2018-02-01, Bello, Aminu K., Alrukhaimi, Mona, Ashuntantang, Gloria E., Bellorin-Font, Ezequiel, Gharbi, Mohammed Benghanem, Braam, Branko, Feehally, John, Harris, David C., Jha, Vivekanand, Jindal, Kailash, Johnson, David W., Kalantar-Zadeh, Kamyar, Kazancioglu, RÜMEYZA, Kerr, Peter G., Lunney, Meaghan, Olanrewaju, Timothy Olusegun, Osman, Mohamed A., Perl, Jeffrey, Rashid, Harun Ur, Rateb, Ahmed, Rondeau, Eric, Sakajiki, Aminu Muhammad, Samimi, Arian, Sola, Laura, Tchokhonelidze, Irma, Wiebe, Natasha, Yang, Chih-Wei, Ye, Feng, Zemchenkov, Alexander, Zhao, Ming-hui, Levin, Adeera, KAZANCIOĞLU, RÜMEYZA

Reliable governance and health financing are critical to the abilities of health systems in different countries to sustainably meet the health needs of their peoples, including those with kidney disease. A comprehensive understanding of existing systems and infrastructure is therefore necessary to globally identify gaps in kidney care and prioritize areas for improvement. This multinational, cross-sectional survey, conducted by the ISN as part of the Global Kidney Health Atlas, examined the oversight, financing, and perceived quality of infrastructure for kidney care across the world. Overall, 125 countries, comprising 93% of the world's population, responded to the entire survey, with 122 countries responding to questions pertaining to this domain. National oversight of kidney care was most common in high-income countries while individual hospital oversight was most common in low-income countries. Parts of Africa and the Middle East appeared to have no organized oversight system. The proportion of countries in which health care system coverage for people with kidney disease was publicly funded and free varied for AKI (56%), nondialysis chronic kidney disease (40%), dialysis (63%), and kidney transplantation (57%), but was much less common in lower income countries, particularly Africa and Southeast Asia, which relied more heavily on private funding with out-of-pocket expenses for patients. Early detection and management of kidney disease were least likely to be covered by funding models. The perceived quality of health infrastructure supporting AKI and chronic kidney disease care was rated poor to extremely poor in none of the high-income countries but was rated poor to extremely poor in over 40% of low-income countries, particularly Africa. This study demonstrated significant gaps in oversight, funding, and infrastructure supporting health services caring for patients with kidney disease, especially in low- and middle-income countries.

2018-10-01T00:00:00Z, Veronese, Nicola, SOYSAL, PINAR, Stubbs, Brendon, Marengoni, Alessandra, Demurtas, Jacopo, Maggi, Stefania, Petrovic, Mirko, Verdejo-Bravo, Carlos, SOYSAL, PINAR

PurposeUrinary incontinence (UI) and frailty are common geriatric syndromes. Although literature increasingly supports a relationship between these two conditions, no systematic review and meta-analysis has been performed on this topic. Therefore, we aimed to investigate the potential association between UI and frailty, through a meta-analytic approach.MethodsA systematic search in major databases was undertaken until 15th March 2018 for studies reporting the association between UI and frailty. The prevalence of UI in people with frailty (vs. those without) was pooled through an odds ratio (OR) and 95% confidence intervals (CIs), with a random-effects model. The other outcomes were summarized descriptively.ResultsAmong 828 papers, 11 articles were eligible, including 3784 participants (mean age 78.2years; 55.1% women). The prevalence of UI was 39.1% in people with frailty and 19.4% in those without. A meta-analysis with five studies (1540 participants) demonstrated that UI was over twice as likely in frail people versus those without (OR 2.28; 95% CI 1.35-3.86; I-2=61%). One cross-sectional study, adjusting for potential confounders and one longitudinal study confirmed that UI is significantly associated with frailty. In two cross-sectional studies, using adjusted analyses, frailty was more common in people with UI.ConclusionUrinary incontinence is twice as common in older people with frailty compared to older people without frailty. Screening and the development of interventions for UI and frailty could prove useful for this common comorbidity.

