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Kiberd J, Quinn RR, Ravani P, Lentine KL, Clarke A, Jeong R, Faruque L, Lam NN. Proton Pump Inhibitors Use in Kidney Transplant Recipients: A Population-Based Study. Can J Kidney Health Dis 2024; 11:20543581241228723. [PMID: 38356921 PMCID: PMC10865938 DOI: 10.1177/20543581241228723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/12/2023] [Indexed: 02/16/2024] Open
Abstract
Background Kidney transplant recipients are commonly prescribed proton-pump inhibitors (PPIs), but due to concern for polypharmacy, chronic use should be limited. Objective The objective was to describe PPI use in kidney transplant recipients beyond their first year of transplant to better inform and support deprescribing initiatives. Design We conducted a retrospective, population-based cohort study using linked health care databases. Setting This study was conducted in Alberta, Canada. Patients We included all prevalent adult, kidney-only transplant recipients between April 2008 and December 2017 who received their transplant between May 2002 and December 2017. Measurements The primary outcome was ongoing or new PPI use and patterns of use, including frequency and duration of therapy, and assessment of indication for PPI use. Methods We ascertained baseline characteristics, covariate information, and outcome data from the Alberta Kidney Disease Network (AKDN). We compared recipients with evidence of a PPI prescription in the 3 months prior to study entry to those with a histamine-2-receptor antagonist (H2Ra) fill and those with neither. Results We identified 1823 kidney transplant recipients, of whom 868 (48%) were on a PPI, 215 (12%) were on an H2Ra, and 740 (41%) were on neither at baseline. Over a median follow-up of 5.4 years (interquartile range [IQR] = 2.6-9.3), there were almost 45 000 unique PPI prescriptions dispensed, the majority (80%) of which were filled by initial PPI users. Recipients who were on a PPI at baseline would spend 91% (IQR = 70-98) of their graft survival time on a PPI in follow-up, and nephrologists were the main prescribers. We identified an indication for ongoing PPI use in 54% of recipients with the most common indication being concurrent antiplatelet use (26%). Limitations Our kidney transplant recipients have access to universal health care coverage which may limit generalizability. We identified common gastrointestinal indications for PPI use but did not include rare conditions due to concerns about the validity of diagnostic codes. In addition, symptoms suggestive of reflux may not be well coded as the focus of follow-up visits is more likely to focus on kidney transplant. Conclusions Many kidney transplant recipients are prescribed a PPI at, or beyond, the 1-year post-transplant date and are likely to stay on a PPI in follow-up. Almost half of the recipients in our study did not have an identifiable indication for ongoing PPI use. Nephrologists frequently prescribe PPIs to kidney transplant recipients and should be involved in deprescribing initiatives to reduce polypharmacy.
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Affiliation(s)
- James Kiberd
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Robert R. Quinn
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Pietro Ravani
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | | | - Alix Clarke
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rachel Jeong
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Labib Faruque
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ngan N. Lam
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
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Loor JM, Ford CG, Leyva Y, Swift S, Ng YH, Zhu Y, Dew MA, Peipert JD, Unruh ML, Croswell E, Kendall K, Puttarajappa C, Shapiro R, Myaskovsky L. Do pre-transplant cultural factors predict health-related quality of life after kidney transplantation? Clin Transplant 2024; 38:e15256. [PMID: 38400674 PMCID: PMC11249207 DOI: 10.1111/ctr.15256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Post-transplant health-related quality of life (HRQOL) is associated with health outcomes for kidney transplant (KT) recipients. However, pretransplant predictors of improvements in post-transplant HRQOL remain incompletely understood. Namely, important pretransplant cultural factors, such as experience of discrimination, perceived racism in healthcare, or mistrust of the healthcare system, have not been examined as potential HRQOL predictors. Also, few have examined predictors of decline in HRQOL post-transplant. METHODS Using data from a prospective cohort study, we examined HRQOL change pre- to post-transplant, and novel cultural predictors of the change. We measured physical, mental, and kidney-specific HRQOL as outcomes, and used cultural factors as predictors, controlling for demographic, clinical, psychosocial, and transplant knowledge covariates. RESULTS Among 166 KT recipients (57% male; mean age 50.6 years; 61.4% > high school graduates; 80% non-Hispanic White), we found mental and physical, but not kidney-specific, HRQOL significantly improved post-transplant. No culturally related factors outside of medical mistrust significantly predicted change in any HRQOL outcome. Instead, demographic, knowledge, and clinical factors significantly predicted decline in each HRQOL domain: physical HRQOL-older age, more post-KT complications, higher pre-KT physical HRQOL; mental HRQOL-having less information pre-KT, greater pre-KT mental HRQOL; and, kidney-specific HRQOL-poorer kidney functioning post-KT, lower expectations for physical condition to improve, and higher pre-KT kidney-specific HRQOL. CONCLUSIONS Instead of cultural factors, predictors of HRQOL decline included demographic, knowledge, and clinical factors. These findings are useful for identifying patient groups that may be at greater risk of poorer post-transplant outcomes, in order to target individualized support to patients.
