Nephrology in Australia

In Australia, hospitalisations attributed to acute kidney injury are increasing at an average 6% per annum, and the vast majority of these cases are managed by critical care physicians instead of nephrologists. Prevalence of chronic kidney disease varies from 4.5% to 43.3% according to age and gender. As in other countries, most are unaware of their kidney disease. The number of people receiving maintenance dialysis has steadily increased in the last two decades with over 13,000 people on dialysis in 2017. The incidence of haemodialysis is approximately fivefold higher for Indigenous Australians compared to non-Indigenous Australians, and the magnitude of this difference has not changed in the last decade. Australia has the second highest prevalence of home haemodialysis and the fifth highest utilisation of peritoneal dialysis in the world. In recent years, average waiting time for a kidney transplant has shortened to 2.4 years for the most common blood group. Emerging paradigms in Australian nephrology include "green nephrology" and exploring different approaches to the burden of chronic kidney disease. Australia has a vibrant kidney research community, and the immediate future promises to be an incubator for nephrology clinicians who have ideas to test in our clinical spaces.No Full Tex

An assessment of randomized controlled trials (RCTs) for non-communicable diseases (NCDs): more and higher quality research is required in less developed countries

Research is crucial to implement evidence-based health interventions for control of non-communicable diseases (NCDs). This study aims to assess main features of randomized controlled trials (RCTs) for the control of NCDs, and to identify gaps in clinical research on NCDs between high-income and less developed countries. The study included 1177 RCTs in 82 Cochrane Systematic reviews (CSRs) and evaluated interventions for adults with hypertension, diabetes, stroke, or heart diseases. Multivariate logistic regression analyses were conducted to explore factors associated with risk of bias in the included RCTs. We found that 78.2% of RCTs of interventions for major NCDs recruited patients in high-income countries. The number of RCTs included in the CSRs was increasing over time, and the increasing speed was more noticeable for RCTs from middle-income countries. RCTs in less developed countries tended to be more recently published, less likely to be published in English, with smaller sample sizes, and at a higher risk of bias. In conclusion, there is still a lack of research evidence for control of NCDs in less developed countries. To brace for rising NCDs and avoid waste of scarce research resources, not only more but also higher quality clinical trials are required in low-and-middle-income countries