf ingrowth. Using s les from Siberia, we demonstrate: (1) excellent correlations between U–Pb and Lu–Hf dates for apatites from igneous protoliths and (2) that Lu–Hf dating can detect primary age information in metamorphic grains. Hence, when used in tandem with U–Pb zircon and apatite geochronology, Lu–Hf apatite dating provides a powerful new tool for provenance studies.
Acute granulomatous interstitial nephritis in a patient with metastatic melanoma on targeted therapy with dabrafenib and trametinib-A case report.
Publisher: Wiley
Date: 05-08-2021
DOI: 10.1002/CNR2.1520
Abstract: Combination molecular targeted therapy with dabrafenib plus trametinib has been shown to improve progression‐free survival and overall survival in patients with BRAF V600 mutated unresectable or metastatic melanoma. In general, these agents are well tolerated. Kidney related adverse events are uncommon with only three case reports of acute interstitial nephritis and one case of a serious acute kidney injury. We report another case of interstitial nephritis related to these drugs. A 37‐year‐old man diagnosed with metastatic melanoma (BRAF V600E mutation) who developed acute interstitial nephritis 5 years into his treatment with combination dabrafenib plus trametinib therapy. He presented with an asymptomatic acute kidney injury on routine surveillance pathology with a creatinine of 174 μmol/L (from baseline 80 μmol/L) and a corresponding estimated glomerular filtration rate (eGFR) of 42 ml/min/1.73 m 2 (from a baseline ml/min/1.73 m 2 ) and microalbuminuria (albumin creatinine ratio [ACR] 8.5 mg/mmol). Renal biopsy revealed a granulomatous interstitial nephritis likely drug related. He was treated with prednisolone 1 mg/kg and ceased his targeted therapy with improvement in his renal function. Although rare, recognition of acute interstitial nephritis, a possible serious adverse outcome due to dabrafenib and trametinib is important and needs to be incorporated into current Australian cancer therapy guidelines.
Risk factors for dialysis withdrawal: an analysis of the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, 1999-2008
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2012
DOI: 10.2215/CJN.07420711
Abstract: Dialysis withdrawal (DW) in patients with ESRD is increasing in importance. This study assessed causes of death and risk factors for DW in Australia and New Zealand in the first year of dialysis. This retrospective observational cohort study included all adult Australians and New Zealanders beginning renal replacement therapy in 1999–2008. A total of 24,884 patients with 10,073 deaths were included. Deaths from cardiac and social causes (predominantly DW) accounted for 38% and 28% of all deaths, respectively. Cumulative incidence of DW was 3.5% at 1 year (95% confidence interval [CI], 3.3%–3.8%), 9.0% at 3 years (95% CI, 8.6%–9.4%), and 13.4% at 5 years (95% CI, 12.8%–13.9%). In multivariate analysis, predictors for DW in the first year were older age (subhazard ratio [SHR], 1.70 per decade [95% CI, 1.59–1.83] P .001), late referral (SHR, 1.83 [95% CI, 1.59–2.11] P .001), comorbid conditions (SHR, 1.33 per each additional comorbid condition [95% CI, 1.25–1.41] P .001), and diabetes (SHR, 1.16 [95% CI, 1.00–1.34] P =0.05). Negative predictors for DW included male sex (SHR, 0.75 [95% CI, 0.66–0.87] P .001), indigenous ethnicity (SHR, 0.74 [95% CI, 0.58–0.95] P =0.02), other nonwhite race (SHR, 0.66 [95% CI, 0.48–0.91] P =0.01), and peritoneal dialysis user (SHR, 0.59 [95% CI, 0.49–0.72] P .001). DW is common among dialysis patients in Australia and New Zealand. Risk factors include older age, female sex, white race, diabetes, higher comorbidity burden, hemodialysis user, and late referral to nephrologist.
