- George Institute for Global Health
219-221, Splendor Forum,
Plot No. 3, Jasola District Centre
New Delhi 110025 INDIA - +91 11 415 880 91-93; Fax: +91 11 415 880 90
Vivekanand Jha
Fortis Escorts Heart Institute, Nephrology, Department Member
- University of Oxford, Nuffield Department of Medicine, Department Memberadd
- Kidney transplantation, Renal replacement therapies, Economics, Economics and Human Biology, Stem cell and Regenerative medicine, Reprogramming, and 22 moreCardiovascular, Clinical Trial, Health Inequalities, Health Outcomes, History Of Medicine In South Asia, Health Disparities, Tropical Medicine, Induced Pluripotent Stem Cells (I Psc), Clinical Epidemiology, Health Sciences, Health Education, Genomics, History of Medicine, Health Promotion, Chronic kidney disease, Genetics, Acute kidney injury, Kidney diseases, Dialysis, Stem Cells, Bioinformatics, and Medicineedit
- Professor Vivekanand "Vivek" Jha [MBBS, MD, DM, PhD, FRCP, FRCP (Edin) FAMS], is the Executive Director, George Insti... moreProfessor Vivekanand "Vivek" Jha [MBBS, MD, DM, PhD, FRCP, FRCP (Edin) FAMS], is the Executive Director, George Institute for Global Health India, Consultant Nephrologist at the Fortis Kidney and Urology Institute, Okhla, New Delhi, and a Professor of Nephrology at University of Oxford. He has been a Professor of Nephrology at the Postgraduate Institute of Medical Education and Research in Chandigarh. Vivek graduated from Patna Medical College, did his postgraduate training in Medicine and Nephrology from the Postgraduate Institute of Medical Education and Research (PGI), Chandigarh, India and a basic science research Fellowship at the Harvard University and Beth Israel Deaconess Medical Center, Boston.
He is leading the development and testing of strategies to improve healthcare delivery in rural areas and urban slums to prevent disease development, with focus on non-cummunicable diseases which cause the highest number of deaths in India using workforce reengineering and implementation of mobile technology and point of care devices. He is also setting up a India-wide cohort of patients with kidney diseases to characterize the clinical and laboratory features that would identify those at high risk so that prevention steps can be targeted and new intervention strategies tested in high risk persons. He is setting up a country-wide network of nephrologists to design and implement clinical studies for finding solutions to the ever increasing burden of kidney disease in India.
He is currently Secretary of the Indian Society of Nephrology, Councilor of International Society of Nephrology, Councilor of the Transplantation Society, Executive Committee member of the Asian Pacific Society of Nephrology and Asian Forum of Chronic Kidney Disease Initiative, member of several Committees of International Society of Nephrology, Transplantation Society and International Society of Peritoneal Dialysis. He is the Deputy Editor of the Indian Journal of Nephrology, Subject Editor of Nephrology (official journal of the Asia Pacific Society of Nephrology), Associate Editor of the American Journal of Kidney Diseases and American Journal of Transplantation, Editor of the Cochrane Renal Group and Advisory Boards of several other journal, Section Editor of the Oxford Textbook of Nephrology. He is a past member of Board of Directors of the Kidney Disease Improving Global Outcomes and a member of KDIGO Guideline Development groups for management of kidney transplant recipients and patients with glomerulonephritis, member of several Task Forces and Expert Committees of the Department of Biotechnology and Indian Council of Medical Research and Review panel of international funding organizations. He has over 220 publications in peer-reviewed journals and 30 chapters in major textbooks. Dr Jha has been elected a Fellow of the Royal college of Physicians (London), Royal college of Physicians (Edinburgh) and the National Academy of Medical Sciences (India).edit
Research Interests:
Chronic kidney disease (CKD) is a unique public health problem in terms of high expenses required for its management and its increasing worldwide incidence. Understanding the existing structure of CKD treatment and its epidemiology is... more
Chronic kidney disease (CKD) is a unique public health problem in terms of high expenses required for its management and its increasing worldwide incidence. Understanding the existing structure of CKD treatment and its epidemiology is pivotal for equitable kidney care globally. The Global Kidney Health Atlas (GKHA) was launched by the International Society of Nephrology (ISN) in 2017 as a part of its “Bridging the Gaps” strategy with a vision to understand the global kidney care capacity. Two rounds of GKHA surveys were conducted and published in 2017 and 2019, respectively. The GKHA surveys showed significant variability in kidney care among global regions. Asia is the largest of all continents and distinct for its heterogeneity. The Asia-Pacific sector comprises four main regional constructs of the ISN; North and East Asia, Oceania and South East Asia, South Asia, and the Middle East. Kidney care capacity varies among these regions in terms of government spending, epidemiology of ...
