1
|
Marbun MBH, Susalit E, Susilowati U, Andina T. Long-term outcomes and prognostic factors in kidney transplant recipients in Jakarta, Indonesia: a cohort study. BMJ Open 2022; 12:e059631. [PMID: 35641009 PMCID: PMC9157350 DOI: 10.1136/bmjopen-2021-059631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To determine the long-term survival rates and prognostic factors in kidney transplant (KT) recipients in Jakarta, Indonesia. DESIGN Retrospective cohort study. SETTING A KT centre in Jakarta. PARTICIPANTS We enrolled 754 consecutive adult recipients who underwent KT between 2010 and 2020. MAIN OUTCOME MEASURES Rates of 10-year patient, all-cause and death-censored graft survival and their prognostic factors in KT recipients. RESULTS The 10-year patient survival, all-cause survival and death-censored graft survival rates of KT recipients were 74%, 68% and 81%, respectively. The prognostic factors for poor patient survival were a pretransplant dialysis duration>24 months (HR 1.64, 95% CI, 1.08 to 2.49; p=0.02), cardiovascular disease (HR 1.59, 95% CI, 1.11 to 2.31; p=0.01), delayed graft function (DGF) (HR 4.94, 95% CI, 2.76 to 8.82; p<0.001), post-transplant infection (HR 2.63, 95% CI, 1.56 to 4.43; p<0.001) and acute rejection (HR 2.49, 95% CI, 1.20 to 5.15; p=0.01). All-cause graft survival was prognosticated by a pretransplant dialysis duration>24 months (HR 1.74, 95% CI, 1.15 to 2.47; p=0.007), cardiovascular disease (HR 1.65, 95% CI, 1.18 to 2.33; p=0.004), DGF (HR 5.39, 95% CI, 3.13 to 9.28; p<0.001), post-transplant infection (HR 2.46, 95% CI, 1.05 to 4.02; p<0.001) and acute rejection (HR 4.18, 95% CI, 2.23 to 7.84; p<0.001). Factors associated with poor death-censored graft survival were a pretransplant dialysis duration >24 months (HR 2.19, 95% CI, 1.32 to 3.63; p=0.002), cardiovascular disease (HR 1.65, 95% CI, 1.02 to 2.68; p=0.04) and acute rejection (HR 5.52, 95% CI, 2.80 to 10.83; p<0.001). CONCLUSIONS The survival rates of KT recipients are prognosticated by pretransplant dialysis duration, cardiovascular disease, DGF, post-transplant infection and acute rejection. Stricter eligibility criteria for recipients, more sensitive cross-match testing methods and better infection management strategies may be beneficial for improving the survival rates.
Collapse
Affiliation(s)
- Maruhum Bonar H Marbun
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Endang Susalit
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Utami Susilowati
- Department of Internal Medicine, Rumah Sakit Umum Pusat Nasional Dr Cipto Mangunkusumo, Central Jakarta, DKI Jakarta, Indonesia
| | - Tantika Andina
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| |
Collapse
|
2
|
Naylor KL, Kim SJ, Kuwornu JP, Dixon SN, Garg AX, McCallum MK, Knoll GA. Pre-transplant maintenance dialysis duration and outcomes after kidney transplantation: A multicenter population-based cohort study. Clin Transplant 2021; 36:e14553. [PMID: 34897824 DOI: 10.1111/ctr.14553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/08/2021] [Accepted: 11/26/2021] [Indexed: 11/27/2022]
Abstract
The association between pre-transplant dialysis duration and post-transplant outcomes may vary by the population and endpoints studied. We conducted a population-based cohort study using linked healthcare databases from Ontario, Canada including kidney transplant recipients (n = 4461) from 2004-2014. Our primary outcome was total graft failure (i.e., death, return to dialysis, or pre-emptive re-transplant). Secondary outcomes included death-censored graft failure, death with graft function, mortality, hospitalization for cardiovascular events, hospitalization for infection, and hospital readmission. We presented results by pre-transplant dialysis duration (pre-emptive transplant, and 0.01-1.43, 1.44-2.64, 2.65-4.25, 4.26-6.45, and 6.46-36.5 years, for quintiles 1-5). After adjusting for clinical characteristics, pre-emptive transplantation was associated with a lower rate of total graft failure (adjusted hazard ratio [aHR] 0.68, 95% CI: 0.46, 0.99), while quintile 4 was associated with a higher rate (aHR 1.31, 95% CI: 1.01, 1.71), when compared to quintile 1. There was no significant relationship between dialysis duration and death-censored graft failure, cardiovascular events, or hospital readmission. For death with graft function and mortality, quintiles 3-5 had a significantly higher aHR compared to quintile 1, while for infection, quintiles 2-5 had a higher aHR. Longer time on dialysis was associated with an increased rate of several adverse post-transplant outcomes. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Kyla L Naylor
