Chronic kidney disease

Researching chronic kidney disease in the Illawarra-Shoalhaven region

The Illawarra – Shoalhaven (I-S) region has one of the highest rates of Chronic Kidney Disease (CKD) in Australia. Across the globe, CKD is a major, potentially avoidable contributor to morbidity, mortality and economic cost. The reasons for the high rates in our region are unknown. Following a strategic planning exercise, researchers in the Health Impacts Research Cluster (HIRC) determined that CKD could serve as a priority area for developing a 3 year collaborative program of research. This program includes evidence analysis, translational research and epidemiology.

A multidisciplinary research program was devised to investigate ‘leverage points’ for potential interventions to prevent or slow the progression of CKD in the region. Three research streams (‘pods’) were developed, blending expertise in epidemiology, medicine, dietetics, exercise physiology, nursing, and psychology.

  • The systematic literature review (SLR) pod is analysing the current evidence supporting practice in CKD community care. Using SLR methodology, reports on interventions to prevent or mitigate the progression of CKD are being quality reviewed and assessed for effect.

Outcomes: 

Neale, E.P., Middleton, J. & Lambert, K. Barriers and enablers to detection and management of chronic kidney disease in primary healthcare: a systematic review. BMC Nephrol 21, 83 (2020). https://doi.org/10.1186/s12882-020-01731-x

Stanford, J., Charlton, K., Stefoska-Needham, A. et al. The gut microbiota profile of adults with kidney disease and kidney stones: a systematic review of the literature. BMC Nephrol 21, 215 (2020). https://doi.org/10.1186/s12882-020-01805-w

  • The epidemiology pod is analysing large health datasets (CHRISP and SIMLR) to investigate risk factors that are associated with the development and progression of CKD in the region’s population.

Outcomes:

Walsan R, Mayne DJ, Feng X, Pai N, Bonney A. Examining the Association between Neighbourhood Socioeconomic Disadvantage and Type 2 Diabetes Comorbidity in Serious Mental Illness. Int J Environ Res Public Health. 2019;16(20):3905. Published 2019 Oct 15. doi:10.3390/ijerph16203905

Cross R,  Bonney AM, Mayne DJ, Weston KM.  Cross-sectional study of area-level disadvantage and glycaemic-related risk in community health service users in the Southern.IML Research (SIMLR) cohort.  Australian Health Review 2017; 43(1):  85-91 https://doi.org/10.1071/AH16298

Toms, R., Feng, X., Mayne, D. J. & Bonney, A. Role of Area-Level Access to Primary Care on the Geographic Variation of Cardiometabolic Risk Factor Distribution: A Multilevel Analysis of the Adult Residents in the Illawarra—Shoalhaven Region of NSW, Australia. International Journal of Environmental Research and Public Health 2020, 17, (12), 4297-1-4297-21.

RIS: 143822 - Verified

Walsan, R., Feng, X., Mayne, D. J., Pai, N. & Bonney, A. Neighborhood Environment and Type 2 Diabetes Comorbidity in Serious Mental Illness. Journal of Primary Care and Community Health 2020, 11, 1-11.

RIS: 143312 - Verified

Cross, R., Bonney, A., Mayne, D. J. & Weston, K. M. Cross-sectional study of area-level disadvantage and glycaemic-related risk in community health service users in the Southern.IML Research (SIMLR) cohort. Australian Health Review 2019, 43, (1), 85-91.

RIS: 116351 - Verified

Toms, R., Bonney, A., Mayne, D. J., Feng, X. & Walsan, R. Geographic and area-level socioeconomic variation in cardiometabolic risk factor distribution: a systematic review of the literature. International Journal of Health Geographics 2019, 18, 1-1-1-12.

RIS: 132489 - Verified

Toms, R., Mayne, D. J., Feng, X. & Bonney, A. Geographic variation in cardiometabolic risk distribution: A cross-sectional study of 256,525 adult residents in the Illawarra-Shoalhaven region of the NSW, Australia. PLoS One 2019, 14, (10), e0223179-1-e0223179-13.

RIS: 139061 - Verified

Walsan, R., Mayne, D. J., Pai, N., Feng, X. & Bonney, A. Exploring the geography of serious mental illness and type 2 diabetes comorbidity in Illawarra-Shoalhaven, Australia (2010 -2017). PLoS One 2019, 14, (12), e0225992-1-e0225992-13.

RIS: 140429 - Verified

Walsan, R., Mayne, D. J., Feng, X., Pai, N. & Bonney, A. Examining the association between neighbourhood socioeconomic disadvantage and type 2 diabetes comorbidity in serious mental illness. International Journal of Environmental Research and Public Health 2019, 16, (20), 3905-1-3905-9.

RIS: 139368 - Verified

Walsan, R., Bonney, A., Mayne, D. J., Pai, N., Feng, X. & Toms, R. Serious Mental Illness, Neighborhood Disadvantage, and Type 2 Diabetes Risk: A Systematic Review of the Literature. Journal of Primary Care and Community Health 2018, 9, 1-7.