Research Interests:
The exact number of patients with chronic kidney disease (CKD) in Asia Pacific is uncertain. In numeric terms, the region is home to the largest population of patients with untreated chronic kidney failure. The climatic, geographic,... more
The exact number of patients with chronic kidney disease (CKD) in Asia Pacific is uncertain. In numeric terms, the region is home to the largest population of patients with untreated chronic kidney failure. The climatic, geographic, social, cultural, economic, and environmentaldiversitywithinthisregionishigherthaninanyotherpartoftheworld.Large parts of the region face a climate-related burden of infectious diseases. Infections contribute to the development and progression of CKD and complicate the course of patients with pre-existing CKD (especially those on dialysis therapy or who are immunosuppressed), increase the cost of CKD care, and contribute to mortality and morbidity. Kidney involvement is a feature of several infectious diseases prevalent in Asia Pacific. Examples include malaria, leptospirosis, scrub typhus, tuberculosis, hepatitis B and C virus, dengue hemorrhagic fever, and Hantaan virus infections. The contribution of infection-associated acute kidney injury to the ove...
Research Interests:
middle-income countries: conclusions from a “Kidney Disease: Improving Global Outcomes” (KDIGO) Controversies Conference Vivekanand Jha, Mustafa Arici, Allan J. Collins, Guillermo Garcia-Garcia, Brenda R. Hemmelgarn, Tazeen H. Jafar,... more
middle-income countries: conclusions from a “Kidney Disease: Improving Global Outcomes” (KDIGO) Controversies Conference Vivekanand Jha, Mustafa Arici, Allan J. Collins, Guillermo Garcia-Garcia, Brenda R. Hemmelgarn, Tazeen H. Jafar, Roberto Pecoits-Filho, Laura Sola, Charles R. Swanepoel, Irma Tchokhonelidze, Angela Yee Moon Wang, Bertram L. Kasiske, David C. Wheeler and Goce Spasovski; for Conference Participants George Institute for Global Health, New Delhi, India; University of Oxford, Oxford, UK; Department of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey; Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota, USA; Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA; Nephrology Service, Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Centre, Hospital 278, Guadalajara, Jalisco, Mexico; Department of Community Health Sciences, Libin Cardiovascular Institute, Institut...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests: Health Care Policy, Global Health, Health Planning, Chronic kidney disease, Dialysis, and 15 moreDeveloping Countries, Health Policy, Chronic, Humans, Kidney, Health workforce, Advocacy, End stage renal diseases, Action Plan, Clinical Sciences, Funding, End stage kidney disease, Global burden of disease, Conservative treatment, and Health Services Accessibility
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Infection with the hepatitis C virus (HCV) has adverse liver, kidney, and cardiovascular consequences in patients with chronic kidney disease (CKD), including those on dialysis therapy and in those with a kidney transplant. Since the... more
Infection with the hepatitis C virus (HCV) has adverse liver, kidney, and cardiovascular consequences in patients with chronic kidney disease (CKD), including those on dialysis therapy and in those with a kidney transplant. Since the publication of the original Kidney Disease: Improving Global Outcomes (KDIGO) HCV Guideline in 2008, major advances in HCV management, particularly with the advent of direct-acting antiviral therapies, have now made the cure of HCV possible in CKD patients. In addition, diagnostic techniques have evolved to enable the noninvasive diagnosis of liver fibrosis. Therefore, the Work Group undertook a comprehensive review and update of the KDIGO HCV in CKD Guideline. This Executive Summary highlights key aspects of the guideline recommendations.
Research Interests: Chronic kidney disease, Kidney transplantation, Dialysis, Hepatitis C, Glomerular Diseases, and 15 moreInfection Control, Kidney, Hemodialysis, Hepatitis C Virus, KDIGO, Guidelines, Clinical Sciences, Executive Summary, Kidney Disease, Intensive Care Medicine, Kidneys, Antivirals, Chronic Kidney Failure, GuideLine, and Cryoglobulinemia
Universal healthcare coverage provides healthcare and financial protection to all citizens and might help to facilitate gender equity in care. We assessed the utilisation of hospital care services among women and men in a large... more
Universal healthcare coverage provides healthcare and financial protection to all citizens and might help to facilitate gender equity in care. We assessed the utilisation of hospital care services among women and men in a large underprivileged population with access to free hospital care in India. The Rajiv Aarogyasri Community Health Insurance Scheme, a state-sponsored scheme, provided access to free hospital care for poor households across undivided Andhra Pradesh. Claims data for hospitalisations between 2008 and 2012 were analysed to determine the number of individuals, hospitalisations, bed-days and hospital expenditure for sex-specific and sex-neutral conditions, by sex, disease category and age group. A total of 961 442 individuals (43% women), 1 223 723 hospitalisations (48% women), 7.7 million bed-days (47% women) and hospital expenditure of US$579.3 million (42% women) were recorded. Sex-specific conditions accounted for 27% of hospitalisations, 12% of bed-days and 15% of ...