- ICES, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - S Joseph Kim
- ICES, Ontario, Canada.,Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Stephanie N Dixon
- ICES, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Amit X Garg
- ICES, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,Division of Nephrology, Western University, London, Ontario, Canada
| | | | - Gregory A Knoll
- Department of Medicine (Nephrology), University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
3
|
Fu R, Kim SJ, de Oliveira C, Coyte PC. An instrumental variable approach confirms that the duration of pretransplant dialysis has a negative impact on the survival of kidney transplant recipients and quantifies the risk. Kidney Int 2019; 96:450-459. [DOI: 10.1016/j.kint.2019.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/11/2019] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
|
4
|
Gaipov A, Jackson CD, Talwar M, Balaraman V, Chakravarty A, Cseprekal O, Mathe Z, Remport A, Kovesdy CP, Eason JD, Mucsi I, Molnar MZ. Association Between Serum Prealbumin Level and Outcomes in Prevalent Kidney Transplant Recipients. J Ren Nutr 2019; 29:188-195. [PMID: 30819599 DOI: 10.1053/j.jrn.2019.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 12/07/2018] [Accepted: 01/07/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE(S) Prealbumin, a transport protein mostly synthesized in the liver, is a marker of nutrition. Although decreased prealbumin levels are associated with increased mortality in end-stage kidney disease patients, its association with mortality in kidney transplant recipients remains unknown. We evaluated the association between prealbumin levels and outcomes in kidney transplant recipients. DESIGN This was a prospective prevalent cohort study. This study included 991 kidney transplant recipients enrolled from December 31, 2006, to December 31, 2007, and followed over a 6-year period. Sociodemographic, past medical history, clinical, and laboratory data were collected at the study entry. Associations between prealbumin levels and death with functioning graft, all-cause mortality, and graft loss were examined using survival models. RESULTS Serum prealbumin levels showed significant negative correlation with estimated glomerular filtration rate (R = -0.28; P < .001) and high-sensitive C-reactive protein (R = -0.24; P < .001). Each 5 mg/dL lower serum prealbumin level was associated with 20% higher risk of death with functioning graft (subdistribution hazard ratio [95% confidence interval]: 1.20 [1.08-1.35]; P = .001), which persisted after multivariable adjustments (subdistribution hazard ratio [95% confidence interval]: 1.13 [1.00-1.28]; P = .039). Qualitatively similar trend was observed in all-cause mortality; however, there was no association between prealbumin levels and graft loss. CONCLUSION(S) Lower serum prealbumin level is associated with increased risk of death with functioning graft in prevalent kidney transplant recipients.
Collapse
Affiliation(s)
- Abduzhappar Gaipov
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee; Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Christopher D Jackson
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Manish Talwar
- James D Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee; Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Vasanthi Balaraman
- James D Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee; Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Arijit Chakravarty
- James D Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee; Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Orsolya Cseprekal
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Zoltan Mathe
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Adam Remport
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee; Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee
| | - James D Eason
- James D Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee; Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Istvan Mucsi
- Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - Miklos Z Molnar
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee; James D Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee; Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee; Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary.
