Impact of CKD on Household Income.

Introduction: The impact of chronic kidney disease (CKD) on income is unclear. We sought to determine whether CKD severity, serious adverse events, and CKD progression affected household income. Methods: Analyses were undertaken in a prospective cohort of adults with moderate-to-severe CKD in the Study of Heart and Renal Protection (SHARP), with household income information available at baseline screening and study end. Logistic regressions, adjusted for sociodemographic characteristics, smoking, and prior diseases at baseline, estimated associations during the 5-year follow-up, among (i) baseline CKD severity, (ii) incident nonfatal serious adverse events (vascular or cancer), and (iii) CKD treatment modality (predialysis, dialysis, or transplanted) at study end and the outcome "fall into relative poverty." This was defined as household income <50% of country median income. Results: A total of 2914 SHARP participants from 14 countries were included in the main analysis. Of these, 933 (32%) were in relative poverty at screening; of the remaining 1981, 436 (22%) fell into relative poverty by study end. Compared with participants with stage 3 CKD at baseline, the odds of falling into poverty were 51% higher for those with stage 4 (odds ratio [OR]: 1.51; 95% confidence interval [CI]: 1.09-2.10), 66% higher for those with stage 5 (OR: 1.66; 95% CI: 1.11-2.47), and 78% higher for those on dialysis at baseline (OR: 1.78, 95% CI: 1.22-2.60). Participants with kidney transplant at study end had approximately half the risk of those on dialysis or those with CKD stages 3 to 5. Conclusion: More advanced CKD is associated with increased odds of falling into poverty. Kidney transplantation may have a role in reducing this risk.RLM was supported by the Australian National Health Medical Research Council (Sidney Sax Public Health Overseas Fellowship No. 1054216). The SHARP study was funded by Merck & Co., Inc., Kenilworth, NJ, USA, with additional support from the Australian National Health Medical Research Council, the British Heart Foundation (CH/1996001/9454), and the UK Medical Research Council (A310). SHARP was initiated, conducted, and interpreted independently of the principal study funder (Merck & Co.). The study sponsor did not have any role in study design; collection, analysis, and interpretation of data; writing the report; and the decision to submit the report for publication

Increase in the use of inhaled nitric oxide in neonatal intensive care units in England: a retrospective population study

Objective To describe temporal changes in inhaled nitric oxide (iNO) use in English neonatal units between 2010 and 2015.Design Retrospective analysis using data extracted from the National Neonatal Research Database.Setting All National Health Service neonatal units in England.Patients Infants of all gestational ages born 2010–2015 admitted to a neonatal unit and received intensive care.Main outcome measures Proportion of infants who received iNO; age at initiation and duration of iNO use.Results 4.9% (6346/129 883) of infants received iNO; 31% (1959/6346) were born &lt;29 weeks, 18% (1152/6346) 29–33 weeks and 51% (3235/6346)&gt;34 weeks of gestation. Between epoch 1 (2010–2011) and epoch 3 (2014–2015), there was (1) an increase in the proportion of infants receiving iNO: &lt;29 weeks (4.9% vs 15.9%); 29–33 weeks (1.1% vs 4.8%); &gt;34 weeks (4.5% vs 5.0%), (2) increase in postnatal age at iNO initiation: &lt;29 weeks 10 days vs 18 days; 29–33 weeks 2 days vs 10 days, (iii) reduction in iNO duration: &lt;29 weeks (3 days vs 2 days); 29–33 weeks (2 days vs 1 day).Conclusions Between 2010 and 2015, there was an increase in the use of iNO among infants admitted to English neonatal units. This was most notable among the most premature infants with an almost fourfold increase. Given the cost of iNO therapy, limited evidence of efficacy in preterm infants and potential for harm, we suggest that exposure to iNO should be limited, ideally to infants included in research studies (either observational or randomised placebo-controlled trial) or within a protocolised pathway. Development of consensus guidelines may also help standardise practice