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Affiliation(s)
- Jamie M Loor
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Sciences, Albuquerque, New Mexico, USA
| | - C Graham Ford
- Durham VA Medical Center, Durham, North Carolina, USA
| | - Yuridia Leyva
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Sciences, Albuquerque, New Mexico, USA
| | - Samuel Swift
- College of Population Health, University of New Mexico, Albuquerque, New Mexico, USA
| | - Yue Harn Ng
- Department of Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Yiliang Zhu
- Department of Internal Medicine, University of New Mexico, School of Medicine, Albuquerque, New Mexico, USA
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA
| | - J Devin Peipert
- Department of Medical Social Sciences and Transplant Outcomes Research Collaboration, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Mark L Unruh
- Department of Internal Medicine, University of New Mexico, School of Medicine, Albuquerque, New Mexico, USA
| | - Emilee Croswell
- Department of Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Chethan Puttarajappa
- Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ron Shapiro
- Mount Sinai Recanati/Miller Transplantation Institute, Icahn School of Medicine, New York, USA
| | - Larissa Myaskovsky
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Sciences, Albuquerque, New Mexico, USA
- Department of Internal Medicine, University of New Mexico, School of Medicine, Albuquerque, New Mexico, USA
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Hu N, Wang A, Chang T. Social support mediates the relationship between illness perception and psychosocial adaptation among young and middle-aged kidney transplant recipients in China. Front Psychol 2023; 14:1062337. [PMID: 36910788 PMCID: PMC9998938 DOI: 10.3389/fpsyg.2023.1062337] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/08/2023] [Indexed: 03/14/2023] Open
Abstract
Background No research has yet been done on social support's influence on the association between illness perception and psychosocial adaptation among young and middle-aged kidney transplant recipients in China. Accordingly, it remains unclear how medical personnel can assist patients in successfully adjusting to the early postoperative period and improving their health. Objective This study sought to explore the influence of illness perception and social support on the psychosocial adaptation of young and middle-aged recipients of kidney transplants in China during the early postoperative period. Methods This study adopted a cross-sectional design. The study included 236 young and middle-aged kidney transplant recipients from a tertiary hospital in China. Demographic and disease-related data were collected. Additionally, the Psychosocial Adjustment to Illness Scale-Self-Report, the Brief Illness Perception Questionnaire, and the Multidimensional Scale of Perceived Social Support were used to assess participants' psychosocial adaptation, illness perception, and social support, respectively. The model was examined using descriptive analysis, Pearson's correlation analysis, hierarchical multiple regression analysis, and the PROCESS Macro in SPSS 26.0. Results A total of 176 (74.56%) participants reported an average psychosocial adaptation score >50, which is relatively negative. Marital status, education level, residence, per capita monthly income (in Chinese yuan), medical insurance, work status, post-transplant time, body mass index, creatinine status, and complications were all related to psychosocial adaptation (p < 0.05). The more negative their illness perception and the worse their social support, the worse the psychosocial adaptation of young and middle-aged kidney transplant recipients. Further, the effect of illness perception on psychosocial adaptation was partially mediated by social support (36.56%). Conclusion In general, the psychosocial adaption level of young and middle-aged kidney transplant recipients was negative during the early postoperative period. Healthcare teams should assist patients in building a positive illness perception shortly following kidney transplantation, while also providing psychological care and support to help them cope with the onset of psychosocial issues.