| |
Collapse
|
5
|
Burkhalter H, De Geest S, Wirz-Justice A, Cajochen C. Melatonin rhythms in renal transplant recipients with sleep-wake disturbances. Chronobiol Int 2016; 33:810-20. [PMID: 27101434 DOI: 10.3109/07420528.2016.1169192] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We assessed salivary melatonin levels in renal transplant (RTx) recipients who participated in a randomised, multicentre wait-list controlled trial on the effect of bright light therapy on their sleep and circadian rhythms. A large proportion of RTx recipients in our cohort had unexpectedly low melatonin values, which precluded calculation of the dim-light melatonin onset (DLMO) as a circadian marker. Thus, the aim of this post hoc analysis was to describe the melatonin profile of home-dwelling RTx recipients diagnosed with sleep-wake disturbances (SWDs). The participants were characterised by means of sleep questionnaires, validated psychometric instruments [Pittsburgh sleep quality Index (PSQI), Epworth sleepiness scale (ESS), Morningness-Eveningness Questionnaire (MEQ) and Depression, Anxiety and Stress Scale (DASS)] in addition to melatonin assay in saliva. Data were analysed with descriptive statistics and group comparisons made with appropriate post hoc tests. RTx recipients [n = 29 (aged 54.83 ± 13.73, transplanted 10.62 ± 6.84 years ago)] were retrospectively grouped into two groups: RTx recipients whose dim light melatonin onset (DLMO) could be calculated (n = 11) and those whose DLMO could not be calculated (n = 18). RTx recipients having a measurable DLMO had a number of differences from those without DLMO: they were younger [46.4 ± 14.9 compared to 60.0 ± 10.3 (p = .007)], had higher haemoglobin values [135.36 ± 12.01 versus 122.82 ± 11.56 (p = .01)], less anxiety [4 (0;8) versus 12 (6.5;14) (p = .021)] and a better overall sense of coherence [SOC Score: 71.09 ± 12.78 versus 56.28 ± 15.48 (p = 0.013)]. These results suggest that RTx recipients whose DLMO could be calculated have less health impairments, underlying the relevance of a stable circadian system.
Collapse
Affiliation(s)
- Hanna Burkhalter
- a Centre for Sleep Medicine , Hirslanden Group , Zürich , Switzerland.,b Institute of Nursing Science, University of Basel , Basel , Switzerland
| | - Sabina De Geest
- b Institute of Nursing Science, University of Basel , Basel , Switzerland.,c Academic Center for Nursing and Midwifery , KU Leuven , Belgium
| | - Anna Wirz-Justice
- d Centre for Chronobiology , Psychiatric Hospital of the University of Basel , Basel , Switzerland
| | - Christian Cajochen
- d Centre for Chronobiology , Psychiatric Hospital of the University of Basel , Basel , Switzerland
| |
Collapse
|
6
|
Abstract
Survival of a kidney transplant recipient beyond 2 decades is a relatively rare event. No studies have been conducted to describe individuals’ longevity attributions, who have had their kidney transplant for many years. The purpose of this qualitative analysis was to examine longevity attributions of kidney transplant recipients who have had a kidney transplant for 25 years or longer. The initial sample was obtained from an informal support group that includes only those who have had their kidney transplant >25 years. A semistructured 1-hour interview was conducted over the phone, audio-taped, and transcribed. Data were examined using thematic content analyses. The sample consisted of 19 participants (7 males and 12 females) ranging in age from 43 to 67 years, with a mean age of 52.8 years (standard deviation [SD] = 6.82). Transplants were performed between 26 and 36 years prior to the interviews, with a mean of 30.7 years (SD = 3.2). Emerging attributions included maintaining a healthy lifestyle, social support, positive attitude, faith, normalcy, participation in decision making, and luck. Prior to transplantation, patients were engaging in self-management behaviors, which many attributed to their success posttransplant. The findings of this study may provide insight and understanding for health-care providers and other transplant recipients regarding longevity attributions of those who have had their kidney transplants for over a quarter century. Future research should explore the impact of supporting kidney transplant recipients in self-management prior to and after transplantation.