Medication prescribing quality in Australian primary care patients with chronic kidney disease
Publisher: Research Square Platform LLC
Date: 06-11-2019
Abstract: Background: Drugs are commonly used in patients with chronic kidney disease (CKD) to treat an underlying cause, or its numerous complications and comorbidities. The objective of this study was to examine the quality of prescribing in patients with CKD in Australian general practice from February 01, 2016 and June 01, 2016, using validated indicators. Methods: We evaluated Australian general practice data obtained from the NPS MedicineWise MedicineInsight dataset for patients with CKD and aged 18 years or older. We used 16 internationally validated prescribing quality indicators focused on medication need, choice and safety in patients with CKD, and we compared results for patients using clinical and sociodemographic factors. Results: Among 44,259 patients with evidence of CKD stages 3-5, 13,263 (30%) had documentation of a diagnosis of diabetes. Less than half of all patients (40.8%) with CKD stages 3-5 and aged 50 to 65 years were prescribed a statin. The use of an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) was higher in patients with concomitant diabetes (64.1%) compared with those without diabetes (51.5% P .001), yet only 69.9% of the patients with diabetes and microalbuminuria were receiving an ACEI or ARB. There were 7,426 patients (16.8%) with CKD stages 3-5 potentially receiving non-steroidal anti-inflammatory drugs (NSAIDs), including 14.3% of those patients with an estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m2. Potentially inappropriate medication use was more common in CKD patients living in relatively disadvantaged socioeconomic areas, as well as in regional and remote areas. Conclusions: We identified areas for possible improvement in the prescribing of preventive medications, as well as deprescribing of potentially nephrotoxic medication, in patients with CKD stages 3-5. Australian programs working to improve quality use of medication need to focus on improving the appropriate prescribing of recommended preventive medications in patients with CKD, such as an ACEI/ARB and statin, and deprescribing of NSAIDs in patients with concurrent ACEI/ARB therapy. Keywords: chronic kidney disease, drug therapy, quality indicators, inappropriate prescribing, general practice, quality use of medicine, primary care
The Coorg Block, southern India: Insights from felsic and mafic magmatic suites on Mesoarchean plate tectonics and correlation with supercontinent Ur
Publisher: Elsevier BV
Date: 06-2023
Formation of the Kokchetav subduction–collision zone (northern Kazakhstan): Insights from zircon U–Pb and Lu–Hf isotope systematics
Publisher: Elsevier BV
Date: 2015
Stratigraphy of deformed permian carbonate reefs in Saraburi Province, Thailand
Publisher: Geological Society of London
Date: 30-08-2018
DOI: 10.1144/JGS2017-035
Teaching peritoneal dialysis in Australia: An opportunity for improvement
Publisher: Wiley
Date: 20-02-2018
DOI: 10.1111/NEP.12992
Abstract: Up to a 10-fold difference in clinical outcomes between Australian peritoneal dialysis (PD) units exists. There is an international focus on the harmonization of educational practices in PD to determine whether this may lead to improved patient outcomes. The aim of this paper is to evaluate the current teaching practices of nurses and patients in Australian PD units. An online survey with questions on nurse and patient training was made available to PD units in Australia. Thirty-eight (70%) of 54 PD units in Australia completed the survey. A written standardized curricula was utilized in 21 units (55%) for nursing staff and 30 units (79%) for patients, with 23% and 12% including an electronic delivery component for each group, respectively. Universal teaching of adult learning principles was not demonstrated. The hours spent on teaching nursing staff ranged from 100 h in 21% of units. The average number of hours spent by nurses each day to train patients ranged from 6 h in 11% of units, with the average total training days ranging from 2 to 3 days in 14% to over 7 days in 14% of units. Staff and patient competency assessments were performed routinely in 37% and 74% of units, respectively. Considerable differences exist amongst Australian PD units in the education of staff and patients. There is a general lack of delivery and competency assessment to meet educational standards. It remains to be seen if harmonization of educational curricula can translate to improved clinical outcomes.
Detrital apatite U-Pb and trace element analysis as a provenance tool: Insights from the Yenisey Ridge (Siberia)
Publisher: Elsevier BV
Date: 08-2018
Late Carboniferous–early Permian arc magmatism in the south-western Alxa Tectonic Belt (NW China): Constraints on the late Palaeozoic subduction history of the Palaeo-Asian Ocean
Publisher: Wiley
Date: 21-10-2019
DOI: 10.1002/GJ.3348
Adherence assessment practices in haemodialysis settings: A qualitative exploration of nurses and pharmacists' perspectives
Publisher: Wiley
Date: 12-03-2019
DOI: 10.1111/JOCN.14821
Abstract: To explore clinician assessment of patient adherence and identify strategies to improve adherence assessment practices in haemodialysis settings. Patients with chronic kidney disease undergoing haemodialysis are typically prescribed complex regimens as such, they are at high risk of medication nonadherence. Current clinical practices focus on prescribing medications however, little attention is paid to measuring and ensuring patient adherence to their prescribed treatments. A qualitative study. Semi-structured in idual interviews were conducted in November and December 2016, with 12 nurses and 6 pharmacists, working in Australian haemodialysis settings. The study was conducted and reported in accordance with COREQ guidelines. Participants were 25-60 years old and had 1-27 years of experience in dialysis. Seven themes related to assessing adherence were identified: prioritisation of resources, interplay between workload and available time, awareness of formalised adherence measures and training deficits, concerns about practicality/suitability of adherence measures, communication of assessment services, patient participation and trust. Three themes related to strategies for improving adherence assessment practices were identified: formalisation of adherence assessment process, integration of assessment processes and tools into routine, and use of multidisciplinary support to assess and promote adherence. Current adherence assessment practices could be improved through formalisation and integration of the assessment process into dialysis unit policy rocedures. Additionally, as barriers to assessing adherence were identified at organisational, professional and patient levels, there is a need to address barriers from each level in order to improve adherence assessment practices in haemodialysis settings. This qualitative study highlights the challenges and practical ways by which adherence assessment practices could be improved in haemodialysis settings. This would encourage renal clinicians to actively participate in adherence assessment and promotion activities to ensure patients benefit from their therapies.
