Some authors indicated that there might be a correlation between anaemia correction & delayed progression of CRF. A literature review is therefore proposed to find out whether the published literatures can provide an answer to the problem.
A literature review to find out whether correction of anaemia with erythropoietin in predialysis anaemic patients can slow the progression of renal damage.
Module Number: P49210
Module Title: Advanced Research Design
Student Name: Mohammed Nazmul Ahsan
Student Number: 06108646
Tutor: Dr. Neil Wheeler
Abstract
The treatment of End Stage Renal Failure (ESRF) with dialysis and kidney transplantation is creating a huge pressure on the healthcare budget & staff all over the world. Till now, there is no known method that can slow the progression of this disease. Physicians & health authorities around the world are desperately looking for an approach that can slow the speed of progression of this medical condition. Different authors have suggested different approaches to address the problem. Some authors indicated that there might be a correlation between anaemia correction & delayed progression of CRF. A literature review is therefore proposed to find out whether the published literatures can provide an answer to the problem.
Table of Contents
. Introduction ........................................................ page 4
2. Title.................................................................. page 4
3. Study Problem......................................................... page 4
4. Relevance of the project...................................... page 5
5. Literature review................................................ page 5
6. Specific study aims and objectives......................... page 6
7. Methodology...................................................... page 6
8. Ethics............................................................... page 11
9. Resources......................................................... page 11
0. Time-plan......................................................... page 12
1. References...................................................... page 12
. Introduction:
Chronic Renal Failure (CRF) is one of the major health problems throughout the world.
CRF starts with minimum degree of renal impairment & may remain asymptomatic for quite a long time. However, all CRF patients move to an End Stage Renal Failure (ESRF) in course of the disease. Renal Replacement Therapy (RRT) which consists of Dialysis & Transplantation is the only treatment of ESRD. Dialysis and transplantation both are very expensive & time consuming procedure yet cannot guarantee a cure. As the incidence of Chronic Renal Failure (CRF) leading to an End Stage Renal Failure (ESRF) is increasing globally, it is creating huge burden on the healthcare services and causing healthcare researcher to think whether there is any treatment approach that can slow the progression of CRF. Anaemia is a very common co-existing condition of CRF requiring Erythropoietin (Epo) therapy. Some of the published researches have indicated that correction of anaemia with erythropoietin might have an effect on the speed of progression of renal damage in CRF. A literature review is therefore proposed to find out a solution to control the progression of the disease.
2. Title
Can correction of anaemia with erythropoietin in predialysis anaemic patients slow the progression of renal damage?
3. Study Problem
Chronic Renal Failure (CRF) is an irreversible & difficult to manage medical condition. All patients move to an end stage renal failure (ESRF) in course of time. Renal Replacement Therapy (RRT), consisting of dialysis & transplantation, is the only way to manage ESRF patients which involves huge amount of money, time & people.
A research to identify a treatment approach which may slow the progression of renal failure should be given highest priority. ...
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2. Title
Can correction of anaemia with erythropoietin in predialysis anaemic patients slow the progression of renal damage?
3. Study Problem
Chronic Renal Failure (CRF) is an irreversible & difficult to manage medical condition. All patients move to an end stage renal failure (ESRF) in course of time. Renal Replacement Therapy (RRT), consisting of dialysis & transplantation, is the only way to manage ESRF patients which involves huge amount of money, time & people.
A research to identify a treatment approach which may slow the progression of renal failure should be given highest priority. A delay in the initiation of RRT will substantially reduce the burden of cost on the healthcare services.
4. Relevance of the project
The current 'UK guidelines for identification, management and referral of chronic kidney disease in adults' admits the huge cost burden of RRT on the health services. It also mentions that the number of patients receiving renal replacement therapy (RRT) in the UK is rising rapidly costing over 2% of the total NHS budget and any improvement in the cost-effective treatment of CRF is highly desirable.
According to Roderick (2005), over 30,000 patients were being treated with RRT in England by 2000, at a cost of about £600 million. The number of UK patients receiving RRT rose from 7,119 in 1982 to 37,439 in 2003, are consuming an ever-larger share of limited NHS budgets. One study showed that 24.3% of dialysis patients died from cardiovascular disease over 5 years emphasising the need to address slowing progression of the disease.
