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UZWR38203 Evidence And Research In Practice

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UZWR38203 Evidence And Research In Practice Question: Chronic Kidney Disease is Independently Associated with Increased Mortality in Patients with Non-alcoholic Fatty Liver Disease. Answer: Introduction: The study by Paik et al. (2018) was aimed at examining the relationship between the varying phases of Chronic Kidney Disease (CKD) and death in the patient with non-alcoholic fatty liver disease (NAFLD). The authors used the NHANES-III mortality files and ascertained NAFLD using hepatic ultrasound. The impact of CKD on cardiovascular death rate was examined using the multivariable Cox proportional hazard model. The study found out that overall mortality rate was linked to NAFLD and advanced phases of CKD. Background Information Studies have shown CKD to be one of the primary public health issues that cause high death rates, illness and high treatment costs (Gansevoort et al., 2013). There is also a strong relationship between CKD and metabolic disorders such as cardiovascular diseases (CVD) (Gansevoort et al., 2013). NAFLD is a significant liver disorder related to metabolic syndrome (MS) (Younossi et al., 2018) and at a worldwide prevalence of 25% (Younossi et al., 2016). The NAFLD patients are estimated to be at a higher risk of CVD (Targher et al., 2010). The study by Kim et al. (2013) indicated that the primary cause of death in NAFLD patients was cardiovascular disease. NAFLD shares several risk factors with chronic illnesses and is regarded as the extrahepatic manifestation (EHM) of NAFLD (Younossi et al., 2018). Some of the most commonly shared characteristics of the MS with regard to CKD and NAFLD are insulin resistance, diabetes mellitus, and obesity (Armstrong et al., 2014). Furthermore, both of the illnesses are linked with an elevated risk of cardiovascular diseases. Notwithstanding the existence of this tie, its association with mortality by making use of data that is population-based has not been adequately addressed. Critical Approach Methods and Results The study design is not expressly identified in the study. However, the study adopted a cohort design which is of benefit because it is less costly and consumes minimal time than random control trials (Song and Chung, 2010). Song and Chung (2010) assert that a cohort study is the most appropriate for assessing and comparing the effectiveness of two or more interventions. The authors do not, however, justify the use of a cohort approach, thus creating doubt on not only its appropriateness but also the credibility of the findings (Von Elm et al., 2014). The authors indicate the source of data “NHANES -III -linked mortality files” which have been described as comprehensive and reliable in other studies by Younossi et al. (2012). This also implies that the findings will most likely be reliable. The comparison being made in the research is between NAFLD and CKD about their relationship about mortality. Furthermore, the study provides a clear definition of the two variables. The restriction of the study to subjects that meet the inclusion criteria only minimises selection bias (Song and Chung, 2010). The results are comprehensive enough to be understood. The rate of proportion between the exposed and unexposed variables is presented using percentages and confidence intervals. This makes the results more precise and reduces any bias due to confounding. Additionally, the observable difference due to the comparison increases the internal validity of the study (Song and Chung, 2010). Data Presentation The analysed data was presented under different themes and compared to each other according to the findings, and the difference noted. For instance, the characteristics the cohorts have been presented separately and comparatively with the variables of each section analysed. This ensures that any possible association between the outcomes and exposure is clearly defined and thus strengthening the credibility of the findings. Each theme has also been summarised in table form, thus making it easy to notice the difference by comparing the outcomes between the exposed and unexposed cohorts. The study has also disclosed the specific measures used to measure the study variables, statistical methods and analysis. This increases the reliability and validity of the study (Song and Chung, 2010). Discussion and Conclusion The authors discuss and summarise the study outcomes in line with the aim of the study, thus ensuring that the existing