Publications by authors named "David J Tunnicliffe"

Background: Patients with kidney failure often lack robust evidence because they are excluded from randomized trials. Trial emulation provides an alternative approach to derive treatment effect estimates when randomized trials cannot be conducted. Critical questions about the comparative efficacy and safety of interventions in kidney failure are now being answered using this approach or parts of it.

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  • Autosomal dominant polycystic kidney disease (ADPKD) is a major hereditary kidney disease, with traditional treatment focusing on symptom management rather than disease progression.
  • Recent advancements in understanding the disease's mechanisms have led to new medications aimed at halting its progression, though their effectiveness for all patients remains uncertain.
  • The review aims to assess the safety and impact of these interventions using patient-focused outcomes while analyzing data from various clinical studies and trials.
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  • SGLT-2 inhibitors have been shown to provide cardiovascular and kidney benefits for adults with chronic kidney disease (CKD), regardless of whether they have type 2 diabetes or not.
  • Current guidelines are incomplete as they do not fully consider the latest evidence or provide specific recommendations based on varying risk levels of CKD progression.
  • The guideline panel recommends SGLT-2 inhibitors for adults with CKD, with stronger recommendations for those at higher risk of disease progression and complications.
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Introduction: Kidney stones is common with an increasing trend over time and has been well studied in the general population. However, incidence and outcomes of kidney stones leading to kidney failure (KF) and receiving kidney replacement therapy (KRT) is poorly examined. We examined the incidence of KF due to kidney stones and compared outcomes to KRT patients due to other causes.

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  • * A national workshop with diverse stakeholders identified six key themes vital for enhancing inclusivity in CKD research: building trust, fostering community, balancing expectations, providing support, making research accessible, and adapting to individual needs.
  • * Implementing strategies based on these themes can lead to more diverse and equitable patient and caregiver participation in CKD research, ultimately improving its relevance and impact.
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Background: Diabetes is associated with high risks of premature chronic kidney disease (CKD), cardiovascular diseases, cardiovascular death and impaired quality of life. People with diabetes are more likely to develop kidney impairment, and approximately one in three adults with diabetes have CKD. People with CKD and diabetes experience a substantially higher risk of cardiovascular outcomes.

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Aim: People with chronic kidney disease experience high rates of cardiovascular disease. Cholesterol-lowering therapy is a mainstay in the management but there is uncertainty in the treatment effects on patient-important outcomes, such as fatigue and rhabdomyolysis. Here, we summarise the updated CARI Australian and New Zealand Living Guidelines on cholesterol-lowering therapy in chronic kidney disease.

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Objectives: The involvement of consumers (people with lived experience of disease) in guidelines is widely advocated to improve their relevance and uptake. However, the approaches to consumer involvement in guidelines vary and are not well documented. We describe the consumer involvement framework of Caring for Australians and New ZealandeRs with kidney Impairment Guidelines.

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Background: IgA nephropathy (IgAN) is the most common primary glomerular disease, with approximately 20% to 40% of patients progressing to kidney failure within 25 years. Non-immunosuppressive treatment has become a mainstay in the management of IgAN by improving blood pressure (BP) management, decreasing proteinuria, and avoiding the risks of long-term immunosuppressive management. Due to the slowly progressive nature of the disease, clinical trials are often underpowered, and conflicting information about management with non-immunosuppressive treatment is common.

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  • Cardiovascular disease poses a significant risk for individuals with early chronic kidney disease (CKD), similar to that in those with coronary artery disease, prompting an updated review of statin use in CKD.
  • The study evaluated randomized controlled trials (RCTs) that compare statins against placebo, no treatment, or standard care in CKD patients, focusing on outcomes like death, cardiovascular events, and kidney function.
  • After analyzing 63 studies involving over 50,000 participants, the research aims to provide insights into the effectiveness and safety of statins for those with CKD not requiring dialysis.
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  • First Nations Australians show resilience despite the lasting impacts of colonization, which have led to higher rates of chronic kidney disease (CKD) among this population.
  • Community consultations have shaped guidelines that prioritize local knowledge and address issues such as institutional racism, cultural safety, and the need for increased family and community involvement in healthcare.
  • The guidelines recommend earlier screening for CKD, more timely referrals to specialists, and emphasize the importance of community engagement and access to care in rural areas to improve kidney health outcomes.
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Background: Chronic kidney disease (CKD) is a long-term condition that occurs as a result of damage to the kidneys. Early recognition of CKD is becoming increasingly common due to widespread laboratory estimated glomerular filtration rate (eGFR) reporting, raised clinical awareness, and international adoption of the Kidney Disease Improving Global Outcomes (KDIGO) classifications. Early recognition and management of CKD affords the opportunity to prepare for progressive kidney impairment and impending kidney replacement therapy and for intervention to reduce the risk of progression and cardiovascular disease.