5. Literature Review
Roderick et al (2004) says that the number of patients receiving renal replacement therapy (RRT) in the UK is rising rapidly and is unlikely to reach steady state for another 25 years. ESRF is a major health problem resulting in considerable increase of morbidity and mortality, in decrease of quality of life, and in heavy costs from renal replacement therapies. Therefore, slowing the progression of renal failure thus appears to be a major therapeutic challenge.
Kumar and Clark (2002) identified anaemia as a consequence of CRF. Anaemia causes severe fatigue and deteriorates the quality of life in CRF patients. Correction of anaemia is an integral part of CRF management. Correction of anaemia reduces the risk of cardiovascular mortality and morbidity. Using erythropoietin to correct anaemia in CRF has now become the standard of care.
However, there is no clear evidence that correction of anaemia slows the rate of renal damage in CRF. Some of the literatures indicate that there might be a correlation between correction of renal anaemia & progression of kidney damage.
So, a review on the available literatures will be conducted to discover whether or not the use of EPO can slow the progression renal damage in CRF patients.
6. Specific Study Aim and Objectives
6.1 Question
Can correction of anaemia with erythropoietin slow the progression of renal damage in CRF patients?
6.2 Aim
To identify whether reversal of renal anaemia with erythropoietin slows renal damage in Predialysis CRF patients
6.3 Objectives
. To understand whether erythropoietin can slow the progression of renal damage in CRF
2. To identify whether there is a relationship between Haemoglobin (Hb) or Haematocrit (Hct) level & renal function
7. Methodology
7.1 Paradigm & Methodology
Without nominating a paradigm as the first step, there is no basis for subsequent choices regarding methodology, methods, literature or research design (Mackenzie & Knipe 2006).
The proposed research belongs to a positivist paradigm which according to Brechin and Sidell (2000), is the research method that has evolved to understand, describe, explain and control the natural world, using observational and experimental methods to shore up our uncertain mental capacity by building in checks against bias.
According to Firestone (1987) quantitative studies are usually based on a positivist paradigm. Therefore, the proposed research will involve the quantitative method of research.
7.2 Literature Search
According to Hart (2001), there are at least five good reasons behind literature search for beginning a research project:
* It helps to identify work already done or in progress that is relevant to the proposed research
* Prevents duplicating what has already been done
* Helps to avoid some of the pitfalls and errors of the previous research
* Helps to design the methodology for the project by identifying the key issues and data collection techniques best suited to the proposed topic
* Enables the researcher to find gaps in existing research, thereby giving a unique topic
For the proposed literature review the following sources will be searched for the literatures:
* Books in the library
* Internet search using google scholar
* MEDLINE (Pubmed) database search using the Boolean logic and with the following key words:
Patient/Problem
Intervention
Outcome/Effect
Chronic Renal Failure
Erythropoietin
Dialysis
* Chronic Kidney Disease
* Predialysis
* CKD
* CRF
* EPO
* Epoietin
* Anaemia Correction
* Renal Replacement Therapy
* End Stage Renal Failure
Search will include:
. Papers concerning predialysis kidney patients
2. Published research literatures
3. Full text, Free full text, Abstracts
4. Literatures published since 1994
5. Literatures published in English
Search will exclude:
. Trials involving Animals
2. Age group below 19
7.3 Critical Appraisal
According to Fowkes and Fulton (1991), the purpose of critically appraising a paper is to discover if the methods and results of the research are sufficiently valid to produce useful information.
Public Health Resource Unit (2006) Critical Appraisal Skill Programme (CASP) aims to enable individuals to develop the skills to find and make sense of research evidence, helping them to put knowledge into practice. The proposed study will be conducted using the CASP (Critical Appraisal Skill Programme).
7.4 Analysis of other peoples' findings
Hart (2001) says that critical evaluation of previous work assess the methodologies and methods that have been employed previously to study the topic and evaluate the relative strengths and weaknesses of the literature.
To evaluate the relative strengths and weaknesses and to assess the methodologies and methods, the following analysis will be done:
* Thematic analysis: suggested by Braun and Clark (2006)
* SWOT analysis: suggested by Wheeler and Grice (2000)
* Fishbone analysis: suggested by Iles (1998)
* Mind map analysis: suggested by Hart (2001)
Thematic analysis:
According to Braun and Clark (2006), thematic analysis is a method for identifying, analysing and reporting patterns (themes) within data.
