ISN Supports Clinical Research Studies in NCDs in Emerging Countries to Improve Patient Outcomes.Reema Parmar
The ISN supports clinical research projects that help detect and manage non-communicable chronic diseases such as CKD, AKI, hypertension, diabetes, and cardiovascular disease in emerging countries through the ISN Clinical Research Program (CRP).
Three CRP investigators recently completed their research projects:
Title of Grant:
Acute Renal Failure in Children. Multicenter Prospective Cohort Study in Medium-Complexity Intensive Care Units from the Colombian Southeast.
From June 2016 to January 2020, a team of researchers identified children who developed compromised renal function during stays in intensive care in Popayan´s hospitals in the Cauca State in Colombia, where most people live in rural areas with a large indigenous population. These patients were matched with a control group from another medium complexity PICU from Cali, the capital of Valle del Cauca.
The study, led by Jaime M. Restrepo, was the first multi-center prospective cohort study conducted in Colombia in medium-complexity PICUs investigating renal involvement in children who enter pediatric intensive care. The hospitals involved are currently established within the ISN SRC-Trio Program.
The ethnicity, nutritional status, type of disease, and other important characteristics of the patients were recorded. Patients were followed up during hospitalization, and recovery or deterioration in renal function was monitored and supported with renal replacement therapy.
The results demonstrated:
- A global 5.2% prevalence of acute kidney injury in pediatric intensive care units (2.7% severe cases; 11.8% mortality rate).
- A majority of patients (77%) receiving subsidies from the Colombian government.
- Over a third of patients (39%) with some form of malnutrition, making them more susceptible to developing infections, electrolyte disorders, and acute kidney injury.
The research provided a more accurate description of regional and national epidemiology to predict better AKI prognosis in Colombian pediatric patients and improve understanding of AKI in Latin America.
The project was carried out in line with the ISN 0by25 Initiative to prevent all deaths due to AKI by 2025 and to conduct timely diagnosis and treatment of AKI to patients with reversible pathologies, especially in countries with low economic resources and limitations in access to health care.
The researchers stressed the importance of understanding local epidemiology to formulate and implement health policies to improve kidney care in the region and preserve kidney function in Colombian children.
Partial results were posted at the 9th International Conference on Pediatric Continuous Renal Replacement Therapy (PCRRT) in Orlando, Florida, in 2017. This research was awarded first place as an oral presentation at the VIII National Congress of Pediatric Residents supported by the Colombian Society of Pediatrics in November 2018.
Title of Grant:
Renal health self-monitoring application
The “Renal Health Project” study, based at the University of Fortaleza in Brazil, aimed to provide educational tools for patients with chronic kidney disease (CKD) and develop novel technologies to help CKD patients to self-monitor their treatment.
The project, supervised by Geraldo B. Silva Junior, was developed over two years and focused on education/prevention and adherence to kidney care treatments.
Social media strategies were implemented to share knowledge on kidney disease to the broadest audience possible, and the public’s general understanding of kidney disease was measured in both Brazil and Portugal.
Technological tools to monitor and improve adherence to patient treatment were developed to help people cope with kidney disease and complex procedures such as dialysis and transplants. These include an insole to automatically measure and register the patient’s weight, a “smart” pillbox to control medication intake, and smart bands to monitor vital signs.
An application, the Renal Health app, was developed to be used by transplant patients and those undergoing dialysis to help them monitor their treatment and to provide information on CKD. The app provides information to the general population on CKD prevention and calculates renal function by estimating glomerular filtration rate. It is currently available at Google Play and the Apple Store, in Portuguese, English, and Spanish.
Further research is planned to investigate the impact of the app on clinical outcomes. The hypothesis is that the app increases adherence to treatment, and therefore decreases the complications of dialysis and kidney transplant. Clinical studies in dialysis clinics and tertiary hospitals are already underway in Brazil.
The educational material developed by the team was also shared via a YouTube channel and an Instagram account. The Instagram profile has over 5,000 followers, and the renal health YouTube videos have been viewed more than 1,000 times.
The material in Portuguese received positive feedback from patients and health care professionals from around the world. Plans are underway to develop the content in English and Spanish.
According to the researchers, understanding the main gaps in the public’s knowledge of kidney disease in Brazil and Portugal provides the data necessary to improve screening campaigns in these countries.
Title of Grant:
A prospective study of clinico-epidemiology, outcome, and catastrophic out-of-pocket expenditure associated with obstetrical-AKI
This prospective study evaluated the causes and factors influencing the outcome of obstetrical-AKI, and the economic consequences on patients.
Raja Ramachandran, evaluated patients with obstetrical-AKI, referred to the Postgraduate Institute of Medical Education and Research, Chandigarh, between August 2015 and August 2017.
All the patients in the study were dialysis-dependent. AKI was most common during the third trimester (33%) and post-partum period (55%). The causes of AKI were found to be multifactorial:
- 20% of patients had evidence of renal cortical necrosis.
- 49% of patients either died or declared end-stage kidney disease.
The results demonstrated that AKI and consequential death are an under-reported cause of maternal mortality rate and that 93% of patient’s families experienced catastrophic out-of-pocket expenses.
These results were presented at the ISN World Congress of Nephrology 2017, Mexico City, Mexico, and ASN Kidney week 2018, San Diego, US.
“Utility of serology in the diagnosis of pre-eclampsia and haemolytic uraemic syndrome in pregnancy-related acute kidney injury.” was published in Nephrology.