Research Interests:
A good understanding of disease burden is the first step in formulating a response to it. Analysis of the Global Burden of Disease 2016 dataset shows an 87% rise in the global burden of chronic kidney disease and a doubling of chronic... more
A good understanding of disease burden is the first step in formulating a response to it. Analysis of the Global Burden of Disease 2016 dataset shows an 87% rise in the global burden of chronic kidney disease and a doubling of chronic kidney disease deaths between 1990 and 2016. Countries with a lower level of socioeconomic development and poorer access to quality health care experience a higher chronic kidney disease burden. Reductions in global disability-adjusted life-years over time indicate progress, but deviations from this trend in some geographies present a call to action.
Research Interests:
Endpoints currently used in lupus nephritis (LN) clinical trials lack uniformity and questionably reflect long-term kidney survival. The objective of this investigation was to identify short-term endpoints that predict long-term kidney... more
Endpoints currently used in lupus nephritis (LN) clinical trials lack uniformity and questionably reflect long-term kidney survival. The objective of this investigation was to identify short-term endpoints that predict long-term kidney outcomes for use in clinical trials. A database of 944 LN patients was assembled from 3 clinical trials and 12 longitudinal cohorts. Variables from the first 12 months of treatment after diagnosis of active LN (prediction period) were assessed as potential predictors of long-term outcomes in a 36 month follow-up period. The long-term outcomes examined were new or progressive chronic kidney disease (CKD), severe kidney injury (SKI), and the need for permanent renal replacement therapy (RRT). Hazard Index Tools (HITs) to predict risk for each outcome were derived using multivariable analysis with Cox proportional hazards regression. Among 550 eligible subjects 54 CKD, 55 SKI and 22 RRT events occurred. Variables in the final CKD HIT were prediction peri...
Research Interests:
Research Interests:
Research Interests:
The National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines recommended the Modification of Diet in Renal Disease study equation for estimating glomerular filtration rate (GFR) for the classification of CKD, but... more
The National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines recommended the Modification of Diet in Renal Disease study equation for estimating glomerular filtration rate (GFR) for the classification of CKD, but its accuracy was limited to North American patients with estimated GFR <60 mL/min per 1.73 m body surface area of European (White) or African (Black) descent. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) developed another equation for estimating GFR, derived from a population that included both participants without kidney disease and with CKD. But many ethnicities were inadequately represented. The International Society of Nephrology, Kidney Disease Improving Global Outcomes committee promulgated clinical practice guidelines, which recommended the CKD-EPI equation. Investigators in Asia subsequently assessed the performance of these GFR estimating equations-the Modification of Diet in Renal Disease study equation, the CKD-EPI eq...
Research Interests: Nephrology, Epidemiology, Asian, Kidney diseases, Chronic kidney disease, and 14 morePublic Health, Medicine, Living kidney donation, Kidney, Renal Function, Clinical Sciences, Chronic Renal Failure, cystatin C, Kidney Disease, Estimation of Glomerular Filtration Rate, Medicine and Health Sciences, Chronic Kidney Failure, Creatinine, and Glomerular Filtration Rate
Research Interests:
Uromodulin, a UMOD gene encoded glycoprotein is synthesized exclusively in renal tubular cells and released into urine. Mutations lead to uromodulin misfolding and retention in the kidney, where it might stimulate cells of immune system... more
Uromodulin, a UMOD gene encoded glycoprotein is synthesized exclusively in renal tubular cells and released into urine. Mutations lead to uromodulin misfolding and retention in the kidney, where it might stimulate cells of immune system to cause inflammation and progression of kidney disease. Genome-wide association studies (GWAS) have identified UMOD locus to be associated with hypertension and diabetic nephropathy (DN). In this study, we investigated the association between rs4293393 variation in UMOD gene and susceptibility to kidney disease in individuals with type 2 diabetes mellitus (T2DM). A total of 646 individuals, 208 with T2DM without evidence of kidney disease (DM), 221 with DN and 217 healthy controls (HC) were genotyped for UMOD variant rs4293393T>C by restriction fragment length polymorphism. Serum uromodulin levels were quantified by enzyme-linked immunosorbent assay. A significant difference was found in genotype and allelic frequency among DM, DN and HC. TC+CC g...
