260 research outputs found
HMG CoA reductase inhibitors (statins) for people with chronic kidney disease not requiring dialysis
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HMG CoA reductase inhibitors (statins) for dialysis patients
No full textBackground: Cardiovascular disease accounts for more than half the number of deaths among dialysis patients. The role of HMG CoA reductase inhibitors (statins) in the treatment of dyslipidaemia in dialysis patients is unclear and their safety has not been established. Objectives: To assess the benefits and harms of statins in peritoneal dialysis (PD) and haemodialysis patients (HD). Search strategy: We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled trials (CENTRAL, in The Cochrane Library), the Cochrane Renal Group's specialised register and handsearched reference lists of textbooks, articles and scientific proceedings. Selection criteria: Randomised controlled trials (RCTs) and quasi-RCTs comparing statins with placebo, no treatment or other hypolipidaemic agents in dialysis patients. Data collection and analysis: Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random effects model after testing for heterogeneity. The results were expressed as mean difference (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). Main results: Fourteen studies (2086 patients) compared statins versus placebo or other lipid lowering agents. Compared to placebo, statins did not decrease all-cause mortality (10 studies, 1884 patients; RR 0.95, 95% CI 0.86 to 1.06) or cardiovascular mortality (9 studies, 1839 patients: RR 0.96, 95% CI 0.65 to 1.40). There was a lower incidence of nonfatal cardiovascular events with statins compared to placebo in haemodialysis patients (1 study, 1255 patients; RR 0.86, 95% CI 0.74 to 0.99). Compared with placebo, statin use was associated with a significantly lower end of treatment average total cholesterol (14 studies, 1823 patients; MD -42.61 mg/dL, 95% CI -53.38 to -31.84), LDL cholesterol (13 studies, 1801 patients; MD -43.06 mg/dL, 95% CI -53.78 to -32.35) and triglycerides (14 studies, 1823 patients: MD -24.01 mg/dL, 95% CI -47.29 to -0.72). There was similar occurrence of rhabdomyolysis and elevated liver function tests with statins in comparison to placebo. Authors' conclusions: Statins decreased cholesterol levels in dialysis patients similar to that of the general population. With the exception of one study, studies were of short duration and therefore the efficacy of statins in decreasing the mortality rate is still unclear. Statins appear to be safe in this high-risk population. Ongoing studies should provide more insight about the efficacy of statins in reducing mortality rates in dialysis patients. © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd
Benefits and Harms of Statin Therapy for Persons With Chronic Kidney Disease A Systematic Review and Meta-analysis
No full textStatins in patients with chronic kidney disease: evidence from systematic reviews and randomized clinical trials.
No full textAldosterone antagonists for preventing the progression of chronic kidney disease
No full textBackground: Treatment with angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) is increasingly used to reduce proteinuria and retard the progression of chronic kidney disease (CKD). But some patients do not attain complete resolution of proteinuria and might have higher aldosterone levels within few months of treatment. The addition of aldosterone antagonists may be beneficial to these patients for reduction of progression of renal damage. Objectives: We evaluated the benefits and harms of adding aldosterone antagonists in patients with CKDcurrently treated with ACEi and/or ARB. Search strategy: We searched MEDLINE, EMBASE, CENTRAL, and hand-searched reference lists of textbooks, articles and scientific proceedings for relevant articles. Selection criteria: Randomised controlled trials (RCTs) and quasi-RCTs comparing aldosterone antagonists in addition to ACEi and/or ARB versus ACEi and/or ARB alone were included. Data collection and analysis: Two authors independently assessed study quality and extracted data. Statistical analyses were performed using a random effects model and heterogeneity was tested formally using the Cochran Q and I2 statistic. Results were expressed as mean difference (MD) for continuous outcomes and risk ratio (RR) for dichotomous outcomes with 95% confidence intervals (CI). Main results: Ten studies (845 patients) were included. Compared to ACEi and/or ARB plus placebo, non-selective aldosterone antagonists along with ACEi and/or ARB significantly reduced 24 hour proteinuria (7 studies, 372 patients;MD -0.80 g, 95% CI -1.23 to -0.38). There was a significant reduction in both systolic and diastolic blood pressure at the end of treatment with the addition of non-selective aldosterone antagonists to ACEi and/or ARB. This did not translate into an improvement in glomerular filtration rate (5 studies, 306 patients; MD -0.70 mL/min/1.73 m 2, 95% CI -4.73 to 3.34). There was a significant increase in the risk of hyperkalaemia with the addition of non-selective aldosterone antagonists to ACEi and/or ARB (8 studies, 436 patients; RR 3.06, 95% CI 1.26 to 7.41). In two studies, the addition of selective aldosterone antagonists to ACEi resulted in an additional reduction in 24 hour proteinuria but without any impact on BP and renal function. Data on cardiovascular outcomes, long-term renal outcomes and mortality were not available. Authors' conclusions: Aldosterone antagonists contribute to reduction of proteinuria in patients with CKD who are already on ACEi and ARB but increase the risk of hyperkalaemia. Available studies are small and have short follow-up. Long-term effects on renal outcomes, mortality and safety are unknown. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd
Designing Incentive Schemes For Privacy-Sensitive Users
No full textBusinesses (retailers) often wish to offer personalized advertisements (coupons) to individuals (consumers), but run the risk of strong reactions from consumers who want a customized shopping experience but feel their privacy has been violated. Existing models for privacy such as differential privacy or information theory try to quantify privacy risk but do not capture the subjective experience and heterogeneous expression of privacy-sensitivity. We propose a Markov decision process (MDP) model to capture (i) different consumer privacy sensitivities via a time-varying state; (ii) different coupon types (action set) for the retailer; and (iii) the action-and-state-dependent cost for perceived privacy violations. For the simple case with two states ("Normal" and "Alerted"), two coupons (targeted and untargeted) model, and consumer behavior statistics known to the retailer, we show that a stationary threshold-based policy is the optimal coupon-offering strategy for a retailer that wishes to minimize its expected discounted cost. The threshold is a function of all model parameters; the retailer offers a targeted coupon if its belief that the consumer is in the "Alerted" state is below the threshold. We extend this two-state model to consumers with multiple privacy-sensitivity states as well as coupon-dependent state transition probabilities. Furthermore, we study the case with imperfect (noisy) cost feedback from consumers and uncertain initial belief state.Peer reviewed
Incentive Schemes for Privacy-Sensitive Consumers
No full textThe final publication is available at Springer via http://dx.doi.org/10.1007/978-3-319-25594-1Peer reviewe
Robust privacy-utility tradeoffs under differential privacy and Hamming distortion
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How to design a randomized controlled trial
No full textRandomized controlled trials are the ideal study design to evaluate the effectiveness of health-care interventions. The conduct of a clinical trial is a collaborative effort between participants, investigators and a range of health-care professionals involved both centrally and locally in the coordination and execution of the trial. In this article, the key steps that are required to design a randomized controlled trial are summarized. Randomized controlled trials are the ideal study design to answer clinical questions about health-care interventions. This article describes the steps required to design a randomized controlled trial
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