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Articles by B. W Gillespie
Total Records ( 4 ) for B. W Gillespie
  J. D Stein , P. A Newman Casey , L. M Niziol , B. W Gillespie , P. R Lichter and D. C. Musch

Objective  To evaluate the relationship between glaucoma medication use and death.

Methods  This study uses longitudinal data from 2003 to 2007 on persons 40 years and older with glaucoma or suspected glaucoma enrolled in a large managed care network. Cox regression analysis was performed to estimate the hazard of death associated with the use of various glaucoma medication classes and combinations thereof. Multivariable models were adjusted for demographic characteristics and comorbid medical conditions.

Results  Of 21 506 participants with glaucoma or suspected glaucoma, 237 (1.1%) died during the study period. The use of any class of glaucoma medication was associated with a 74% reduced hazard of death (adjusted hazard ratio [HR], 0.26; 95% confidence interval [CI], 0.16-0.40) compared with no glaucoma medication use. This association was observed for use of a single agent alone, such as a topical β-antagonist (0.44; 0.24-0.83) or a prostaglandin analogue (0.31; 0.18-0.54), and for use of different combinations of drug classes.

Conclusions  After adjustment for potential confounding variables, the use of glaucoma medications was associated with a reduced likelihood of death in this large sample of US adults with glaucoma. Future investigations should explore this association further because these findings may have important clinical implications.

  D Miskulin , J Bragg Gresham , B. W Gillespie , F Tentori , R. L Pisoni , H Tighiouart , A. S Levey and F. K. Port

Background and objectives: Abstracting information about comorbid illnesses from the medical record can be time-consuming, particularly when a large number of conditions are under consideration. We sought to determine which conditions are most prognostic and whether comorbidity continues to contribute to a survival model once laboratory and clinical parameters have been accounted for.

Design, setting, participants, & measurements: Comorbidity data were abstracted from the medical records of Dialysis Outcomes and Practice Pattern Study (DOPPS) I, II, and III participants using a standardized questionnaire. Models that were composed of different combinations of comorbid conditions and case-mix factors were compared for explained variance (R2) and discrimination (c statistic).

Results: Seventeen comorbid conditions account for 96% of the total explained variance that would result if 45 comorbidities that were expected to be predictive of survival were added to a demographics-adjusted survival model. These conditions together had more discriminatory power (c statistic 0.67) than age alone (0.63) or serum albumin (0.60) and were equivalent to a combination of routine laboratory and clinical parameters (0.67). The strength of association of the individual comorbidities lessened when laboratory/clinical parameters were added, but all remained significant. The total R2 of a model adjusted for demographics and laboratory/clinical parameters increased from 0.13 to 0.17 upon addition of comorbidity.

Conclusions: A relatively small list of comorbid conditions provides equivalent discrimination and explained variance for survival as a more extensive characterization of comorbidity. Comorbidity adds to the survival model a modest amount of independent prognostic information that cannot be substituted by clinical/laboratory parameters.

  R Saran , E Hedgeman , L Plantinga , N. R Burrows , B. W Gillespie , E. W Young , J Coresh , M Pavkov , D Williams , N. R Powe and for the CKD Surveillance Team

Despite the recognized importance of chronic kidney disease (CKD), the United States currently lacks a comprehensive, systematic surveillance program that captures and tracks all aspects of CKD in the population. As part of its CKD Initiative, the Centers for Disease Control and Prevention (CDC) funded two teams to jointly initiate the development of a CKD surveillance system. Here, we describe the process and methods used to establish this national CDC CKD Surveillance System. The major CKD components covered include burden (incidence and prevalence), risk factors, awareness, health consequences, processes and quality of care, and health system capacity issues. Goals include regular reporting of the data collected, plus development of a dynamic project web site and periodic issuance of a CKD fact sheet. We anticipate that this system will provide an important foundation for widespread efforts toward primary prevention, earlier detection, and implementation of optimal disease management strategies, with resultant increased awareness of CKD, decreased rates of CKD progression, lowered mortality, and reduced resource utilization. Final success will be measured by usage, impact, and endorsement.

  S Korgaonkar , A Tilea , B. W Gillespie , M Kiser , G Eisele , F Finkelstein , P Kotanko , B Pitt and R. Saran

Background and objectives: The relationship between serum potassium (SK) and mortality in chronic kidney disease (CKD) has not been systematically investigated.

Design, setting, participants, & measurements: We examined the predictors and mortality association of SK in the Renal Research Institute CKD Study cohort, wherein 820 patients with CKD were prospectively followed at four US centers for an average of 2.6 years. Predictors of SK were investigated using linear and repeated measures regression models. Associations between SK and mortality, the outcomes of ESRD, and cardiovascular events in time-dependent Cox models were examined.

Results: The mean age was 60.5 years, 80% were white, 90% had hypertension, 36% had diabetes, the average estimated GFR was 25.4 ml/min per 1.73 m2, and mean baseline SK was 4.6 mmol/L. Higher SK was associated with male gender, lower estimated GFR and serum bicarbonate, absence of diuretic and calcium channel blocker use, diabetes, and use of angiotensin-converting enzyme inhibitors and/or statins. A U-shaped relationship between SK and mortality was observed, with mortality risk significantly greater at SK ≤4.0 mmol/L compared with 4.0 to 5.5 mmol/L. Risk for ESRD was elevated at SK ≤4 mmol/L in SK categorical models. Only the composite of cardiovascular events or death as an outcome was associated with higher SK (≥5.5).

Conclusions: Although clinical practice usually emphasizes greater attention to elevated SK in the setting of CKD, our results suggest that patients who have CKD and low or even low-normal SK are at higher risk for dying than those with mild to moderate hyperkalemia.

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