2019-01-01, Gursu, MELTEM, ARICI, MUSTAFA, Ates, Kenan, Kazancioglu, RÜMEYZA, Yavas, Pinar Guneser, Öztürk, Murat, ALTUN, BÜLENT, Arinsoy, Turgay, GÜRSU, MELTEM, KAZANCIOĞLU, RÜMEYZA

Background/Aims: Refugee dialysis is a worldwide growing dilemma with limited experience. This report presents the largest hemodialysis (HD) patient registry data of Syrian refugees in Turkey. Methods: Demographic, clinical, laboratory, and dialysis practice data of 345 Syrian HD patients during one year were collected and analyzed. Results: There were 345 prevalent Syrian HD patients at the end of 2016. Majority of the patients were placed in the Southeast Anatolian Region. The majority of the patients (74.8%) are in the age range of 20-64 years. Dialysis vintage in Turkey is less than 12 months in 20.8% and less than one month in 29.3% of patients. The vascular access was arteriovenous fistula in the majority of patients (72.5%). Kt/V is over 1.7 in 57%, serum albumin is above 35 g/L in 65.8% and hemoglobin level is more than 100 g/L in %65.2 of the patients. The ratio of patients with serum phosphorus level of 1.13-1.77 mmol/L was 56.2%. Twenty Syrian HD patients (14 male, 6 female) died within the year 2016 and annual mortality rate was 5.7%. Conclusion: This study with the largest number of Syrian refugees undergoing maintenance hemodialysis showed good dialysis practices, acceptable values for dialysis adequacy and biochemical parameters along with lower mortality compared to native HD population of Turkey. Longer follow up will enrich the knowledge related to care of refugee population in all over the world.

2019-12-01, Smith, Lee, Koyanagi, Ai, Pardhan, Shahina, Grabovac, Igor, Swami, Viren, SOYSAL, PINAR, Isik, Ahmet, Lopez-Sanchez, Guillermo F., McDermott, Daragh, Yang, Lin, Jackson, Sarah E., SOYSAL, PINAR

Sexual activity is a central component of intimate relationships and has been shown to have numerous benefits for health and wellbeing. Studies have shown that people with disabilities often report less satisfaction with their sex lives, but none have examined the levels of sexual activity in older adults with visual problems. We investigated associations between self-rated eyesight and sexual activity in a population-based sample of older adults. Analyses were conducted using data from 2587 men and 3238 women participating in the English Longitudinal Study of Ageing. Participants provided information on self-rated eyesight in three domains: overall, at distance, and up close (categorised as: excellent/very good/good/fair-poor), sexual activity (any vs. none in the last year), and frequency of sexual intercourse in the last month (not at all, once, 2-3 times, once a week or more) among those who were sexually active. Associations between self-rated eyesight and sexual activity were examined using adjusted logistic regression. Relative to excellent self-rated eyesight, fair-poor eyesight was consistently associated with significantly lower odds of being sexually active in men (overall eyesight OR 0.41, 95% CI 0.26-0.64, p < 0.001) but not in women (overall eyesight OR = 0.99, 95% CI 0.70-1.41, p = 0.959). However, among women who were sexually active, there was some evidence that fair-poor eyesight was associated with lower frequency of sexual intercourse in the last month (e.g. fair-poor eyesight at distance OR = 0.45, 95% CI 0.31-0.66, p < 0.001). No association between self-rated eyesight and frequency of sexual intercourse was observed for men. Identifying ways to help older patients with impaired vision achieve a more active sex life could help to improve the health and wellbeing of this population group. Visual impairment is associated with lower prevalence of any sexual activity in older men, and lower frequency of sexual intercourse in older women.

2019-11-07, Veronese, Nicola, Smith, Lee, Torbahn, Gabriel, Jackson, Sarah E., Yang, Lin, SOYSAL, PINAR, Rivasi, Giulia, Rafanelli, Martina, Petrovic, Mirko, Maggi, Stefania, Isik, Ahmet Turan, Demurtas, Jacopo, SOYSAL, PINAR

Purpose Orthostatic hypotension (OH) is associated with older age and many negative clinical outcomes in geriatric practice. We aimed to capture the breadth of outcomes that have been associated with the presence of OH and systematically assess the quality, strength and credibility of these associations using an umbrella review with integrated meta-analyses. Methods We systematically searched several major databases from their commencements through to 16th May 2019 for meta-analyses of observational studies of OH and any health-related outcome. We used these metrics to categorize the strength of evidence of significant outcomes (p < 0.05) from class I (convincing) to class IV (weak), according to the pre-established criteria. Results From 975 abstracts, seven meta-analyses of 12 outcomes were included. For each outcome, the median number of studies was four, and the median number of participants was 46,493, with a median of 3630 incident cases. There was suggestive (class III) evidence that OH was associated with significantly higher risk of coronary heart disease (HR = 1.32, 95% CI 1.12-1.56), stroke (HR = 1.22, 95% CI 1.08-1.38), congestive heart failure (HR = 1.30, 95% CI 1.09-1.55), all-cause mortality (RR = 1.50, 95% CI 1.24-1.81), falls (OR = 1.84, 95% CI 1.39-2.44), and dementia (HR = 1.22, 95% CI 1.11-1.35). Conclusion The current evidence base indicates that OH is significantly associated with a range of adverse cardiovascular, cognitive, and mortality outcomes in older people, although the strength of this evidence remains only suggestive. Further research in larger samples and with lower risk of bias is required to build a fuller picture of the impact of OH on health.

