Dataset Information

Piloting a multidisciplinary clinic for the management of non-alcoholic fatty liver disease: initial 5-year experience.

ABSTRACT:

Objective

A multidisciplinary approach is advocated for the management of Non-Alcoholic Fatty Liver Disease (NAFLD), but few clinical data exist to support this. The objective of this study was to investigate the effectiveness of a multidisciplinary NAFLD clinic using surrogate markers of liver injury and cardiovascular risk.

Design

Retrospective survey of clinical practice.

Setting

The multidisciplinary NAFLD clinic in a secondary/tertiary care setting with hepatology, diabetology, dietetic and exercise therapy input: initial 5-years' experience (2007-2012).

Patients

180 patients with NAFLD but without hepatic comorbidities were followed up for a median of 19.5 (range 3-57) months. 52% had type 2 diabetes mellitus, 48% were Europoid Caucasian, 17% were South Asian.

Interventions

Multiple clinical interventions were employed including lifestyle (diet and exercise) advice, pharmacological intervention for cardiovascular risk factors, weight loss and exercise therapy.

Main outcome measures

Change in alanine aminotransferase (ALT), weight, HbA1c, lipid profile and blood pressure.

Results

Median ALT fell from 61 (12-270) U/l to 50 (11-221) U/l, -18%, p<0.001, and weight fell from 90.5 (42.7-175.0) kg to 87.3 (45.9-175.3) kg, -3.5%, p<0.001. There were significant improvements in total cholesterol overall, triglycerides (among dyslipidaemic patients), HbA1c (among diabetic patients) and systolic blood pressure (among hypertensive patients). 24% of patients achieved ≥7% weight loss during follow-up and 17% maintained this weight loss throughout.

Conclusions

Improvement in liver biochemistry and cardiovascular risk factors was seen in patients attending the multidisciplinary NAFLD clinic. Refinement of this approach is warranted in light of these data, novel therapies and a growing evidence base.

SUBMITTER: Cobbold JFL

PROVIDER: S-EPMC5369842 | biostudies-literature | 2013 Oct

REPOSITORIES: biostudies-literature

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Publications

Piloting a multidisciplinary clinic for the management of non-alcoholic fatty liver disease: initial 5-year experience.

Cobbold Jeremy F L JFL Raveendran Sarrah S Peake Christopher M CM Anstee Quentin M QM Yee Michael S MS Thursz Mark R MR

Frontline gastroenterology 20130523 4

<h4>Objective</h4>A multidisciplinary approach is advocated for the management of Non-Alcoholic Fatty Liver Disease (NAFLD), but few clinical data exist to support this. The objective of this study was to investigate the effectiveness of a multidisciplinary NAFLD clinic using surrogate markers of liver injury and cardiovascular risk.<h4>Design</h4>Retrospective survey of clinical practice.<h4>Setting</h4>The multidisciplinary NAFLD clinic in a secondary/tertiary care setting with hepatology, dia ...[more]

PMID: 28839736

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Project description:Rationale & objectiveThere has been an increasing demand for the expertise provided by a renal genetics clinic. Such programs are limited in the United States and typically operate in a genomics research setting. Here we report a 3-year, real-world, single-center renal genetics clinic experience.Study designRetrospective cohort.Setting & participantsOutpatient cases referred to the renal genetics clinic of the Cleveland Clinic between January 2019 and March 2022 were reviewed.Analytical approachClinical and laboratory characteristics were analyzed. All genetic testing was performed in clinical labs.Results309 new patients referred from 15 specialties were evaluated, including 118 males and 191 females aged 35.1 ± 20.3 years. Glomerular diseases were the leading presentation followed by cystic kidney diseases, electrolyte disorders, congenital anomalies of kidneys and urinary tract, nephrolithiasis, and tubulointerstitial kidney diseases. Dysmorphic features were noted in 27 (8.7%) patients. Genetic testing was recommended in 292 (94.5%) patients including chromosomal microarray (8.9%), single-gene tests (19.5%), multigene panels (77.3%), and exome sequencing (17.5%). 80.5% of patients received insurance coverage for genetic testing. 45% (115/256) of patients had positive results, 25% (64/256) had variants of unknown significance, and 22.3% (57/256) had negative results. 43 distinct monogenic disorders were diagnosed. Family history of kidney disease was present in 52.8% of patients and associated with positive genetic findings (OR, 2.28; 95% CI, 1.40-3.74). 69% of patients with positive results received a new diagnosis and/or a change in the diagnosis. Among these, 39.7% (31/78) of patients received a significant change in disease management.LimitationsRetrospective and single-center study.ConclusionsThe renal genetics clinic plays important roles in the diagnosis and management of patients with genetic kidney diseases. Multigene panels are the most frequently used testing modality with a high diagnostic yield. Family history of kidney disease is a strong indication for renal genetics clinic referral.

Dataset Information

Piloting a multidisciplinary clinic for the management of non-alcoholic fatty liver disease: initial 5-year experience.

Objective

Design

Setting

Patients

Interventions

Main outcome measures

Results

Conclusions

Publications

Piloting a multidisciplinary clinic for the management of non-alcoholic fatty liver disease: initial 5-year experience.

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