Research Interests: Bioinformatics, Endocrinology, Genetics, Immunology, Genomics, and 15 moreComputational Biology, Diabetes, Chronic kidney disease, Diabetes Mellitus and Its Complications, Humans, Internal Medicine, Diabetes mellitus, Female, Male, Genotype, Adult, Allele, alleles, Medical and Health Sciences, and Diabetic nephropathies
Research Interests:
Despite the growing number of haemodialysis (HD) patients in India, little is known about vascular access practice. We investigated the use and cost of different vascular accesses by Indian nephrologists. An online survey was emailed to... more
Despite the growing number of haemodialysis (HD) patients in India, little is known about vascular access practice. We investigated the use and cost of different vascular accesses by Indian nephrologists. An online survey was emailed to 920 Indian nephrologists and 388 (42.1%) responded; 98.5% of whom were responsible for managing dialysis patients, 98% in hospitals. Sixty-four percent of patients initiated renal replacement therapy with HD, 7% with peritoneal dialysis, 10% kidney transplantation and 19% conservative care. Forty-eight percent of patients were self-paying, 26% had employee reimbursement and 23% had insurance. According to 59% of responders, more than three-quarters of patients started dialysis with uncuffed catheter, less than one-quarter started dialysis with fistula; and very few used grafts or tunnelled catheters. Among prevalent HD patients, over half were dialysing with fistula (79% nephrologists), rather than uncuffed catheters (15% nephrologists) or grafts (&l...
Research Interests: Chronic kidney disease, Dialysis, Medicine, India, Transplantation, and 14 moreHumans, Female, Hemodialysis, Male, Chronic Renal Failure, Health Expenditures, Reimbursement, Dialysis Vascular Access, Health Care Costs, Catheter, Vascular Access, Renal Dialysis, Socioeconomic Factors, and Health Care Surveys
Availability of basic mental health services is limited in rural areas of India. Health system and individual level factors such as lack of mental health professionals and infrastructure, poor awareness about mental health, stigma related... more
Availability of basic mental health services is limited in rural areas of India. Health system and individual level factors such as lack of mental health professionals and infrastructure, poor awareness about mental health, stigma related to help seeking, are responsible for poor awareness and use of mental health services. We implemented a mental health services delivery model that leveraged technology and task sharing to facilitate identification and treatment of common mental disorders (CMDs) such as stress, depression, anxiety and suicide risk in rural areas of the state of Andhra Pradesh, India. The intervention was delivered by lay village health workers (Accredited Social Health Activists - ASHAs) and primary care doctors. An anti-stigma campaign was implemented prior to this activity. This paper reports the process evaluation of the intervention using mixed methods. A mixed methods pre-post evaluation assessed the intervention using quantitative service usage analytics from ...
Research Interests: Psychology, Mental Health, Medicine, India, Community Health Workers, and 11 moreSocial Stigma, Humans, Female, Mental Disorders, Mental health services, Clinical Sciences, Adult, Public health systems and services research, Guidance and Counseling Intervention Programs, Rural Population, and Referral and consultation
Vitamin D deficiency, cardiovascular disease and abnormal bone mineral metabolism are common in chronic kidney disease (CKD). Abnormal bone mineral metabolism has been linked to vascular calcification in CKD. Sclerostin has emerged as an... more
Vitamin D deficiency, cardiovascular disease and abnormal bone mineral metabolism are common in chronic kidney disease (CKD). Abnormal bone mineral metabolism has been linked to vascular calcification in CKD. Sclerostin has emerged as an important messenger in cross talk between bone-vascular axis. We analyzed sclerostin in subjects who participated in the randomized, double blind, placebo controlled trial investigating the effect of cholecalciferol supplementation on vascular function in non-diabetic CKD stage G3-4 and vitamin D ≤20ng/ml [CTRI/2013/05/003648]. Patients were randomized (1:1) to receive either two directly observed oral doses of 300,000 IU of cholecalciferol or matching placebo at baseline and 8 weeks. Of the 120 subjects enrolled, 58 in the cholecalciferol group and 59 in the placebo group completed the study. At baseline, serum levels of sclerostin were similar in both groups (cholecalciferol - median;190pg/ml, IQR;140-260pg/ml and placebo - median;180pg/ml, IQR; 1...
Research Interests:
Vitamin D deficiency is common and associated with mortality in chronic kidney disease (CKD) patients. Cardiovascular disease (CVD) is the commonest cause of mortality in CKD patients. In a randomized, double blind, placebo controlled... more
Vitamin D deficiency is common and associated with mortality in chronic kidney disease (CKD) patients. Cardiovascular disease (CVD) is the commonest cause of mortality in CKD patients. In a randomized, double blind, placebo controlled trial, we have recently reported favorable effects of vitamin D supplementation on vascular & endothelial function and inflammatory biomarkers in vitamin D deficient patients with non-diabetic stage 3-4 CKD (J Am Soc Nephrol 28: 3100-3108, 2017). Subjects in the placebo group who had still not received vitamin D after completion of the trial received two oral doses 300000 IU of oral cholecalciferol at 8 weeks interval followed by flow mediated dilatation (FMD), pulse wave velocity (PWV), circulating endothelial and inflammatory markers (E-Selectin, vWF, hsCRP and IL-6), 1,25 (OH)2D, iPTH and iFGF-23 assessment at 16 weeks. 31 subjects completed this phase of the study. Last values recorded in the preceding clinical trial were taken as baseline values. ...