Collapse
Affiliation(s)
- Michelle L. Matteson-Kome
- Division of Gastroenterology and Hepatology, Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Todd Ruppar
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Cynthia Russell
- School of Nursing & Health Studies, University of Missouri–Kansas City, Kansas City, MO, USA
| |
Collapse
|
7
|
Pieloch D, Dombrovskiy V, Osband AJ, DebRoy M, Mann RA, Fernandez S, Mondal Z, Laskow DA. The Kidney Transplant Morbidity Index (KTMI): A Simple Prognostic Tool to Help Determine Outcome Risk in Kidney Transplant Candidates. Prog Transplant 2015; 25:70-6. [DOI: 10.7182/pit2015462] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background The Kidney Transplant Morbidity Index (KTMI) is a novel prognostic morbidity index to help determine the impact that pretransplant comorbid conditions have on transplant outcome. Objective To use national data to validate the KTMI. Design Retrospective analysis of the Organ Procurement and Transplant Network/United Network for Organ Sharing database. Setting and Participants The study sample consisted of 100 261 adult patients who received a kidney transplant between 2000 and 2008. Main Outcome Measure Kaplan-Meier survival curves were used to demonstrate 3-year graft and patient survival for each KTMI score. Cox proportional hazards regression models were created to determine hazards for 3-year graft failure and patient mortality for each KTMI score. Results A sequential decrease in graft survival (0 = 91.2%, 1 = 88.2%, 2 = 85.4%, 3 = 81.7%, 4 = 77.8%, 5 = 74.0%, 6 = 69.8%, and ≥7 = 68.7) and patient survival (0 = 98.2%, 1 = 96.6%, 2 = 93.7%, 3 = 89.7%, 4 = 84.8%, 5 = 80.8%, 6 = 76.0%, and ≥7 = 74.7%) is seen as KTMI scores increase. The differences in graft and patient survival between KTMI scores are all significant ( P < .001) except between 6 and ≥7. Multivariate regression analysis reveals that KTMI is an independent predictor of higher graft failure and patient mortality rates and that risk increases as KTMI scores increase. Conclusion The KTMI strongly predicts graft and patient survival by using pretransplant comorbid conditions; therefore, this easy-to-use tool can aid in determining outcome risk and transplant candidacy before listing, particularly in candidates with multiple comorbid conditions.
Collapse
Affiliation(s)
- Daniel Pieloch
- Robert Wood Johnson University Hospital (DP, AJO, MD, RAM, SF, ZM, DAL) and Medical School (VD, AJO, MD, RAM, SF, ZM, DAL) New Brunswick, New Jersey
| | - Viktor Dombrovskiy
- Robert Wood Johnson University Hospital (DP, AJO, MD, RAM, SF, ZM, DAL) and Medical School (VD, AJO, MD, RAM, SF, ZM, DAL) New Brunswick, New Jersey
| | - Adena J. Osband
- Robert Wood Johnson University Hospital (DP, AJO, MD, RAM, SF, ZM, DAL) and Medical School (VD, AJO, MD, RAM, SF, ZM, DAL) New Brunswick, New Jersey
| | - Meelie DebRoy
- Robert Wood Johnson University Hospital (DP, AJO, MD, RAM, SF, ZM, DAL) and Medical School (VD, AJO, MD, RAM, SF, ZM, DAL) New Brunswick, New Jersey
| | - Richard A. Mann
- Robert Wood Johnson University Hospital (DP, AJO, MD, RAM, SF, ZM, DAL) and Medical School (VD, AJO, MD, RAM, SF, ZM, DAL) New Brunswick, New Jersey
| | - Sonalis Fernandez
- Robert Wood Johnson University Hospital (DP, AJO, MD, RAM, SF, ZM, DAL) and Medical School (VD, AJO, MD, RAM, SF, ZM, DAL) New Brunswick, New Jersey
| | - Zahidul Mondal
- Robert Wood Johnson University Hospital (DP, AJO, MD, RAM, SF, ZM, DAL) and Medical School (VD, AJO, MD, RAM, SF, ZM, DAL) New Brunswick, New Jersey
| | - David A. Laskow
- Robert Wood Johnson University Hospital (DP, AJO, MD, RAM, SF, ZM, DAL) and Medical School (VD, AJO, MD, RAM, SF, ZM, DAL) New Brunswick, New Jersey
| |
Collapse
|
8
|