Associations of fish oil and vitamin B and E supplementation with cardiovascular outcomes and mortality in people receiving haemodialysis: a review
Publisher: Springer Science and Business Media LLC
Date: 18-08-2015
New Genetic Loci Associated With Chronic Kidney Disease in an Indigenous Australian Population
Publisher: Frontiers Media SA
Date: 16-04-2019
Macrophage-derived interleukin-18 in experimental renal allograft rejection
Publisher: Oxford University Press (OUP)
Date: 16-02-2005
DOI: 10.1093/NDT/GFH712
Abstract: Interleukin 18 (IL-18) is primarily a macrophage-derived, pro-inflammatory cytokine. As macrophages can act as effector cells in acute rejection, we examined the role of IL-18 in a rat model of acute renal allograft rejection. Life-sustaining orthotopic DA to Lewis allograft and Lewis-Lewis isograft kidney transplants were performed. In the same model, macrophage-depleted animals, achieved with liposomal-clodronate therapy, were also studied. Macrophage (ED1+) accumulation and IL-18 expression was assessed by immunohistochemistry. CD11b+ cells (macrophages) were isolated from kidney and spleen by micro beads. Real-time PCR was used to assess IL-18 and INF-gamma mRNA expression in tissue and cell isolates. Allografts, but not isografts, developed severe tubulo-interstitial damage and increased serum creatinine by day 5 (P<0.001). Immunohistochemistry revealed a greater ED1+ cell accumulation in day 5 allografts compared with isografts (P<0.001). IL-18 mRNA expression was increased 3-fold in allografts compared to isografts (P<0.001). Accordingly, IL-18 protein was increased in allografts (P<0.001), and was predominantly expressed by ED1+ macrophages. CD11b+ macrophages isolated from allografts had a 6-fold upregulation of IL-18 mRNA expression compared to isograft macrophages (P<0.001). Macrophage depletion resulted in a marked attenuation of allograft rejection, ED1+ and IL-18+ cells were significantly reduced (P<0.05) as was IL-18 mRNA expression (29.28+/-2.85 vs 62.48+/-3.05, P<0.001). INF-gamma mRNA expression (P<0.01) and iNOS (P<0.001) production were also significantly reduced in the macrophage-depleted animals. This study demonstrates that IL-18 is significantly increased during acute rejection and is principally produced by intra-graft macrophages. We hypothesize that IL-18 upregulation may be an important macrophage effector mechanism during the acute rejection process.
Indigenous Australians and Living Kidney Donation
Publisher: Massachusetts Medical Society
Date: 08-10-2009
DOI: 10.1056/NEJMC0905777
Medication adherence perspectives in haemodialysis patients: a qualitative study
Publisher: Springer Science and Business Media LLC
Date: 22-05-2017
URINE MACROPHAGE MIGRATION INHIBITORY FACTOR CONCENTRATIONS AS A DIAGNOSTIC TOOL IN HUMAN RENAL ALLOGRAFT REJECTION1
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2001
DOI: 10.1097/00007890-200106270-00013
Abstract: Macrophage migration inhibitory factor (MIF) is a pro-inflammatory cytokine that is a potent activator of macrophages and T cells. Previous studies have shown that local MIF production is increased in acute renal allograft rejection, suggesting that it may play an important role in the rejection process. To determine if urine and serum MIF concentrations: (1) are increased in acute rejection, and (2) can be used as noninvasive tools to discriminate between acute rejection (AR) and cyclosporine nephrotoxicity (CyA toxicity). In a prospective study of nine renal allograft patients (five acute rejection and four stable), serial urine MIF concentrations were measured by ELISA in the first 14 days after transplantation. In a retrospective study, MIF concentrations in urine and serum were measured in 24 patients who were biopsied for acute renal transplant dysfunction (11 AR, 13 CyA toxicity). Urine and serum MIF were also measured in 23 stable renal transplant patients and 10 normals. MIF was readily detected in the urine of normal healthy controls (106+/-61 pg/micromol creatinine). In the prospective study, the urinary MIF concentration was increased substantially on day 1 posttransplantation and subsequently fell in parallel with the serum creatinine. However, urine MIF increased before episodes of biopsy proven acute rejection. The retrospective study showed that urine MIF concentrations in patients with AR were increased 5-fold compared to normal controls (439+/-313 pg/micromol Cr P<0.01). In contrast, urine MIF concentrations in CyA toxicity were not significantly different to normal controls (145+/-119 pg/micromol Cr P=NS). A marked increase in MIF immunostaining was seen in biopsies of AR, but not in CyA toxicity. No significant differences were evident in serum MIF levels between normals and any transplant patient group. These results suggest that measurement of urine MIF concentration may be useful in monitoring renal transplant patients for acute rejection and as a discriminator from cyclosporine nephrotoxicity.