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Affiliation(s)
- Na Hu
- Transplantation Department, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Aiping Wang
- Department of Public Service, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Tiantian Chang
- Transplantation Department, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
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Kim SM, Kang M, Kang E, Kim JH, Kim Y, Ryu H, Han SS, Lee H, Kim YC, Oh KH. Associations among body composition parameters and quality of life in peritoneal dialysis patients. Sci Rep 2022; 12:19192. [PMID: 36357419 PMCID: PMC9649675 DOI: 10.1038/s41598-022-19715-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 09/02/2022] [Indexed: 11/11/2022] Open
Abstract
Health-related quality of life (HRQOL) is an important issue among patients undergoing dialysis treatment. Peritoneal dialysis (PD) is associated with a number of adverse body composition changes. However, whether body composition is associated with HRQOL is uncertain. The purpose of this study was to analyze the effects of body composition on HRQOL in PD patients. We performed a cross-sectional observational study on the association between body composition and HRQOL in PD patients at a single center. Body composition was determined by multifrequency bioimpedance spectroscopy. HRQOL is summarized to three composite scores: kidney disease component summary (KDCS), physical component summary (PCS), and mental component summary (MCS). The relationships between HRQOL and the hydration index, lean tissue index (LTI), and fat tissue index (FTI) were analyzed by regression analysis. One hundred and ninety-seven PD patients were included in the present study. Patients with severe fluid overload showed a lower PCS. The hydration index and FTI showed statistically significant negative associations with PCS. In subgroup analysis, the associations between the hydration index and PCS remained robust after stratifying according to sex, age, and residual urine. Our results indicated that both the hydration index and FTI were negatively associated with HRQOL, especially PCS.
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Affiliation(s)
- Seon-Mi Kim
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daehakro, Jongno-Gu, Seoul, 03080 Republic of Korea
| | - Minjung Kang
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daehakro, Jongno-Gu, Seoul, 03080 Republic of Korea
| | - Eunjeong Kang
- grid.255649.90000 0001 2171 7754Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Ji Hye Kim
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daehakro, Jongno-Gu, Seoul, 03080 Republic of Korea
| | - Yunmi Kim
- grid.411625.50000 0004 0647 1102Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Hyunjin Ryu
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daehakro, Jongno-Gu, Seoul, 03080 Republic of Korea
| | - Seung Seok Han
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daehakro, Jongno-Gu, Seoul, 03080 Republic of Korea
| | - Hajeong Lee
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daehakro, Jongno-Gu, Seoul, 03080 Republic of Korea
| | - Yong Chul Kim
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daehakro, Jongno-Gu, Seoul, 03080 Republic of Korea
| | - Kook-Hwan Oh
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daehakro, Jongno-Gu, Seoul, 03080 Republic of Korea
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Poor Physical Function Trajectory Predicts Impaired Patient Survival in Older Recipients of Deceased Donor Kidneys: A Prospective Cohort Study. Transplant Direct 2022; 8:e1374. [PMID: 36245999 PMCID: PMC9553385 DOI: 10.1097/txd.0000000000001374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/02/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022] Open
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Waterman AD, Nair D, Purnajo I, Cavanaugh KL, Mittman BS, Peipert JD. The Knowledge Assessment of Renal Transplantation (KART) 2.0: Development and Validation of CKD and Transplant Knowledge Scales. Clin J Am Soc Nephrol 2022; 17:555-564. [PMID: 35332061 PMCID: PMC8993477 DOI: 10.2215/cjn.11490821] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/18/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Many individuals with kidney disease, particularly those belonging to racial and ethnic minority groups and whose primary language is not English, lack knowledge related to kidney disease symptoms, physiologic functions of the kidney, and benefits and risks of kidney transplantation. Valid instruments to assess patients' knowledge of CKD and kidney transplantation are needed. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Using a sample of 977 patients with stages 3-5 CKD in the Kaiser Permanente health system, we developed the Knowledge Assessment of Renal Transplantation (KART) 2.0 instrument. We conducted cognitive interviews followed by item response theory (IRT) to reduce 48 candidate items. Construct validity was tested by examining differences in scores between patients who spent <1 and ≥1 hour receiving CKD and transplant education. RESULTS Cognitive interviews modified four items and omitted 11. IRT analyses resulted in two scales: the KART 2.0-Transplant Knowledge Scale (16 items; Cronbach's α=0.8) and the KART 2.0-CKD Knowledge Scale (nine items; Cronbach's α=0.79). Differential item functioning showed that the scales were unbiased to capture knowledge across self-identified race, primary language, CKD stage, and sex. Both scales distinguished patients who had spent <1 and ≥1 hour speaking with health professionals (effect size [ES]=0.33 [transplant], 0.54 [CKD]; P<0.001 for both), reading about kidney disease (ES=0.45 [transplant], 0.62 [CKD]; P<0.001), reading about kidney transplantation (ES=0.67 [transplant], 0.69 [CKD]; P<0.001), and reading about living donor kidney transplant (ES=0.76 [transplant], 0.62 [CKD]; P<0.001). CONCLUSIONS The KART 2.0 is a valid tool to assess patients' knowledge of CKD and kidney transplantation.