2019-05-01, SOYSAL, PINAR, Veronese, Nicola, STUBBS, Brendon, Maggi, Stefania, Jackson, Sarah E, DEMURTAS, Jacopo, Celotto, S., KOYANAGI, AI, Bolzetta, F., Smith, Lee, SOYSAL, PINAR

2019-05-21, Dokuzlar, O, Koc, Okudur, Smith, L, Isik, AT, Aydin, AE, SOYSAL, PINAR

Background Women aged 65 years and over are at increased risk of falling. Falls in this age group increase the risk of morbidity and mortality. Aims The aim of the present study was to find the most common factors that increase the risk of falling in older women, by using four different assessment methods. Methods 682 women, who attended a geriatric outpatient clinic and underwent comprehensive geriatric assessment, were included in the study. History of falling last year, the Timed Up and Go (TUG) test, Performance-Oriented Mobility Assessment (POMA), and 4-m walking speed test were carried out on all patients. Results The mean age (SD) of patients were 74.4 (8.5) years. 31.5% of women had a history of falling in the last year. 11%, 36.5%, and 33.3% of patients had a falling risk according to POMA, TUG and 4-m walking speed test, respectively. We identified the following risk factors that increase the risk of falling, according to these four methods: urinary incontinence, dizziness and imbalance, using a walking stick, frailty, dynapenia, higher Charlson Comorbidity Index and Geriatric Depression Scale score, and lower basic and instrumental activities of daily living scores (p < 0.05). We found a significant correlation between all the assessment methods (p < 0.001). Conclusion There is a strong relationship between fall risk and dizziness, using a walking stick, dynapenia, high number of comorbidities, low functionality, and some geriatric syndromes such as depression, frailty, and urinary incontinence in older women. Therefore, older women should routinely be screened for these risk factors.

2018-02-01, Okpechi, Ikechi G., Alrukhaimi, Mona, Ashuntantang, Gloria E., Bellorin-Font, Ezequiel, Gharbi, Mohammed Benghanem, Braam, Branko, Feehally, John, Harris, David C., Jha, Vivekanand, Jindal, Kailash, Johnson, David W., Kalantar-Zadeh, Kamyar, Kazancioglu, RÜMEYZA, Levin, Adeera, Lunney, Meaghan, Olanrewaju, Timothy Olusegun, Perkovic, Vlado, Perl, Jeffrey, Rashid, Harun Ur, Rondeau, Eric, Salako, Babatunde lawal, Samimi, Arian, Sola, Laura, Tchokhonelidze, Irma, Wiebe, Natasha, Yang, Chih-Wei, Ye, Feng, Zemchenkov, Alexander, Zhao, Ming-hui, Bello, Aminu K., KAZANCIOĞLU, RÜMEYZA

Due to the worldwide rising prevalence of chronic kidney disease (CKD), there is a need to develop strategies through well-designed clinical studies to guide decision making and improve delivery of care to CKD patients. A cross-sectional survey was conducted based on the International Society of Nephrology Global Kidney Health Atlas data. For this study, the survey assessed the capacity of various countries and world regions in participating in and conducting kidney research. Availability of national funding for clinical trials was low (27%, n = 31), with the lowest figures obtained from Africa (7%, n = 2) and South Asia (0%), whereas high-income countries in North America and Europe had the highest participation in clinical trials. Overall, formal training to conduct clinical trials was inadequate for physicians (46%, n = 53) and even lower for nonphysicians, research assistants, and associates in clinical trials (34%, n = 39). There was also diminished availability of workforce and funding to conduct observational cohort studies in nephrology, and participation in highly specialized transplant trials was low in many regions. Overall, the availability of infrastructure (bio-banking and facilities for storage of clinical trial medications) was low, and it was lowest in low-income and lower-middle-income countries. Ethics approval for study conduct was mandatory in 91% (n = 106) of countries and regions, and 62% (n = 66) were reported to have institutional committees. Challenges with obtaining timely approval for a study were reported in 53% (n = 61) of regions but the challenges were similar across these regions. A potential limitation is the possibility of over-reporting or under-reporting due to social desirability bias. This study highlights some of the major challenges for participating in and conducting kidney research and offers suggestions for improving global kidney research.