research gap the research intended to fill has been accomplished and as a result adding more information to the body of knowledge relevant to the area of study. Furthermore, the findings are compared with previous studies to ascertain any difference or consistency. This gives strength to the credibility of the findings and is a clear indication of the depth of the analysis because the results can be compared to those that had previously been researched and reviewed (Declan Devane and Dip, 2011). The limitation of the study has been discussed. The major weakness of the research is on the accuracy of the diagnosis of NAFLD and the absence of follow-up information on the NHANES data. Such limitations can be potential sources of selection bias because any inaccuracy of NAFLD might lead to differences between the study groups of comparison. The lack of follow-up information on the NHANES data may make the study findings not to be up to date, thus giving an incorrect status and impact of the intervention under assessment (Song and Chung, 2010). The multiplicity of analyses in the study also increases the validity and reliability of the study because similar variables are tested using different instruments of measurement. The NHANES data was based on a large sample size thus increasing the generalizability of the study. Whereas the restriction of the study population to specific age bracket minimised selection bias, it also reduced the sample size, a move that further limited the generalizability of the study (Euser et al., 2009). Personal Opinion The findings of the study can be relied upon due to the large and representative sample size with a similar evaluation of NAFLD. Additionally, the study found out that there exists a distinct relationship between CKD and NAFLD. These outcomes are in line with previous studies, thus confirming the credibility of the research. Quality of the Study The quality of the study can be rated as above average because there is a connection between the study aim, methods and results. Additionally, the authors have made attempts to minimise any selection bias, and the measurement of outcomes have been done using standardised instruments. The findings are also consistent with previous research. References Armstrong, M.J., Adams, L.A., Canbay, A. and Syn, W.K., 2014. Extrahepatic complications of nonalcoholic fatty liver disease. Hepatology, 59(3), pp.1174-1197. Declan Devane, R.G.N. and Dip, H.E., 2011. Methodological considerations in cohort study designs. Nurse Researcher (through 2013), 18(3), p.32. Euser, A.M., Zoccali, C., Jager, K.J. and Dekker, F.W., 2009. Cohort studies: prospective versus retrospective. Nephron Clinical Practice, 113(3), pp.c214-c217. Gansevoort, R.T., Correa-Rotter, R., Hemmelgarn, B.R., Jafar, T.H., Heerspink, H.J.L., Mann, J.F., Matsushita, K. and Wen, C.P., 2013. Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention. The Lancet, 382(9889), pp.339-352. Kim, D., Kim, W.R., Kim, H.J. and Therneau, T.M., 2013. Association between noninvasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States. Hepatology, 57(4), pp.1357-1365. Paik, J., Golabi, P., Younoszai, Z., Mishra, A., Trimble, G. and Younossi, Z.M., 2018. Chronic Kidney Disease is Independently Associated with Increased Mortality in Patients with Non?alcoholic Fatty Liver Disease. Liver International. Song, J.W. and Chung, K.C., 2010. Observational studies: cohort and case-control studies. Plastic and reconstructive surgery, 126(6), p.2234. Targher, G., Day, C.P. and Bonora, E., 2010. Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease. New England Journal of Medicine, 363(14), pp.1341-1350. Von Elm, E., Altman, D.G., Egger, M., Pocock, S.J., Gøtzsche, P.C., Vandenbroucke, J.P. and Strobe Initiative, 2014. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. International journal of surgery, 12(12), pp.1495-1499. Younossi, Z., Anstee, Q.M., Marietti, M., Hardy, T., Henry, L., Eslam, M., George, J. and Bugianesi, E., 2018. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nature reviews Gastroenterology & hepatology, 15(1), p.11. Younossi, Z.M., Koenig, A.B., Abdelatif, D., Fazel, Y., Henry, L. and Wymer, M., 2016. Global epidemiology of nonalcoholic fatty liver disease—meta?analytic assessment of prevalence, incidence, and outcomes. Hepatology, 64(1), pp.73-84. Younossi, Z.M., Stepanova, M., Negro, F., Hallaji, S., Younossi, Y., Lam, B. and Srishord, M., 2012. Nonalcoholic fatty liver disease in lean individuals in the United States. Medicine, 91(6), pp.319-327.

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