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Affiliation(s)
- Amy D Waterman
- Department of Surgery and J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, Texas
| | - Devika Nair
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt O'Brien Center for Kidney Disease, Nashville, Tennessee
| | | | - Kerri L Cavanaugh
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt O'Brien Center for Kidney Disease, Nashville, Tennessee
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brian S Mittman
- Health Services Research and Implementation Science, Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - John Devin Peipert
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, Illinois
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7
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Pan JS, Chen YD, Ding HD, Lan TC, Zhang F, Zhong JB, Liao GY. A Statistical Prediction Model for Survival After Kidney Transplantation from Deceased Donors. MEDICAL SCIENCE MONITOR : INTERNATIONAL MEDICAL JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022; 28:e933559. [PMID: 34972813 PMCID: PMC8729034 DOI: 10.12659/msm.933559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background In an environment of limited kidney donation resources, patient recovery and survival after kidney transplantation (KT) are highly important. We used pre-operative data of kidney recipients to build a statistical model for predicting survivability after kidney transplantation. Material/Methods A dataset was constructed from a pool of patients who received a first KT in our hospital. For allogeneic transplantation, all donated kidneys were collected from deceased donors. Logistic regression analysis was used to change continuous variables into dichotomous ones through the creation of appropriate cut-off values. A regression model based on the least absolute shrinkage and selection operator (LASSO) algorithm was used for dimensionality reduction, feature selection, and survivability prediction. We used receiver operating characteristic (ROC) analysis, calibration, and decision curve analysis (DCA) to evaluate the performance and clinical impact of the proposed model. Finally, a 10-fold cross-validation scheme was implemented to verify the model robustness. Results We identified 22 potential variables from which 30 features were selected as survivability predictors. The model established based on the LASSO regression algorithm had shown discrimination with an area under curve (AUC) value of 0.690 (95% confidence interval: 0.557–0.823) and good calibration result. DCA demonstrated clinical applicability of the prognostic model when the intervention progressed to the possibility threshold of 2%. An average AUC value of 0.691 was obtained on the validation data. Conclusions Our results suggest that the proposed model can predict the mortality risk for patients after kidney transplants and could help kidney specialists choose kidney recipients with better prognosis.
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Affiliation(s)
- Jia-Shan Pan
- Department of Urology, The First Affiliated Hospital of Anhui Medical University and Institute of Urology and Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Yi-Ding Chen
- Department of Urology, The First Affiliated Hospital of Anhui Medical University and Institute of Urology and Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Han-Dong Ding
- Department of Urology, The First Affiliated Hospital of Anhui Medical University and Institute of Urology and Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Tian-Chi Lan
- Department of Urology, The First Affiliated Hospital of Anhui Medical University and Institute of Urology and Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Fei Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University and Institute of Urology and Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Jin-Biao Zhong
- Department of Urology, The First Affiliated Hospital of Anhui Medical University and Institute of Urology and Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Gui-Yi Liao
- Department of Urology, The First Affiliated Hospital of Anhui Medical University and Institute of Urology and Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, Anhui, China (mainland)
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8
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Tsarpali V, Midtvedt K, Lønning K, Bernklev T, Lippe NVD, Reisæter AV, Brunborg C, Heldal K. Health-Related Quality of Life in Older Kidney Transplant Recipients: A National Cohort Study of Short- and Longer-Term Outcomes. Kidney Med 2021; 3:974-983.e1. [PMID: 34939006 PMCID: PMC8664696 DOI: 10.1016/j.xkme.2021.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Rationale & Objective Assessing the optimal therapy for older patients (aged ≥65 years) with end-stage kidney disease requires knowledge of longevity and health-related quality of life (HRQoL) outcomes. Kidney transplantation prolongs survival but its long-term impact on HRQoL in older recipients is not well defined. We aimed to prospectively evaluate HRQoL changes from enlisting until 3 years posttransplantation and examine pretransplantation predictors of posttransplantation outcomes. Study Design Prospective cohort study. Setting & Participants Patients 65 years and older enlisted at the Norwegian National Transplant Center between January 2013 and November 2016. Predictors Kidney transplantation, dialysis vintage, and pretransplantation comorbidity assessed using the Liu Comorbidity Index. Outcomes HRQoL, assessed using the Kidney Disease Quality of Life Short Form, version 1.3. Analytical Approach HRQoL scores obtained at 3 years posttransplantation were compared with those obtained pretransplantation and after 1 year using a paired-sample t test. Multivariable linear mixed-effect models were used to identify possible predictors of HRQoL changes over time. Results Among 289 patients included, 220 (mean age, 71.5 years) had undergone transplantation and 136 had completed the 3-year HRQoL follow-up by October 2020. Posttransplant HRQoL, both generic and kidney specific, substantially improved and the benefit persisted for 3 years. For wait-listed candidates remaining on dialysis, HRQoL gradually deteriorated, and recipients who died within 3 years posttransplantation experienced no improvement during the first year. Moderately elevated pretransplantation comorbidity scores and prolonged dialysis vintage independently predicted poor HRQoL outcomes posttransplantation. Recipients receiving dialysis for 1 year or longer with pretransplantation comorbidity scores ≥ 7 experienced a marked and sustained physical deterioration after transplantation. Limitations Homogenous and highly selected population. Conclusions Transplantation is associated with a sustained HRQoL improvement and should be the preferred treatment for selected older patients. The value of a pretransplant comorbidity score to predict posttransplantation outcomes warrants further evaluation and may improve the selection process.