Phases of thematic analysis:
I. Familiarising with data
II. Generating initial codes
III. Searching for themes
IV. Reviewing themes
V. Defining and naming themes
VI. Producing the report
SWOT Analysis:
As suggested by Wheeler and Grice (2000), analyses of strength, weakness, opportunity & threat will be done by SWOT analysis.
Strength (Internal)
Weakness (Internal)
Opportunity (External)
Threat (External)
* Fishbone analysis:
Iles (1998) suggested the use of Fishbone analysis to analyse problem and causes.
* Mind map analysis:
As suggested by Hart (2001), a Mind-map analysis will be done. Mind Maps are more compact than conventional notes, often taking up one side of paper. This helps to make associations easily. A complete Mind Map may have main topic lines radiating in all directions from the centre.
8. Ethics
As suggested by Beauchamp and Childress (2001), it will be made sure that the following duties towards the patients were ensured:
* Autonomy
* Beneficence
* Non-maleficence
* Justice
As described by Hart (2001), using the literature on a topic the researcher is using the ideas, concepts and theories of other people. It is therefore the responsibility of the researcher to use the work of other in a way that that is balanced, fair and legal. This involves ensuring that the sources are cited correctly and, where, where necessary, not infringing copyright or even Data Protection Act. To perform duties toward the researchers following actions will be avoided:
* Falsification
* Fabrication
* Sloppiness
* Nepotism
* Plagiarism
9. Resources
The research will involve 1215 pound sterling:
* 200 working hours of a research assistant @ 6 pound sterling = 1200 Pounds
* Computer print-out: 200 pages @ 5 pence= 10 Pound Sterling
* Photocopy: 100 pages @ 5 pence= 5 Pound Sterling
0. Time-Plan:
Time plan for the literature review is provided below:
September 2007: Start
October 2007: Search for literatures
December 2007: Review the literatures
January 2008: Analysis
March 2008: Start writing the report
June 2008: Submission of report
1. References:
. Joint Specialty Committee on Renal Medicine of the Royal College of Physicians and the Renal Association, and the Royal College of General Practitioners (2006) Chronic kidney disease in adults: UK guidelines for identification, management and referral. London: Royal College of Physicians.
2. Griffin SV and MacGregor MS (2005) Facing an epidemic of chronic kidney disease. Clinical Medicine 5, 521-525.
3. Roderick P et al (2005) An evaluation of the cost, effectiveness and quality of renal replacement therapy provision in renal satellite units in England and Wales. Health Technology Assessment 9 (24).
4. Roderick P, Davies R, Jones C, Feest T, Smith S and Farrington K (2004) Simulation model of renal replacement therapy: predicting future demand in England. Nephroogy Diaysis Transplantation. 19, 692-701.
5. Firestone WA (1987) Meaning in Method: The Rhetoric of Quantitative and Qualitative Research. Educational Researcher. 16 (7), 16-21.
6. Fowkes FGR and P M Fulton (1991) Critical appraisal of published research: introductory guidelines. British Medical Journal. 302, 1136-1140
7. Public Health Resource Unit (2006) Critical Appraisal Skills Programme (CASP) and Evidence-based Practice. Available at http://www.phru.nhs.uk/learning/critical_appraisal_tools.htm (accessed 25/03/2007)
8. Kumar P and Clark M (Eds) (2002) Clinical Medicine (5th Edition). Edinburgh: EB Saunders
9. Tapolyai M, Kadomatsu S and Chong MP (2003) r.hu-Erythropoietin (EPO) treatment of pre-ESRD patients slows the rate of progression of renal decline. BMC Nephrology. 4 (3), 1-4.
0. Mackenzie N and Knipe S. (2006) Research dilemmas: Paradigms, methods and methodology. Issues In Educational Research. 16(2), 193-205.
1. Brechin P and Sidell M (Eds) (2000) Using Evidence in Health and Social Care. London: Sage.
2. Braun V and Clarke V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology. 3, 77-101
3. Wheeler N and Grice D (2000) Management in health care. Cheltenham: Stanley Thornes.
4. Iles V (1997) Really Managing Healthcare. Buckingham: Open University Press.
5. Hart C (2001) Doing a literature search: a comprehensive guide for the social sciences. London: Sage.
6. Beauchamp TL and Childress JF (2001) Principles of Biomedical Ethics (5th edition). Oxford: Oxford University Press.
Module Number: P49210 Module Title: Advanced Research Design
Student Name: Mohammed Nazmul Ahsan Student Number: 06108646
