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BACKGROUND: The real-world consequences of a Philips/Respironics recall for positive airway pressure (PAP) devices distributed between 2009 and 2021 are unknown. METHODS: We conducted a retrospective population-based study using health administrative databases (Ontario, Canada) on all new adult PAP users identified through the provincial funding system, free of cancer at baseline, who initiated (claimed) PAP treatment between 2012 and 2018. Everyone was followed from the PAP claim date to the earliest of incident cancer diagnosis, death, or the end of the follow-up (March 2022). We used inverse probability of treatment weighting to balance baseline characteristics between individuals on recalled devices and those on devices from other manufacturers. Weighted hazard ratios of incident cancer were compared between groups. RESULTS: Of 231 692 individuals identified, 58 204 (25.1%) claimed recalled devices, and 173 488 (74.9%) from other manufacturers. A meaningful baseline difference between groups (standardised difference≥0.10) was noted only by location-relevant covariates; other variables were mostly equally distributed (standardised differences≤0.06). Over a median follow-up of 6.3â years (IQR: 4.9-8.0), 11 166 (4.8%) developed cancer: unadjusted rates per 10 000 Person-Year (95 CI%) of 78.8 (76.0-81.7) in the recall group versus74.0 (72.4-75.6) in others (p=0.0034). Propensity score weighting achieved excellent balance in baseline characteristics between groups (standardised differences≤0.07). On a weighted sample, there was no statistical difference in the hazard of incident cancer between groups: cause-specific hazard ratio (recalled versus others) of 0.97, 95% CI: 0.89-1.06. CONCLUSION: In our real-world population study, compared to other manufacturers and adjusting for confounders, recalled devices do not appear to be independently associated with developing cancer.
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INTRODUCTION: In Canada, regional evaluations of screening practices for chronic kidney disease (CKD) among people with diabetes highlight areas for improvement; however, national estimates are notably absent. Estimates of CKD incidence often discount the expected decline in eGFR associated with age; age-adaptive thresholds may help account for this. We describe the frequency of screening and diagnosis of CKD among adults with diabetes among a nationally representative primary care cohort. METHODS: In this retrospective cohort study, we used electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). We followed adult patients (18+) with diabetes without CKD at baseline for 5 years starting in 2014. We determined the frequency of ACR and/or eGFR testing over time. We identified incident CKD diagnoses based on eGFR measurements using fixed-threshold and age-adaptive definitions and quantified the incidence proportion and rate. RESULTS: We analysed records from 37,604 patients with diabetes. Only 13% of patients had yearly eGFR and ACR testing for CKD, though roughly 60% had non-yearly use of both tests in 5 years. eGFR testing was performed more frequently than ACR testing (94.1% vs. 76.6% having testing over follow-up). We found increased incidence proportions (14.6 % vs. 6.0%) and rates (33.1 vs. 13.4 diagnoses/1000 person-years) of CKD using the fixed-threshold compared to age-adaptive definitions. CONCLUSIONS: Our study presents the first national understanding of screening practices for CKD among people with diabetes in Canada. In particular, increased use of ACR testing should be encouraged for early detection of changes in kidney function.
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SOURCE CITATION: Vazquez MA, Oliver G, Amarasingham R, et al; ICD-Pieces Study Group. Pragmatic trial of hospitalization rate in chronic kidney disease. N Engl J Med. 2024;390:1196-1206. 38598574.