Abstract Background The Chronic Kidney Disease Screening and Quality Use of Medicines trial aimed to improve chronic kidney disease (CKD) detection and optimise medication use in Australia. This analysis evaluates the feasibility of pharmacy‐based screening for identifying individuals at risk of CKD and reports participant baseline characteristics. Methods Eligible participants for the trial were aged 35–74 years and had ≥1 CKD risk factor. The intervention group received a QKidney® risk assessment, point‐of‐care test (POCT) and medication reviews, while the control group received the risk assessment only. QKidney® scores and blood pressure (BP) classified 5‐year CKD risk as low, moderate or high. Intervention participants at moderate‐to‐high risk underwent POCT of serum creatinine to estimate estimated glomerular filtration rate (eGFR). Reduced kidney function was defined as eGFR < 60 mL/min/1.73 m 2 and prevalence was compared with Australian National Health Measures Survey 2022–2024 estimates. Data were analysed in Statistical Package for Social Sciences (version 31) using descriptive statistics. Results Of the 1486 participants recruited between March 2023 and December 2024, 1189 were included in this analysis (550 (46%) intervention, 639 (54%) control). Risk assessment was completed in 99.9% of participants using QKidney® and in 100% using BP. A POCT was performed for 84% of intervention participants at moderate to high risk. Of those fulfilling pre‐defined general practice referral criteria, 73% were referred. Overall, 68% of trial participants were at moderate to high CKD risk (59% identified by QKidney® and 30% by BP). Additionally, 21% had reduced kidney function based on POCT results – substantially higher than the national estimates (5.2%). Conclusions Pharmacy‐based targeted screening was feasible for identifying individuals at risk of developing CKD and could strengthen early detection efforts in Australia.
Abstract Background Pulmonary infiltrates in immunocompromised patients are associated with high morbidity and mortality, and accurate diagnosis is often challenging due to overlapping infectious and non‐infectious aetiologies. Flexible bronchoscopy with bronchoalveolar lavage (BAL) is widely used, but its contemporary real‐world clinical utility across heterogeneous immunocompromised populations remains uncertain. Aims To retrospectively evaluate the clinical utility of inpatient flexible bronchoscopy with BAL in immunocompromised adults presenting with new pulmonary infiltrates at a tertiary referral centre. Methods Retrospective cohort study conducted at a Victorian tertiary centre including immunocompromised adults who underwent inpatient flexible bronchoscopy for new CT‐confirmed pulmonary infiltrates between January 2022 and December 2024. The primary outcomes were diagnostic yield and the proportion of procedures resulting in a change in clinical management. Results Sixty‐two patients were included (mean age 60.3 ± 16.9 years; 38.7% female). Patients with underlying haematological malignancy accounted for 59.7% of cases, and 83.9% were receiving empiric antibiotic therapy prior to bronchoscopy. Overall diagnostic yield was 43.5% (27/62). Bronchoscopy resulted in a change in clinical management in 64.5% of cases (40/62), most commonly initiation of targeted antimicrobial therapy (47.5%). The median interval from imaging to bronchoscopy was 4.5 days. Procedural complications were uncommon and limited (4.8%). Patients with haematological malignancy had higher odds of fungal infection (OR 6.81, 95% CI 1.33–68.54; P = 0.009) and mortality at 12 months (51.4% vs 20.0%; OR 4.22, CI 1.17–17.16, P = 0.017) compared to non‐haematological causes of immunocompromise. Conclusion In immunocompromised inpatients with pulmonary infiltrates, bronchoscopy with BAL was associated with frequent changes in clinical management and a low rate of procedure‐related complications. These observational findings support its use in appropriately selected patients, while prospective studies are needed to determine its effect on patient‐centred outcomes.