Research Interests:
Kidney biopsies to elucidate the cause of chronic kidney disease (CKD) are performed in a minority of persons with CKD living in high-income countries, since associated conditions-that is, diabetes mellitus, vascular disease or obesity... more
Kidney biopsies to elucidate the cause of chronic kidney disease (CKD) are performed in a minority of persons with CKD living in high-income countries, since associated conditions-that is, diabetes mellitus, vascular disease or obesity with pre-diabetes, prehypertension or dyslipidaemia-can inform management targeted at slowing CKD progression in a majority. However, attributes of CKD may differ substantially among persons living in low-income and middle-income countries (LMICs). We used data from population or community-based studies from five LMICs (China, urban India, Moldova, Nepal and Nigeria) to determine what proportion of persons with CKD living in diverse regions fit one of the three major clinical profiles, with data from the US National Health Nutrition and Examination Survey as reference. In the USA, urban India and Moldova, 79.0%-83.9%; in China and Nepal, 62.4%-66.7% and in Nigeria, 51.6% persons with CKD fit one of three established risk profiles. Diabetes was most co...
Research Interests:
Research Interests:
Linear properties of ternary chalcopyrite semiconductors have been studied. New relations based on plasma oscillations theory of solids have been proposed for calculation of homopolar, heteropolar and average energy gaps, dielectric... more
Linear properties of ternary chalcopyrite semiconductors have been studied. New relations based on plasma oscillations theory of solids have been proposed for calculation of homopolar, heteropolar and average energy gaps, dielectric constant and ionicity of A–C and B–C bonds in AIBIIIC2VI and AIIBIVC2V groups of semiconductors. The values of these parameters for 13 new chalcopyrites of AIIBIVC2V family have been calculated. The calculated values are compared with the available reported values and a fairly good agreement has been obtained.
Research Interests:
Research Interests:
Influenza is a global public health problem and concern especially in high risk people. Prevention plays a key role in avoiding complications of influenza related illnesses. Despite the existing prevalence of influenza, and documented... more
Influenza is a global public health problem and concern especially in high risk people. Prevention plays a key role in avoiding complications of influenza related illnesses. Despite the existing prevalence of influenza, and documented importance of vaccination, the uptake of influenza vaccine is very poor. This document provide recommendations for influenza vaccination in high-risk individuals and help implement best practices in the South Asian region and improve coverage of influenza vaccination to achieve better outcomes in this population.
Research Interests:
Ability to predict the manner in which a recipient's immune system would respond to a transplanted graft by analyzing cytokine profiles of the "allograft antigen sensitized" recipient lymphocytes in vitro might provide a... more
Ability to predict the manner in which a recipient's immune system would respond to a transplanted graft by analyzing cytokine profiles of the "allograft antigen sensitized" recipient lymphocytes in vitro might provide a means to identify patients at risk to adverse clinical endpoints. Cytokine/chemokine gene expression profiles of peripheral blood mononuclear cells co-cultured with allograft antigen-pulsed macrophages were studied in 49 renal transplant recipients-12 with acute cellular rejection (ACR) with or without antibody-mediated rejection (AMR), 7 with AMR (without ACR), and 30 with stable allografts (SA). An 86-gene inflammatory cytokines and receptors PCR array was used to measure fold changes in gene expression between pulsed and un-pulsed cultures. On linear discriminant analysis and multivariate analysis of variance, a gene set comprising C3, CCL3, IL1B, TOLLIP, IL10, CXCL5, ABCF1, CCR3, IL10RB, CXCL1, and IL1R1 differentiated the ACR-AMR from the SA group...
Research Interests:
Research Interests:
Guidelines recommend corticosteroids in patients with IgA nephropathy and persistent proteinuria, but the effects remain uncertain. To evaluate the efficacy and safety of corticosteroids in patients with IgA nephropathy at risk of... more
Guidelines recommend corticosteroids in patients with IgA nephropathy and persistent proteinuria, but the effects remain uncertain. To evaluate the efficacy and safety of corticosteroids in patients with IgA nephropathy at risk of progression. The Therapeutic Evaluation of Steroids in IgA Nephropathy Global (TESTING) study was a multicenter, double-blind, randomized clinical trial designed to recruit 750 participants with IgA nephropathy (proteinuria greater than 1 g/d and estimated glomerular filtration rate [eGFR] of 20 to 120 mL/min/1.73 m2 after at least 3 months of blood pressure control with renin-angiotensin system blockade] and to provide follow-up until 335 primary outcomes occurred. Patients were randomized 1:1 to oral methylprednisolone (0.6-0.8 mg/kg/d; maximum, 48 mg/d) (n = 136) or matching placebo (n = 126) for 2 months, with subsequent weaning over 4 to 6 months. The primary composite outcome was end-stage kidney disease, death due to kidney failure, or a 40% decreas...
