Browsing by Author "Luyckx, V.A."
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Item A developmental approach to the prevention of hypertension and kidney disease: a report from the Low Birth Weight and Nephron Number Working Group(The Lancet, 2017) Luyckx, V.A.; Perico, N.; Somaschini, M.; Manfellotto, D.; Valensise, H.; Cetin, I.; Simeoni, U.; Allegaert, K.; Vikse, B.E.; Steegers, E.A; Adu, D.; Montini, G.; Remuzzi, G.; Brenner, B.M.; Benedetto, C.; Charlton, J.; Chevalier, R.; Cortinovis, M.; D'Anna, R.; Duvekot, J.; Escribano, J.; Fanos, V.; Ferrazzi, E.; Frusca, T.; Glassock, R.; Gyselaers, W.; Mecacci, F.; Osmond, C.; Ramenghi, L.; Romagnani, P.; Santoro, A.Item Global case studies for chronic kidney disease/end-stage kidney disease care(Kidney International Supplements, 2020-02-19) Osafo, C.; Yang, C-W.; Harris, D.C.H.; Luyckx, V.A.; Nangaku, M.; Hou, F.F.; Garcia, G.G.; Abu-Aisha, H.; Niang, A.; Sola, L.; Bunnag, S.; Eiam-Ong, S.; Tungsanga, K.; Richards, M.; Richards, N.; Goh, B.L.; Dreyer, G.; Evans, R.; Mzingajira, H.; Twahir, A.; McCulloch, M.I.; Ahn, C.; Hsu, H-H.; Barnieh, L.; Donner, J-A.; Tonelli, M.The prevalence of chronic kidney disease and its risk factors is increasing worldwide, and the rapid rise in global need for end-stage kidney disease care is a major challenge for health systems, particularly in low- and middle-income countries. Countries are responding to the challenge of end-stage kidney disease in different ways, with variable provision of the components of a kidney care strategy, including effective prevention, detection, conservative care, kidney transplantation, and an appropriate mix of dialysis modalities. This collection of case studies is from 15 countries from around the world and offers valuable learning examples from a variety of contexts. The variability in approaches may be explained by country differences in burden of disease, available human or financial resources, income status, and cost structures. In addition, cultural considerations, political context, and competing interests from other stakeholders must be considered. Although the approaches taken have often varied substantially, a common theme is the potential benefits of multistakeholder engagement aimed at improving the availability and scope of integrated kidney care.Item Outcomes in adults and children with end-stage kidney disease requiring dialysis in sub-Saharan Africa: a systematic review(The Lancet Global Health, 2017-04) Ashuntantang, G.; Osafo, C.; Olowu, W.A.; Arogundade, F.; Niang, A.; Porter, J.; Naicker, S.; Luyckx, V.A.Background The burden of end-stage kidney disease (ESKD) in sub-Saharan Africa is unknown but is probably high. Access to dialysis for ESKD is limited by insufficient infrastructure and catastrophic out-of-pocket costs. Most patients remain undiagnosed, untreated, and die. We did a systematic literature review to assess outcomes of patients who reach dialysis and the quality of dialysis received. Methods We searched PubMed, African Journals Online, WHO Global Health Library, and Web of Science for articles in English or French from sub-Saharan Africa reporting dialysis outcomes in patients with ESKD published between Jan 1, 1990, and Dec 22, 2015. No studies were excluded to best represent the current situation in sub-Saharan Africa. Outcomes of interest included access to dialysis, mortality, duration of dialysis, and markers of dialysis quality in patients with ESKD. Data were analysed descriptively and reported using narrative synthesis. Findings Studies were all of medium to low quality. We identified 4339 studies, 68 of which met inclusion criteria, comprising 24 456 adults and 809 children. In the pooled analysis, 390 (96%) of 406 adults and 133 (95%) of 140 children who could not access dialysis died or were presumed to have died. Among those dialysed, 2747 (88%) of 3122 adults in incident ESKD cohorts, 496 (16%) of 3197 adults in prevalent ESKD cohorts, and 107 (36%) of 294 children with ESKD died or were presumed to have died. 2508 (84%) of 2990 adults in incident ESKD cohorts discontinued dialysis compared with 64 (5%) of 1364 adults in prevalent ESKD cohorts. 41 (1%) of 4483 adults in incident ESKD cohorts, 2280 (19%) of 12 125 adults in prevalent ESKD cohorts, and 71 (19%) of 381 children with ESKD received transplants. 16 studies reported on management of anaemia, 17 on dialysis frequency, eight on dialysis accuracy, and 22 on vascular access for dialysis Interpretation Most patients with ESKD starting dialysis in sub-Saharan Africa discontinue treatment and die. Further work is needed to develop equitable and sustainable strategies to manage individuals with ESKD in sub-Saharan Africa. Funding None. © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND licenseItem Outcomes of acute kidney injury in children and adults in sub-Saharan Africa: A systematic review(The Lancet Global Health, 2016-04) Olowu, W.A.; Niang, A.; Osafo, C.; Ashuntantang, G.; Arogundade, F.A.; Porter, J.; Naicker, S.; Luyckx, V.A.Background: Access to diagnosis and dialysis for acute kidney injury can be life-saving, but can be prohibitively expensive in low-income settings. The burden of acute kidney injury in sub-Saharan Africa is presumably high but remains unknown. We did a systematic review to assess outcomes of acute kidney injury in sub-Saharan Africa and identify barriers to care. Methods: We searched PubMed, African Journals Online, WHO Global Health Library, and Web of Science for articles published between Jan 1, 1990, and Nov 30, 2014. We scored studies, and all were of medium-to-low quality. We made a pragmatic decision to include all studies to best reflect reality, and did a descriptive analysis of extracted data. This study is registered with PROSPERO, number CRD42015015690. Findings: We identified 3881 records, of which 41 met inclusion criteria, including 1403 adult patients and 1937 paediatric patients. Acute kidney injury in sub-Saharan Africa is severe, with 1042 (66%) of 1572 children and 178 (70%) 253 of adults needing dialysis in studies reporting dialysis need. Only 666 (64%) of 1042 children (across 11 studies) and 58 (33%) of 178 adults (across four studies) received dialysis when needed. Overall mortality was 34% in children and 32% in adults, but rose to 73% in children and 86% in adults when dialysis was needed but not received. Major barriers to access to care were out-of-pocket costs, erratic hospital resources, late presentation, and female sex. Interpretation: Patients in these studies are those with resources to access care. In view of overall study quality, data interpretation should be cautious, but high mortality and poor access to dialysis are concerning. The global scarcity of resources among patients and health centres highlights the need for a health-system-wide approach to prevention and management of acute kidney injury in sub-Saharan Africa. © 2016 Olowu et al. Open Access article distributed under the terms of CC BY.