2018-02-01, Htay, Htay, Alrukhaimi, Mona, Ashuntantang, Gloria E, braum, branko, gharbiğ, mohammed benghanem, Feehally, John, Harris, David C, KAZANCIOĞLU, RÜMEYZA, KAZANCIOĞLU, RÜMEYZA

Access to essential medications and health products is critical to effective management of kidney disease. Using data from the ISN Global Kidney Health Atlas multinational cross-sectional survey, global access of patients with kidney disease to essential medications and health products was examined. Overall, 125 countries participated, with 118 countries, composing 91.5% of the world's population, providing data on this domain. Most countries were unable to access eGFR and albuminuria in their primary care settings. Only one-third of low-income countries (LICs) were able to measure serum creatinine and none were able to access eGFR or quantify proteinuria. The ability to monitor diabetes mellitus through serum glucose and glycated hemoglobin measurements was suboptimal. Pathology services were rarely available in tertiary care in LICs (12%) and lower middle-income countries (45%). While acute and chronic hemodialysis services were available in almost all countries, acute and chronic peritoneal dialysis services were rarely available in LICs (18% and 29%, respectively). Kidney transplantation was available in 79% of countries overall and in 12% of LICs. While over one-half of all countries publicly funded RRT and kidney medications with or without copayment, this was less common in LICs and lower middle-income countries. In conclusion, this study demonstrated significant gaps in services for kidney care and funding that were most apparent in LICs and lower middle-income countries.

2019-12-01, Veronese, Nicola, Demurtas, Jacopo, SOYSAL, PINAR, Smith, Lee, Torbahn, Gabriel, Schoene, Daniel, Schwingshackl, Lukas, Sieber, Cornel, Bauer, Jurgen, Cesari, Matteo, Bruyere, Oliviere, Reginster, Jean-Yves, Beaudart, Charlotte, Cruz-Jentoft, Alfonso J., Cooper, Cyrus, Petrovic, Mirko, Maggi, Stefania, SOYSAL, PINAR

Key summary pointsAimTo investigate associations of sarcopenia with adverse health-related outcomes, through an umbrella review method.FindingsSarcopenia appears to be significantly associated with several adverse outcomes in older people, with a strong evidence for increased risk of mortality, disability, and falls.MessageSarcopenia is associated with several adverse health-related outcomes in older people, indicating the need of assessing this condition in daily practice. AbstractBackgroundThe clinical relevance of sarcopenia has increasingly been recognized. However, whether it is associated with the development of other medical conditions is still unclear. Therefore, we aimed to capture the scale of outcomes that have been associated with the presence of sarcopenia and systematically assess the quality, strength, and credibility of these associations using an umbrella review methodology.MethodsA systematic review in several databases was carried out, until 20th February 2019. For each association, random-effects summary effect size, 95% confidence intervals (CIs), heterogeneity (I-2), evidence for small-study effect, evidence for excess significance bias, and 95%-prediction intervals were estimated. We used these metrics to categorize the evidence of significant outcomes (p<0.05) from class I (convincing) to class IV (weak), according to pre-established criteria.ResultsFrom 358 abstracts, 6 meta-analyses with 14 associations were included. Sarcopenia was associated with higher risk of other comorbidities and mortality in 11 of 14 outcomes explored. However, only 3 outcomes (i.e., association between sarcopenia and increased risk of death in community-dwelling older people [odds ratio, OR=3.60; 95% CI 2.96-4.37; n=14,305], disability [OR=3.04; 95% CI 1.80-5.12; n=8569], and falls [OR=1.60; 95% CI 1.31-1.97; n=12,261]) presented a highly suggestive evidence (class II). Other association was classified as having only a weak evidence.ConclusionSarcopenia is associated with several adverse health-related outcomes in older people, and its associations with mortality, disability, and falls are supported by a highly suggestive evidence. The effect of interventions on sarcopenia to improve these outcomes needs to be investigated.