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  • The KDIGO 2022 Clinical Practice Guideline updates the 2020 guidelines for managing diabetes in patients with chronic kidney disease (CKD), based on new evidence and a structured evaluation approach.
  • Key changes were made to recommendations in areas related to comprehensive care and glucose-lowering therapies, while other chapters maintained their prior guidance.
  • Clinicians are advised to focus on preserving kidney function through a layered care strategy that includes lifestyle changes, self-management, and specific medications that enhance heart and kidney protection, along with managing risk factors for CKD and cardiovascular issues.
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Objectives: Producing living guidelines requires making important decisions about methods for evidence identification, appraisal, and integration to allow the living mode to function. Clarifying what these decisions are and the trade-offs between options is necessary. This article provides living guideline developers with a framework to enable them to choose the most suitable model for their living guideline topic, question, or context.

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Introduction: The slow transformation of new research findings into clinical guidelines is a barrier to providing evidence-based care. The Caring for Australians and New Zealanders with Kidney Impairment (CARI) guidelines are developing models to improve guideline production, one methodology involves more functional concordance between trial groups, such as the Australian Kidney Trials Network (AKTN) and CARI. The objective of this project was to rapidly produce an evidence-based guideline on urate-lowering therapy in patients with chronic kidney disease (CKD), in response to new clinical trial publications on the topic by the AKTN.

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The Kidney Disease: Improving Global Outcomes (KDIGO) 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (CKD) represents a focused update of the KDIGO 2020 guideline on the topic. The guideline targets a broad audience of clinicians treating people with diabetes and CKD. Topic areas for which recommendations are updated based on new evidence include Chapter 1: Comprehensive care in patients with diabetes and CKD and Chapter 4: Glucose-lowering therapies in patients with type 2 diabetes (T2D) and CKD.

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Background: Primary membranous nephropathy (PMN) is a common cause of nephrotic syndrome in adults. Without treatment, approximately 30% of patients will experience spontaneous remission and one third will have persistent proteinuria. Approximately one-third of patients progress toward end-stage kidney disease (ESKD) within 10 years.

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  • The KDIGO Clinical Practice Guideline for Glomerular Diseases updates the 2012 guidelines to assist clinicians in managing various types of glomerulonephritis (GN) in both adults and children, covering conditions like IgA nephropathy and lupus nephritis.
  • The guideline offers a structured format for each condition that includes guidance on diagnosis, prognosis, and treatment, alongside infographics and expert insights to provide actionable recommendations.
  • It emphasizes evidence-based approaches, utilizing the GRADE system to evaluate the quality of evidence and recommendations, while also highlighting knowledge gaps for future research and considering policy implications and costs.
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  • The KDIGO organization has updated its guidelines on blood pressure management in chronic kidney disease (CKD), first issued in 2012, now refined in 2021.
  • The revised guidelines are backed by systematic literature reviews and the GRADE methodology, and include chapters on BP measurement, lifestyle changes, and specific management for different patient groups including adults, kidney transplant recipients, and children.
  • A key recommendation suggests a target systolic blood pressure of less than 120 mm Hg for most CKD patients not on dialysis, relying on standardized measurement protocols rather than routine readings.
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Importance: Transgender and nonbinary youths have a higher incidence of a range of health conditions and may paradoxically face limited access to health care.

Objective: To describe the perspectives and needs of transgender youths in accessing health care.

Evidence Review: MEDLINE, Embase, PsycInfo, and the Cumulative Index to Nursing and Allied Health Literature were searched from inception to January 2021.

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Description: The Kidney Disease: Improving Global Outcomes (KDIGO) 2021 clinical practice guideline for the management of blood pressure (BP) in patients with chronic kidney disease (CKD) not receiving dialysis is an update of the KDIGO 2012 guideline on the same topic and reflects new evidence on the risks and benefits of BP-lowering therapy among patients with CKD. It is intended to support shared decision making by health care professionals working with patients with CKD worldwide. This article is a synopsis of the full guideline.

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