Recipient-related risk factors for graft failure and death in elderly kidney transplant recipients. PLoS One 2014; 9:e112938. [PMID: 25389964 PMCID: PMC4229296 DOI: 10.1371/journal.pone.0112938] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 10/17/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Elderly patients with end-stage renal disease have become the fastest growing population of kidney transplant candidates in recent years. However, the risk factors associated with long-term outcomes in these patients remain unclear. METHODS We retrospectively analyzed 166 recipients aged 60 years or older who underwent primary deceased kidney transplantation between 2002 and 2013 in our center. The main outcomes included 1-, 3- and 5-year patient survival as well as overall and death-censored graft survival. The independent risk factors affecting graft and patient survival were analyzed using Cox regression analysis. RESULTS The 1-, 3-, 5-year death-censored graft survival rates were 93.6%, 89.4% and 83.6%, respectively. Based on the Cox multivariate analysis, panel reactive antibody (PRA)>5% [hazard ratio (HR) 4.295, 95% confidence interval (CI) 1.321-13.97], delayed graft function (HR 4.744, 95% CI 1.611-13.973) and acute rejection (HR 4.971, 95% CI 1.516-16.301) were independent risk factors for graft failure. The 1-, 3-, 5-year patient survival rates were 84.8%, 82.1% and 77.1%, respectively. Longer dialysis time (HR 1.011 for 1-month increase, 95% CI 1.002-1.020), graft loss (HR 3.501, 95% CI 1.559-7.865) and low-dose ganciclovir prophylaxis (1.5 g/d for 3 months) (HR 3.173, 95% CI 1.063-9.473) were risk factors associated with patient death. CONCLUSIONS The five-year results show an excellent graft and patient survival in elderly kidney transplant recipients aged ≥60 years. PRA>5%, delayed graft function, and acute rejection are risk factors for graft failure, while longer duration of dialysis, graft loss and low-dose ganciclovir prophylaxis are risk factors for mortality in elderly recipients. These factors represent potential targets for interventions aimed at improving graft and patient survival in elderly recipients.
Collapse
|
9
|
Impact of Early Graft Function on 10-Year Graft Survival in Recipients of Kidneys From Standard- or Expanded-Criteria Donors. Transplantation 2013; 96:176-81. [DOI: 10.1097/tp.0b013e318297443b] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
10
|
Caro-Oleas J, González-Escribano M, Gentil-Govantes M, Acevedo M, González-Roncero F, Bernal-Blanco G, Núñez-Roldán A. Influence of donor specific HLA antibodies detected by Luminex in kidney graft survival: A multivariate analysis. Hum Immunol 2013; 74:545-9. [DOI: 10.1016/j.humimm.2013.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 01/07/2013] [Accepted: 01/14/2013] [Indexed: 11/30/2022]
|
11
|
|
12
|
Cilan H, Sipahioglu MH, Oguzhan N, Unal A, Turan T, Koc AN, Tokgoz B, Utas C, Oymak O. Association between depression, nutritional status, and inflammatory markers in peritoneal dialysis patients. Ren Fail 2012; 35:17-22. [PMID: 23150953 DOI: 10.3109/0886022x.2012.741643] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To investigate the relationship between depression, nutritional status, and inflammatory markers in patients on peritoneal dialysis (PD). PATIENTS AND METHODS This prospective study included 40 PD patients and 20 healthy people. The severity of depressive symptoms was assessed using the Beck depression inventory, the Hamilton depression rating scale, and the Hamilton anxiety rating scale. The depressive patients received antidepressant drug for 8 weeks. Blood samples were taken before and after antidepressant treatment for the high-sensitive C-reactive protein (hs-CRP), interleukin (IL)-1, IL-6, and tumor necrosis factor-α (TNF-α) levels. RESULTS Ten (25%) of the 40 PD patients had depression. No significant difference was determined between depressive patients and nondepressive patients. The mean erythrocyte sedimentation rate was higher in depressive patients. There was no significant difference for other inflammation parameters, including hs-CRP, TNF-α, IL-1, and IL-6, between depressive patients and nondepressive patients. In the depressive patients, we did not observe any significant change in nutritional parameters after antidepressant treatment. When we evaluated inflammation parameters of the depressive patients before and after antidepressant treatment, only IL-1 and IL-6 levels were significantly increased after antidepressant treatment. CONCLUSION The depressive disorder in PD patients is a common psychopathology and has no significant effects on nutritional status and inflammation.
Collapse
Affiliation(s)
- Havva Cilan
- Department of Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey.