Research Interests: Gastroenterology, Chronic kidney disease, Medicine, Glomerular Diseases, Humans, and 15 moreInternal Medicine, Female, Infection, Male, Adult, Corticosteroids, IgA nephropathy, Chronic Kidney Failure, Chronic Glomerulonephritis, Glucocorticoids, JAMA, Glomerulonephritis, Glomerular Filtration Rate, Adverse effect, and Medical and Health Sciences
Despite the high costs of treatment of people with kidney disease and associated comorbid conditions, the amount of reliable information available to guide the care of such patients is very limited. Some treatments have been assessed in... more
Despite the high costs of treatment of people with kidney disease and associated comorbid conditions, the amount of reliable information available to guide the care of such patients is very limited. Some treatments have been assessed in randomized trials, but most such trials have been too small to detect treatment effects of a magnitude that would be realistic to achieve with a single intervention. Therefore, KDIGO convened an international, multidisciplinary controversies conference titled "Challenges in the Conduct of Clinical Trials in Nephrology" to identify the key barriers to conducting trials in patients with kidney disease. The conference began with plenary talks focusing on the key areas of discussion that included appropriate trial design (covering identification and evaluation of kidney and nonkidney disease outcomes) and sensible trial execution (with particular emphasis on streamlining both design and conduct). Break out group discussions followed in which th...
Research Interests: Nephrology, Clinical Trials, Clinical Trial, Kidney diseases, Acute kidney injury, and 13 moreChronic kidney disease, Kidney transplantation, Medicine, Humans, Internal Medicine, Kidney, Congress, Clinical Sciences, Human Clinical Trials, Kidney Disease, Intensive Care Medicine, Trial Design, and Clinical Trials as Topic
The years of life lost and years lived with disability resulting from chronic kidney disease (CKD) increased globally by 90% and 49.5%, respectively, between 1990 and 2013. In addition to the traditional factors, infections, low... more
The years of life lost and years lived with disability resulting from chronic kidney disease (CKD) increased globally by 90% and 49.5%, respectively, between 1990 and 2013. In addition to the traditional factors, infections, low birthweight, environmental factors, and low socioeconomic status contribute to the CKD burden in low- and middle-income countries. System-level challenges such as poor appreciation of the burden, insufficient human resources, high health care costs, poor referral pathways, unreliable health information systems, and inadequate medicine supply pose barriers to CKD control. In this article, we present evidence that the CKD burden in low- and middle-income countries is related to system-wide issues, which could be reduced effectively using innovative, affordable, and scalable interventions. A multipronged approach is required including improving socioeconomic determinants of health, enabling the environment for healthy decision making, and sustainable interventi...
Research Interests: Poverty, Global Health, Environmental Health, Chronic kidney disease, Public Health, and 14 moreMedicine, Mhealth, Humans, Psychological Intervention, Socioeconomic Status, Clinical Sciences, Morbidity, Kidney Disease, Non Communicable Diseases, mHealth and eHealth, Socioeconomic Factors, Disability Evaluation, quality assurance in health care, and Referral
About 25% of the Indian population experience common mental disorders (CMD) but only 15-25% of them receive any mental health care. Stigma, lack of adequate mental health professionals and mental health services account for this treatment... more
About 25% of the Indian population experience common mental disorders (CMD) but only 15-25% of them receive any mental health care. Stigma, lack of adequate mental health professionals and mental health services account for this treatment gap, which is worse in rural areas. Our project evaluated task shifting and mobile-technology based electronic decision support systems to enhance the ability of primary care health workers to provide evidence-based mental health care for stress, depression, and suicidal risk in 30 remote villages in the state of Andhra Pradesh, India. The Systematic Medical Appraisal Referral and Treatment (SMART) Mental Health project between May 2014 and April 2016 trained lay village health workers (Accredited Social Health Activists - ASHAs) and primary care doctors to screen, diagnose and manage individuals with common mental disorders using an electronic decision support system. An anti-stigma campaign using multi-media approaches was conducted across the vi...