Physical and chemical stability of ceftazidime and cefazolin in peritoneal dialysis solutions packaged in dual-chamber infusion bags
Publisher: Oxford University Press (OUP)
Date: 09-2013
DOI: 10.2146/AJHP120692
Stability of Cefepime in pH-Neutral Peritoneal Dialysis Solutions Packaged in Dual-Compartment Bags
Publisher: SAGE Publications
Date: 07-2016
Abstract: Intraperitoneal cefepime is used for the treatment of peritoneal dialysis (PD)-associated peritonitis caused by gram-negative bacteria. The current study investigated the stability of cefepime in a pH-neutral PD solution. A reconstituted solution of cefepime was injected into a total of 9 PD bags and stored at 4°C, 25°C or 37°C for various time points. Cefepime retained more than 90% of its initial concentration for 168, 96, and 12 hours at 4°C, 25°C and 37°C, respectively. No apparent physical precipitation or pH change was observed during the study. This study provides crucial information to healthcare professionals on the physical and chemical stability of cefepime in the pH-neutral solution to help them in preparing such admixtures in advance where required.
Supplementary material to Calibration methods for laser ablation Rb–Sr geochronology: comparisons and recommendation based on NIST glass and natural reference materials
Publisher: Copernicus GmbH
Date: 12-09-2023
Leukocyte phenotype and function predicts infection risk in renal transplant recipients
Publisher: Oxford University Press (OUP)
Date: 19-07-2005
DOI: 10.1093/NDT/GFI007
Abstract: The degree to which transplant recipients are immunosuppressed influences their risks of rejection, infection and cancer. Current measures of immune suppression are crude (clinical events) or indirect (drug exposure). We assessed a direct measure of immune status, leukocyte phenotype and function (LPF, a composite measure of five aspects of peripheral blood leukocyte phenotype and function), as a predictor of infection. A double-blind, prospective, cohort study was conducted, to determine the burden of infection in stable renal transplant recipients with moderate-severe (Group I, n = 34) or minimal (Group II, n = 36) impairment of LPF, a composite score of: (i) CD4 count (ii) lymphocyte proliferation in response to phytohaemagglutinin A (PHA) (iii) serum Ig concentrations (iv) neutrophil phagocytic function and (v) reactive oxygen species generation. Subjects completed a 6 month diary and each recorded infection was scored 1-4: 1, minor undefined infection (e.g. URTI) 2, minor, microbiologically defined infection (e.g. UTI) 3, major defined infection (requiring hospitalization) 4, opportunistic infection (e.g. Herpes zoster). Final infection score was the sum of all infective episodes. Subjects were then followed-up for 5 years for outcome measures. Groups were well matched for age, sex, diabetes, serum creatinine, rejection and trough cyclosporin concentrations. Group I (moderate to severe impairment of LPF) recorded a higher infection score, 2.4+/-2.8 vs 1.2+/-1.2 for Group II, P = 0.02, due to a higher incidence of moderate to severe infection. This relationship was confirmed by multivariate analysis (OR 1.83, CI 1.08, 3.11, P = 0.03 per unit increase in infection score). During the 5 year follow-up period they had significantly more episodes of admission to hospital, and twice as many admissions due to infections, but no difference in malignancy, graft or patient outcome. LPF testing prospectively identified a cohort who incurred a higher burden of infection. Further studies are required to determine the predictive value of LPF for acute rejection, infection and cancer, and to determine whether adjustments to therapy on the basis of LPF can lead to improved outcomes.
Multi-method chronometric constraints on the evolution of the Northern Kyrgyz Tien Shan granitoids (Central Asian Orogenic Belt): From emplacement to exhumation
Publisher: Elsevier BV
Date: 04-2010
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