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Dołęgowska B, Błogowski W, Stępniewska J, Safranow K, Jakubowska K, Olszewska M. Presence of glucose in dialyzing fluid and synthesis of selected lipoxygenase-derived eicosanoids during hemodialysis. Int Urol Nephrol 2011; 44:1799-804. [PMID: 22127406 DOI: 10.1007/s11255-011-0089-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 11/04/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE Active metabolites of arachidonic acid (AA), eicosanoids, are exerting a significant influence on renal homeostasis. In our recent paper, we demonstrated that high levels of lipoxygenase (LOX)-derived AA metabolites, hydroxyeicosatetraenoic acids (HETEs), unfavorably influence post-transplant function of kidney allografts. Hence, in this study, we wanted (1) to analyze 5-, 12- and 15-HETE levels in non-diabetic chronic kidney disease (CKD) patients, already undergoing regular hemodialysis treatment, and determine factors that may influence these eicosanoids' generation, as well as, (2) to verify whether application of glucose-containing, instead of glucose-free, dialyzing fluids may be beneficial for the limitation of 5-, 12- and 15-HETE synthesis during a single hemodialysis session. METHODS Twenty-four healthy individuals and 50 CKD patients undergoing regular hemodialysis treatment were included in the study. CKD patients were divided into two subgroups depending on presence/absence of glucose in dialyzing fluid. LOX-derived HETEs were measured using liquid chromatography. RESULTS Results demonstrated higher levels of examined eicosanoids in CKD patients (P<0.05 for all). Older age and higher C-reactive protein levels were associated with HETEs concentrations. Presence of glucose in dialyzing fluid significantly diminished the increase in 5- and 12-HETE synthesis (411.24% vs. 107.29%, P<0.006; 301.70% vs. 98.21%, P<0.0008, respectively), however, it did not influence 15-HETE generation (156.98% vs. 135.24%, P=0.26). CONCLUSIONS Non-diabetic CKD patients have higher levels of LOX-derived HETEs, which are associated mainly with age and intensified inflammatory process. The presence of glucose in the dialysate is associated with a reduced synthesis of selected LOX-derived HETEs in these patients; hence, we speculate that the application of such a simple hemodialysis fluid modification may have a favorable influence on post-transplant outcomes.
Collapse
Affiliation(s)
- Barbara Dołęgowska
- Department of Laboratory Diagnostics and Molecular Medicine, Pomeranian Medical University, Al. Powstancow Wlkp. 72, 70-111, Szczecin, Poland
| | | | | | | | | | | |
Collapse
|
14
|
It is not polite to ask a dialysis patient his age! Int Urol Nephrol 2011; 43:1101-5. [PMID: 21547468 DOI: 10.1007/s11255-011-9968-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Accepted: 04/07/2011] [Indexed: 10/18/2022]
|
15
|
Turunc T, Micozkadioglu H, Dirim A, Kuzgunbay B, Aygun C, Ozkardes H, Haberal M. Evaluation of video-urodynamic studies before renal transplantation in chronic renal failure patients. Int Urol Nephrol 2010; 42:903-7. [PMID: 20464488 DOI: 10.1007/s11255-010-9739-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Accepted: 04/08/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the role of video-urodynamic examination prior to renal transplantation. METHODS Sixty-four kidney transplant recipients were included into the study. All patients underwent video-urodynamic examination and separate uroflowmetry. Results were evaluated based on daily mean amount of urine, duration of chronic renal failure and presence of diabetes mellitus. RESULTS Thirty-five (54.6%) patients showed video-urodynamic abnormalities. The mean detrusor capacity was 234 ml, the mean detrusor compliance was 17.5 cm H(2)O/ml, the mean maximum detrusor pressure was 61.9 cm H(2)O and the mean Q (max) was 13.8 ml/s in all patients. Vesicoureteral reflux was detected in 15 (23%) patients. The mean detrusor compliance and detrusor capacity significantly decreased as the daily amount of urine decreased and as the duration of chronic renal failure increased. Also, there was no significant relation between presence of diabetes mellitus and detrusor capacity and detrusor compliance. CONCLUSION Video-urodynamic studies before renal transplantation provide earlier diagnosis of lower tract abnormalities, which are likely to cause graft dysfunction.
Collapse
Affiliation(s)
- Tahsin Turunc
- Department of Urology, Adana Teaching and Medical Research Center, Baskent University Faculty of Medicine, 01250, Adana, Ankara, Turkey.
| | | | | | | | | | | | | |
Collapse
|