Year: 2018
Type: dissertation
Study designs: Systematic Review, Meta-Analysis
Abstract: Background: The global burden of kidney disease continues to rise but important gaps exist in our understanding of the prevalence of CKD and its complications globally and by region. Scarcity of evidence to guide public health decisions about CKD presents a serious challenge. There is a critical need to identify patterns of disease prevalence, risk factors and potential treatments. Methods: This thesis, based on contemporary evidence, has reported various epidemiological indices in kidney disease at a global and regional level, and explored whether regional dietary patterns might be associated with improved clinical outcomes. This research programme has utilised a series of quantitative methodologies, including meta-analysis of published randomised control trials (RCTs) and observational studies. Results: This research programme included a pooled analysis of disparate data sources to estimate the global burden of ESKD, the development of a novel collaboration among leading researchers in the field of nephrology in Asia: the Asian Renal Collaboration (ARC). Through a series of meta-analyses and pooled data analyses, the main findings of this thesis are that 1) 2.62 million people received RRT in 2010, but at least that many more did not have access to it and died prematurely due to ESKD, 2) 370 million adults have earlier stage CKD in Asia, 3) renal anaemia prevalence increased with progressively worsening CKD and treatment patterns varied dramatically, 4) a major shortage of evidence in exploring the Mediterranean diet as a potential therapeutic intervention for CKD, 5) potential beneficial effects of the Mediterranean diet on cardiovascular outcomes, 6) a lack of systematic data recording system in most countries in Asia. Conclusion: This thesis highlights the importance of kidney disease as a global and regional problem, and the urgent need for a standardised data collection system for kidney disease to inform public health and clinical strategies. It also highlights the need for improved access to treatment for ESKD, and for methods to standardise evidence based care for the complications of kidney disease. Future research and resources to develop methods for prevention, early detection, and delay progression of CKD will also be key. The Mediterranean diet has shown moderate beneficial effects for multiple determinants of vascular risk, exploring the role of the Mediterranean diet in the onset and progression of CKD may be an important area of future research.
Author: Thaminda Liyanage
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: U.S. Department of Health and Human Services, Amgen, Bristol-Myers Squibb, Eli Lilly and Company, Pfizer, AstraZeneca, GlaxoSmithKline, Sanofi, Queensland Health, Pratt Foundation, Australian Government, ResMed, Diabetes Australia, Kidney Health Australia, Novo Nordisk, Astellas Pharma, Alberta Innovates, Servier, Menzies Institute for Medical Research, Canadian Institutes of Health Research, Eli Lilly Australia, Medical Research Council, National Health and Medical Research Council, Cilag
OpenAlex ID: W3021163115