Research Interests:
Research Interests:
The global nephrology community recognises the need for a cohesive plan to address the problem of chronic kidney disease (CKD). In July, 2016, the International Society of Nephrology hosted a CKD summit of more than 85 people with diverse... more
The global nephrology community recognises the need for a cohesive plan to address the problem of chronic kidney disease (CKD). In July, 2016, the International Society of Nephrology hosted a CKD summit of more than 85 people with diverse expertise and professional backgrounds from around the globe. The purpose was to identify and prioritise key activities for the next 5-10 years in the domains of clinical care, research, and advocacy and to create an action plan and performance framework based on ten themes: strengthen CKD surveillance; tackle major risk factors for CKD; reduce acute kidney injury-a special risk factor for CKD; enhance understanding of the genetic causes of CKD; establish better diagnostic methods in CKD; improve understanding of the natural course of CKD; assess and implement established treatment options in patients with CKD; improve management of symptoms and complications of CKD; develop novel therapeutic interventions to slow CKD progression and reduce CKD com...
Research Interests: Nephrology, Global Health, Acute kidney injury, Chronic kidney disease, Drug Discovery, and 15 moreHealth Policy, Medicine, Humans, Psychological Intervention, Action Plan, Kidney Disease, Intensive Care Medicine, Disease Progression, Risk Factors, Disease Management, Placebo Controlled Trial, Health Priorities, Glomerular Filtration Rate, Clinical Trials as Topic, and Medical and Health Sciences
The burden of premature death and health loss from ESRD is well described. Less is known regarding the burden of cardiovascular disease attributable to reduced GFR. We estimated the prevalence of reduced GFR categories 3, 4, and 5 (not on... more
The burden of premature death and health loss from ESRD is well described. Less is known regarding the burden of cardiovascular disease attributable to reduced GFR. We estimated the prevalence of reduced GFR categories 3, 4, and 5 (not on RRT) for 188 countries at six time points from 1990 to 2013. Relative risks of cardiovascular outcomes by three categories of reduced GFR were calculated by pooled random effects meta-analysis. Results are presented as deaths for outcomes of cardiovascular disease and ESRD and as disability-adjusted life years for outcomes of cardiovascular disease, GFR categories 3, 4, and 5, and ESRD. In 2013, reduced GFR was associated with 4% of deaths worldwide, or 2.2 million deaths (95% uncertainty interval [95% UI], 2.0 to 2.4 million). More than half of these attributable deaths were cardiovascular deaths (1.2 million; 95% UI, 1.1 to 1.4 million), whereas 0.96 million (95% UI, 0.81 to 1.0 million) were ESRD-related deaths. Compared with metabolic risk fact...
Research Interests: Global Health, Kidney diseases, Chronic kidney disease, Risk assessment, Cardiovascular disease, and 14 moreMedicine, Humans, Kidney, Burden of Disease, Risk factors, Renal Function, Clinical Sciences, World Health Organization, Cardiovascular Diseases, Risk Factors, Risk Assessment, End stage kidney disease, Global burden of disease, and Glomerular Filtration Rate
Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health. To quantify and describe levels and trends of mortality and nonfatal health... more
Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health. To quantify and describe levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion. Cause-specific mortality and nonfatal health outcomes were analyzed for 195 countries and territories by age group, sex, and year from 1990 to 2015 using standardized approaches for data processing and statistical modeling, with subsequent analysis of the findings to describe levels and trends across geography and time among children and adolescents 19 years or younger. A composite indicator of income, education, and fertility was developed (Socio-demographic Index [SDI]) for each geographic unit and year, which evaluates the historical association between SDI and health loss. Global child and adolescent mortality decreased from 14.18 million (95% uncert...
Research Interests: Demography, Child and adolescent mental health, Child health, Children and Families, Child Development, and 15 moreEnvironmental Health, Adolescent Health, Adolescent, Child, Female, Disabled children, Behavioral and Developmental Pediatrics, Age Factors, Child and Adolescent Mental Health, Child mortality, Global burden of disease, Global Burden of Diseases, applied Epidemiology, Disease Burden, and Cause of death
Treatment for end-stage kidney disease is a major economic challenge and a public health concern worldwide. Renal-replacement therapy poses several practical and ethical dilemmas of global relevance for patients, clinicians, and policy... more
Treatment for end-stage kidney disease is a major economic challenge and a public health concern worldwide. Renal-replacement therapy poses several practical and ethical dilemmas of global relevance for patients, clinicians, and policy makers. These include how to: promote patients' best interests; increase access to dialysis while maintaining procedural and distributive justice; minimise the influence of financial incentives and competing interests; ensure quality of care in service delivery and access to non-dialytic supportive care when needed; minimise the financial burden on patients and health-care system; and protect the interests of vulnerable groups during crisis situations. These issues have received comparatively little attention, and there is scant ethical analysis and guidance available to decision makers. In this Health Policy, we provide an overview of the major ethical issues related to dialysis provision worldwide, identify priorities for further investigation a...
