The goal of this three-year study is to evaluate the implications on outcomes and costs of a variety of alternative dialysis initiation strategies. Because a randomized control trial is not feasible, the study will develop simulation models of alternative initiation strategies, and estimate effects on survival, quality of life, rehabilitation, functional status, and costs. Input data for the Monte Carlo simulations will be derived from a variety of sources, including published data, data collected expressly for this study, and existing claims data. Data sources consist of 1) 270 patients in 3 GFR categories drawn from multiple dialysis clinics and several ambulatory nephrology practices in the Bay Area (for aim 2, utilities assessment); 2) 10,000 chronic renal insufficiency cohorts from Kaiser Permanente Northern CA (KPNC) and the San Francisco Community Health Network (for aim 3, demographic and clinical factors associated with outcomes), and 3) multiple HCFA data files from the ESRD program (for aim 4, to determine the best evidence for the effect of dialysis initiation timing, adjusting for selection biases).
The final aim of the study is to estimate the feasibility of an RCT of various dialysis initiation strategies, to be achieved by a national survey of 1000 physicians. This is a resubmission of an application reviewed 3/00. The investigators have provided additional preliminary studies and have provided an extensive, detailed example of how the Monte Carlo models will be specified, validated, and optimized.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
5R01DK058411-03
Application #
6654484
Study Section
Health Care Quality and Effectiveness Research (HQER)
Program Officer
Eggers, Paul Wayne
Project Start
2001-09-30
Project End
2005-08-31
Budget Start
2003-09-01
Budget End
2005-08-31
Support Year
3
Fiscal Year
2003
Total Cost
$553,253
Indirect Cost
Name
University of California San Francisco
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Zhou, Tianhao; Wu, Nan; Meng, Fanyin et al. (2018) Knockout of secretin receptor reduces biliary damage and liver fibrosis in Mdr2-/- mice by diminishing senescence of cholangiocytes. Lab Invest 98:1449-1464
Sato, Keisaku; Meng, Fanyin; Giang, Thao et al. (2018) Mechanisms of cholangiocyte responses to injury. Biochim Biophys Acta Mol Basis Dis 1864:1262-1269
Pei, Ya; Li, Honggui; Cai, Yuli et al. (2018) Regulation of adipose tissue inflammation by adenosine 2A receptor in obese mice. J Endocrinol 239:365-376
Kennedy, Indsey; Francis, Heather; Meng, Fanyin et al. (2017) Diagnostic and therapeutic potentials of microRNAs in cholangiopathies. Liver Res 1:34-41
Hall, Chad; Ehrlich, Laurent; Venter, Julie et al. (2017) Inhibition of the apelin/apelin receptor axis decreases cholangiocarcinoma growth. Cancer Lett 386:179-188
Hall, Chad; Ehrlich, Laurent; Meng, Fanyin et al. (2017) Inhibition of microRNA-24 increases liver fibrosis by enhanced menin expression in Mdr2-/- mice. J Surg Res 217:160-169
Wu, Nan; Nguyen, Quy; Wan, Ying et al. (2017) The Hippo signaling functions through the Notch signaling to regulate intrahepatic bile duct development in mammals. Lab Invest 97:843-853
Raggi, Chiara; Gammella, Elena; Correnti, Margherita et al. (2017) Dysregulation of Iron Metabolism in Cholangiocarcinoma Stem-like Cells. Sci Rep 7:17667
Wan, Ying; McDaniel, Kelly; Wu, Nan et al. (2017) Regulation of Cellular Senescence by miR-34a in Alcoholic Liver Injury. Am J Pathol 187:2788-2798
Ehrlich, Laurent; Hall, Chad; Venter, Julie et al. (2017) miR-24 Inhibition Increases Menin Expression and Decreases Cholangiocarcinoma Proliferation. Am J Pathol 187:570-580

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