Non-Medical Risk Factors as Avoidable Determinants of Excess Mortality in Children with Chronic Kidney Disease. A Prospective Cohort Study in Nicaragua, a Model Low Income Country.
Giovanni MontiniAlberto EdefontiYajaira Silva GalánMabel Sandoval DíazMarta Medina ManzanarezGiuseppina MarraFabio RobustoGianni TognoniFabio SereniPublished in: PloS one (2016)
The unfavourable socioeconomic and cultural background of the pediatric study cohort and the severity of kidney damage at diagnosis were the key determinants of the clinical risk conditions at baseline and of the mortality outcome. Long-term structural interventions on such backgrounds must be adopted to assure effectiveness of medical care and to assure an earlier diagnosis of CKD in these patients. The translation-extension of our results is currently underway with an agenda which includes: 1) better integration of chronic pediatric conditions into primary care strategies to promote prevention and early timely referral; 2) the consideration of socioeconomic conditions as a mandatory component of the packages of best-care; 3) the formulation and flexible adaptation of guidelines and educational programs, based on the information generated by a context-specific, epidemiological monitoring of needs and outcomes, guaranteed by an effective database.
Keyphrases
- chronic kidney disease
- end stage renal disease
- risk factors
- primary care
- healthcare
- peritoneal dialysis
- cardiovascular events
- newly diagnosed
- randomized controlled trial
- palliative care
- oxidative stress
- systematic review
- young adults
- drug delivery
- physical activity
- emergency department
- prognostic factors
- clinical practice
- quality improvement
- metabolic syndrome
- patient reported
- social media
- health information
- adverse drug
- insulin resistance
- general practice