RIS: 130396 - Verified

Walsan, R., Mayne, D., Feng, X., Pai, N. & Bonney, A. Neighbourhoods Matter too: Association between Neighbourhood Socio Economic Disadvantage and Type 2 Diabetes Comorbidity in Serious Mental Illness. In 2020 Congress of the Schizophrenia International Research Society; 2020;

RIS: 143028 - Verified

Toms, R., Bonney, A., Mayne, D. J. & Feng, X. Area-level socioeconomic disadvantage and cardiometabolic risk distribution: an analysis of 256,565 adult residents in the Illawarra-Shoalhaven region of the NSW Australia. In 8th Annual NHMRC Symposium on Research Translation; 2019;

RIS: 140392 - Verified

Walsan, R., Bonney, A., Mayne, D. J., Pai, N. & Feng, X. Geographic inequalities in the distribution of serious mental illness - type 2 diabetes comorbidity. In 18th International Medical Geography Symposium; 2019;

RIS: 138381 - Verified

Walsan, R., Bonney, A., Mayne, D. J., Pai, N. & Feng, X. Spatial analysis of serious mental illness and type 2 diabetes comorbidity: Is there evidence of clustering?. In 5th International Conference on Public Health; 2019; p 10 July to 12 July.

RIS: 138382 - Verified

Williams, F., Bonney, A., Mullan, J., Ellis, Y. & Hammond, A. Cardiometabolic screening in serious mental illness. In GP19 Conference; 2019;

RIS: 142211 - Verified

Toms, R., Bonney, A., Mayne, D. J. & Feng, X. Geographic variance in distribution of cardiometabolic risk factors in the Illawarra-Shoalhaven region of the NSW, Australia. In 15th WONCA World Rural Health Conference 2018, New Delhi, India.; 2018; pp 1-11.

RIS: 130220 - Verified

Walsan, R., Bonney, A., Mayne, D. J., Pai, N., Feng, X. & Toms, R. Melkias Baby Selvi. Neighbourhood Disadvantage and Type 2 Diabetes Comorbidity in Serious Mental Illness: A Systematic Review of Literature. In The Mental Health Services (TheMHS)  Conference; 2018;

RIS: 130397 - Verified

Toms, R., Bonney, A., Mayne, D. J. & Feng, X. Geographic distribution of cardiometabolic risk factors: a small area level approach. In Public Health Prevention Conference; 2018; pp 1-1.

RIS: 130221 - Verified

Toms, R., Mayne, D.J., Feng, X. et al. Geographic variation in cardiometabolic risk factor prevalence explained by area-level disadvantage in the Illawarra-Shoalhaven region of the NSW, Australia. Sci Rep 10, 12770 (2020). https://doi.org/10.1038/s41598-020-69552-4

https://www.nature.com/articles/s41598-020-69552-4

  • The community engagement pod is using qualitative methodologies to better understand the diverse experiences of community members and health care workers with CKD, and how this influences management of the different stages of the disease.
  • A fourth pod was added to the program after the planning day, bringing in a nurse-led study on management of hypertension in primary care.

Outcomes:

Chowdhury, S., Stephen, C., McInnes, S. & Halcomb, E. Nurse-led interventions to manage hypertension in general practice: A systematic review protocol. Collegian 2020; 27 (3): 340-343.

Stephen C, Halcomb E, McInnes S, Batterham M, Zwar N. Improving blood pressure control in primary care: The ImPress study. Int J Nurs Stud. 2019;95:28-33. doi:10.1016/j.ijnurstu.2019.03.019

Zwar N, Hermiz O, Halcomb E, Davidson PM, Bodenheimer  T. Improving blood pressure control in general practice: A pilot study of the ImPress intervention. Australian Family Physician 2017; 46: 306-311. 

Stephen, CM, Hermiz, OS, Halcomb, EJ, McInnes, S, Zwar, N. Feasibility and acceptability of a nurse-led hypertension management intervention in general practice. Collegian 2018; 25:33-38  DOI:https://doi.org/10.1016/J.COLEGN.2017.03.003

The first phase of the HIRC program will identify opportunities for improving interventions related to CKD in the local community from both the evidence-based literature and healthcare provider perspectives. At the population level it will provide a profile of CKD prevalence and risk factors in the region (based on CHRISP data). The research will lead to a pilot intervention and subsequent Category 1 and other related grant applications.

The HIRC CKD project will not only benefit the local community but also build research capacity and translatable evidence for interventions nationally and internationally.

Principal investigators:

Karen Charlton, Karen Fildes, Anita Stefoska-Needham, Josie Atkinson, Pippa Burns, Elizabeth Neale, Eleanor Beck, Kelly Lambert, Maureen Lonergan, Yasmine Probst, Ian Wilson, Liz Halcomb, Nick Zwar, Andrew Bonney, Linda Tapsell.