Research Interests: Decision Making, Dialysis, General Internal Medicine, Public Health, Health Policy, and 15 moreMedicine, Humans, Cost, Hemodialysis, Access, Care, Incentive, ESRD, Kidney Disease, Intensive Care Medicine, Chronic Kidney Failure, Renal Dialysis, Delivery of Health Care, Quality of health care, and Medical and Health Sciences
Background: With the exponential increase in mobile phone users in India, a large number of public health initiatives are leveraging information technology and mobile devices for healthcare delivery. Given the considerable financial and... more
Background:
With the exponential increase in mobile phone users in India, a large number of public health initiatives are leveraging information technology and mobile devices for healthcare delivery. Given the considerable financial and human resources being invested in these initiatives, it is important to ascertain their role in strengthening healthcare systems.
Objective:
We undertook this review to identify the published mobile health (mHealth) or telemedicine initiatives in India in terms of their current role in health systems strengthening. The review classifies these initiatives based on the disease areas, geographical distribution and target users and assesses the quality of the available literature.
Methods:
A search of the literature was done to identify mHealth or telemedicine articles published between January 1997 and June 2017 from India. The electronic bibliographic databases and registries searched included MEDLINE, EMBASE, Joanna Briggs Institute Database and Clinical Trial Registry of India. The WHO Health System Building Block framework was used to categorize the published initiatives as per their role in the health system. Quality assessment of the selected articles was done using the Cochrane risk of bias assessment and National Institutes of Health, U.S. tools.
Results:
The combined search strategies yielded 2150 citations out of which 318 articles were included (primary research articles=125; reviews and system architectural, case studies and opinion articles= 193). A sharp increase was seen after the 2012, driven primarily by NCD focused articles. Majority of the primary studies had their sites in the South Indian states, with no published articles from Jammu and Kashmir and North-Eastern parts of India. Service delivery was the primary focus of 60% of the selected articles. A majority of these articles had their focus on one (36%) or two (46%) domains of health system, most frequently service delivery and health workforce. Initiatives commonly used client education as a tool for improving health system. More than 90% of the studies lacked a sample size justification had used convenience sampling. Methodological rigor of the selected trials (n=11) was assessed to be poor as majority of the studies had a high risk for bias in at least two categories.
Conclusions:
In conclusion, mHealth initiatives are being increasingly tested to improve healthcare delivery in India. Our review highlights the poor quality of current evidence-base and an urgent need for focused research aimed at generating high quality evidence on the efficacy, user acceptability, and cost effectiveness of mHealth interventions aimed towards health systems strengthening. A pragmatic approach would be to include an implementation research component into the existing and proposed digital health initiatives to support generation of evidence for health system strengthening on strategically important outcomes.
With the exponential increase in mobile phone users in India, a large number of public health initiatives are leveraging information technology and mobile devices for healthcare delivery. Given the considerable financial and human resources being invested in these initiatives, it is important to ascertain their role in strengthening healthcare systems.
Objective:
We undertook this review to identify the published mobile health (mHealth) or telemedicine initiatives in India in terms of their current role in health systems strengthening. The review classifies these initiatives based on the disease areas, geographical distribution and target users and assesses the quality of the available literature.
Methods:
A search of the literature was done to identify mHealth or telemedicine articles published between January 1997 and June 2017 from India. The electronic bibliographic databases and registries searched included MEDLINE, EMBASE, Joanna Briggs Institute Database and Clinical Trial Registry of India. The WHO Health System Building Block framework was used to categorize the published initiatives as per their role in the health system. Quality assessment of the selected articles was done using the Cochrane risk of bias assessment and National Institutes of Health, U.S. tools.
Results:
The combined search strategies yielded 2150 citations out of which 318 articles were included (primary research articles=125; reviews and system architectural, case studies and opinion articles= 193). A sharp increase was seen after the 2012, driven primarily by NCD focused articles. Majority of the primary studies had their sites in the South Indian states, with no published articles from Jammu and Kashmir and North-Eastern parts of India. Service delivery was the primary focus of 60% of the selected articles. A majority of these articles had their focus on one (36%) or two (46%) domains of health system, most frequently service delivery and health workforce. Initiatives commonly used client education as a tool for improving health system. More than 90% of the studies lacked a sample size justification had used convenience sampling. Methodological rigor of the selected trials (n=11) was assessed to be poor as majority of the studies had a high risk for bias in at least two categories.
Conclusions:
In conclusion, mHealth initiatives are being increasingly tested to improve healthcare delivery in India. Our review highlights the poor quality of current evidence-base and an urgent need for focused research aimed at generating high quality evidence on the efficacy, user acceptability, and cost effectiveness of mHealth interventions aimed towards health systems strengthening. A pragmatic approach would be to include an implementation research component into the existing and proposed digital health initiatives to support generation of evidence for health system strengthening on strategically important outcomes.