Corrinda Black

Long term effects of gestational hypertension and pre-eclampsia on kidney function: Record linkage study

Highlights • We examine risk of chronic kidney disease (CKD) after pregnancy hypertension.• We found increased risk of chronic kidney disease after gestational hypertension.• Risk of chronic kidney disease was further increased after preeclampsia.• Women with pregnancy hypertension develop CKD earlier than normotensive women.

Models of care for chronic kidney disease: a systematic review

Chronic kidney disease (CKD) is common and presents an increasing burden to patients and health services. However, the optimal model of care for patients with CKD is unclear. We systematically reviewed the clinical effectiveness of different models of care for the management of CKD.

Diagnostic sensitivity and false positive AKI alerts through unlinking of an integrated Grampian biochemistry service

Background Grampian has a relatively unique position of an integrated biochemistry service for the whole region. This is helpful when studying AKI, where accurate baseline is crucial and one missing test result can alter findings. Ealert AKI systems that appear to perform reasonably in Grampian may not perform as well in other areas if care is shared across different services that are not integrated. Grampian biochemistry service contains two linked laboratories in Aberdeen and Elgin. Of 417295 patients with biochemistry profiles in Grampian 1999-2009, there were 32053 patients (7.7%) that had blood tests processed by each of the two laboratories (i.e. border patients). Without integration of the two laboratories, this minority of patients may be at risk of being misclassified by an automated detection algorithm. Note that in other areas the proportion of patients in border areas will vary greatly, but this analysis here has been restricted only to those 32053 bordering patients (integration will have made no difference in the others).

Acute kidney injury in the UK: a replication cohort study of the variation across three regional populations

Objectives A rapid growth in the reported rates of acute kidney injury (AKI) has led to calls for greater attention and greater resources for improving care. However, the reported incidence of AKI also varies more than tenfold between previous studies. Some of this variation is likely to stem from methodological heterogeneity. This study explores the extent of cross-population variation in AKI incidence after minimising heterogeneity. Design Population-based cohort study analysing data from electronic health records from three regions in the UK through shared analysis code and harmonised methodology. Setting Three populations from Scotland, Wales and England covering three time periods: Grampian 2003, 2007 and 2012; Swansea 2007; and Salford 2012. Participants All residents in each region, aged 15 years or older. Main outcome measures Population incidence of AKI and AKI phenotype (severity, recovery, recurrence). Determined using shared biochemistry-based AKI episode code and standardised by age and sex. Results Respectively, crude AKI rates (per 10 000/year) were 131, 138, 139, 151 and 124 (p=0.095), and after standardisation for age and sex: 147, 151, 146, 146 and 142 (p=0.257) for Grampian 2003, 2007 and 2012; Swansea 2007; and Salford 2012. The pattern of variation in crude rates was robust to any modifications of the AKI definition. Across all populations and time periods, AKI rates increased substantially with age from ~20 to ~550 per 10 000/year among those aged <40 and ≥70 years. Conclusion When harmonised methods are used and age and sex differences are accounted for, a similar high burden of AKI is consistently observed across different populations and time periods (~150 per 10 000/year). There are particularly high rates of AKI among older people. Policy-makers should be careful not draw simplistic assumptions about variation in AKI rates based on comparisons that are not rigorous in methodological terms.

Hip fracture incidence and mortality in chronic kidney disease : the GLOMMS-II record linkage cohort study

Background Individuals on renal replacement therapy (RRT) have increased fracture risk, but risk in less advanced chronic kidney disease (CKD) is unclear. Objective To investigate CKD associations with hip fracture incidence and mortality. Design Record linkage cohort study Grampian Laboratory Outcomes Mortality and Morbidity Study II. Setting Single health region in Scotland. Participants All individuals (≥15 years) with sustained CKD stages 3–5 and those on RRT, and a 20% random sample of those with normal renal function, in the resident population in 2003. Outcome measures Outcomes were (1) incident hip fracture measured with (A) admissions or (B) deaths, with at least 5.5 years follow-up and (2) post-hip fracture mortality. Unadjusted and adjusted, incident rate ratios (IRRs) and mortality rate ratios were calculated using Poisson regression. Results Of 39 630 individuals identified in 2003 (41% males, mean age 63.3 years), 19 537 had CKD stages 3–5, 345 were on RRT and 19 748 had normal estimated glomerular filtration rate (eGFR). Hip fracture incidence, measured by admissions, was increased in CKD stages 3–5 (compared with normal eGFR), both overall (adjusted IRR 1.49 (95% CI 1.24 to 1.79)) and for individual CKD stages 3a, 3b and 4. Hip fracture incidence, measured using deaths, was increased in those with CKD stages 3b and 4. Post-hip fracture mortality was only increased in CKD stage 4. There was only a small number of individuals and events for CKD stage 5, resulting in insufficient statistical power. Conclusion Hip fracture incidence was higher in CKD stages 3–5 compared with normal eGFR. Post-hip fracture mortality was only increased in CKD stage 4. Reducing hip fracture incidence in CKD through regular fall and fracture risk review should reduce overall deaths after hip fracture in the population.