Summary of quality of reporting as assessed using the Manuscript STROBE Score (MSS).

<p>Summary of quality of reporting as assessed using the Manuscript STROBE Score (MSS).</p

PRISMA flow diagram.

<p>PRISMA flow diagram.</p

Time series of Manuscript STROBE scores (MSS) from spline linear regression models.

<p>Time series of Manuscript STROBE scores (MSS) from spline linear regression models.</p

Summary of pre and post-STROBE period Manuscript STROBE score (MSS), Manuscript NOS score (MNOS), Manuscript SIGN score (MSiS) & Manuscript CASP score (MCAS) by article.

<p>The citations for the manuscripts are listed in online supplementary material (Item B in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0155078#pone.0155078.s001" target="_blank">S1 File</a>).</p

Symptom clusters in chronic kidney disease and their association with people’s ability to perform usual activities

Background People living with a long-term condition, such as chronic kidney disease (CKD), often suffer from multiple symptoms simultaneously, making symptom management challenging. This study aimed to identify symptom clusters in adults with CKD across treatment groups and investigate their association with people’s ability to perform their usual activities. Methods We conducted a secondary analysis of both cross-sectional and longitudinal data collected as part of a national service improvement programme in 14 kidney centres in England, UK. This data included symptom severity (17 items, POS-S Renal) and the extent to which people had problems performing their usual activities (single item, EQ-5D-5L). We categorised data by treatment group: haemodialysis (n = 1,462), transplantation (n = 866), peritoneal dialysis (n = 127), or CKD without kidney replacement therapy (CKD non-KRT; n = 684). We used principal component analysis to identify symptom clusters per treatment group, and proportional odds models to assess the association between clusters and usual activities. Results Overall, clusters related to: lack of energy and mobility; gastrointestinal; skin; and mental health. Across groups, the ‘lack of energy and mobility’ clusters were associated with having problems with usual activities, with odds ratios (OR) ranging between 1.24 (95% confidence interval [CI], 1.21–1.57) for haemodialysis and 1.56 for peritoneal dialysis (95% CI, 1.28–1.90). This association was confirmed longitudinally in haemodialysis (n = 399) and transplant (n = 249) subgroups. Implications Our findings suggest that healthcare professionals should consider routinely assessing symptoms in the ‘lack of energy & mobility’ cluster in all people with CKD, regardless of whether they volunteer this information; not addressing these symptoms is likely to be related to them having problems with performing usual activities. Future studies should explore why symptoms within clusters commonly co-occur and how they interrelate. This will inform the development of cluster-level symptom management interventions with enhanced potential to improve outcomes for people with CKD.</p

Additional file 1: of The risks and benefits of patients temporarily discontinuing medications in the event of an intercurrent illness: a systematic review protocol

Search strategy Medline. (DOC 68 kb

Median STROBE QUESTION SCORE (SQS), Difference (95% CI) with p value of the 55 data items (22 items were further sub-divided to 55 questions in total) in 37 CKD cohort studies, by publication period.

<p>Median STROBE QUESTION SCORE (SQS), Difference (95% CI) with p value of the 55 data items (22 items were further sub-divided to 55 questions in total) in 37 CKD cohort studies, by publication period.</p

Box plot summarising methodological quality of the studies in the Pre and Post-STROBE period as assessed using the NOS, CASP and SIGN.

<p>Box plot summarising methodological quality of the studies in the Pre and Post-STROBE period as assessed using the NOS, CASP and SIGN.</p

Quality of the reporting of observational studies as assessed using the Manuscript STROBE score (MSS) over time.

<p>Quality of the reporting of observational studies as assessed using the Manuscript STROBE score (MSS) over time.</p

Impact of chronic kidney disease on case ascertainment for hospitalised acute myocardial infarction: an English cohort study

Objectives: Acute myocardial infarction (AMI) case ascertainment improves for the UK general population using linked health data sets. Because care pathways for people with chronic kidney disease (CKD) change based on disease severity, AMI case ascertainment for these people may differ compared with the general population. We aimed to determine the association between CKD severity and AMI case ascertainment in two secondary care data sets, and the agreement in estimated glomerular filtration rate (eGFR) between the same data sets. METHODS: We used a cohort study design. Primary care records for people with CKD or risk factors for CKD, identified using the National CKD Audit (2015-2017), were linked to the Myocardial Ischaemia National Audit Project (MINAP, 2007-2017) and Hospital Episode Statistics (HES, 2007-2017) secondary care registries. People with an AMI recorded in either MINAP, HES or both were included in the study cohort. CKD status was defined using eGFR, derived from the most recent serum creatinine value recorded in primary care. Moderate-severe CKD was defined as eGFR <60 mL/min/1.73 m2, and mild CKD or at risk of CKD was defined as eGFR ≥60 mL/min/1.73 m2 or eGFR missing. CKD stages were grouped as (1) At risk of CKD and Stages 1-2 (eGFR missing or ≥60 mL/min/1.73 m2), (2) Stage 3a (eGFR 45-59 mL/min/1.73 m2), (3) Stage 3b (eGFR 30-44 mL/min/1.73 m2) and (4) Stages 4-5 (eGFR <30 mL/min/1.73 m2). RESULTS: We identified 6748 AMIs: 23% were recorded in both MINAP and HES, 66% in HES only and 11% in MINAP only. Compared with people at risk of CKD or with mild CKD, AMIs in people with moderate-severe CKD were more likely to be recorded in both MINAP and HES (42% vs 11%, respectively), or MINAP only (22% vs 5%), and less likely to be recorded in HES only (36% vs 84%). People with AMIs recorded in HES only or MINAP only had increased odds of death during hospitalisation compared with those recorded in both (adjusted OR 1.61, 95% CI 1.32 to 1.96 and OR 1.60, 95% CI 1.26 to 2.04, respectively). Agreement between eGFR at AMI admission (MINAP) and in primary care was poor (kappa (K) 0.42, SE 0.012). CONCLUSIONS: AMI case ascertainment is incomplete in both MINAP and HES, and is associated with CKD severity.</p