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Affiliation(s)
- Vasiliki Tsarpali
- Clinic of Internal Medicine, Telemark Hospital Trust, Skien, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Karsten Midtvedt
- Department of Transplantation Medicine, Section of Nephrology, Oslo University Hospital, Oslo, Norway
| | - Kjersti Lønning
- Department of Transplantation Medicine, Section of Nephrology, Oslo University Hospital, Oslo, Norway
| | - Tomm Bernklev
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Research and Innovation, Vestfold Hospital Trust, Tønsberg, Oslo University Hospital, Oslo, Norway
| | - Nanna von der Lippe
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Medicine, Section of Nephrology, Oslo University Hospital, Oslo, Norway
| | - Anna Varberg Reisæter
- Department of Transplantation Medicine, Section of Nephrology, Oslo University Hospital, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Center for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Kristian Heldal
- Clinic of Internal Medicine, Telemark Hospital Trust, Skien, Norway.,Department of Transplantation Medicine, Section of Nephrology, Oslo University Hospital, Oslo, Norway
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Ryu JH, Koo TY, Ro H, Cho JH, Kim MG, Huh KH, Park JB, Lee S, Han S, Kim J, Oh KH, Yang J. Better health-related quality of life in kidney transplant patients compared to chronic kidney disease patients with similar renal function. PLoS One 2021; 16:e0257981. [PMID: 34606505 PMCID: PMC8489710 DOI: 10.1371/journal.pone.0257981] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/14/2021] [Indexed: 11/19/2022] Open
Abstract
Renal functional deterioration is associated with physical and mental burdens for kidney transplant (KT) and chronic kidney disease (CKD) patients. However, the change in health-related quality of life (HRQOL) over time in KT patients compared to that of native CKD patients has not been evaluated. We addressed this issue using KT patients registered in the KNOW-KT cohort study and patients at CKD stage 1–3 registered in the KNOW-CKD cohort study. HRQOL scores were assessed using the Kidney Disease Quality of Life Short Form at baseline, 2-, and 4-years follow-up in 842 KT patients and at baseline and 5-year follow-up in 1,355 CKD patients. SF-36 scores declined at the 4-year follow-up, whereas CKD-targeted scores showed no change in the KT group. In contrast, CKD-targeted scores as well as SF-36 scores were decreased at the 5-year follow-up in CKD patients. When prognostic factors were analyzed for longitudinal HRQOL data over time, renal functions, diabetes, cardiovascular and cerebrovascular diseases, hemoglobin level, marital status, income, employment, and health care were significant prognostic factors. Furthermore, KT was an independent prognostic factor for better HRQOL. These results highlight that KT can offer a better HRQOL than that of CKD patients, even when renal function is similar.
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Affiliation(s)
- Jung-Hwa Ryu
- Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea
- Nephrology, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Tai Yeon Koo
- Nephrology, Seongnam Citizens Medical Center, Seongnam, Republic of Korea
| | - Han Ro
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Myung-Gyu Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyu Ha Huh
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Berm Park
- Department of Surgery, Seoul Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Sik Lee
- Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Seungyeup Han
- Department of Internal Medicine, Keimyung University, Dongsan Medical Center, Daegu, Republic of Korea
| | - Jayoun Kim
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jaeseok Yang
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail: ,
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Zhang J, Dewitt B, Tang E, Breitner D, Saqib M, Li D, Siddiqui R, Edwards N, Peipert JD, Hays RD, Hanmer J, Mucsi I. Evaluation of PROMIS Preference Scoring System (PROPr) in Patients Undergoing Hemodialysis or Kidney Transplant. Clin J Am Soc Nephrol 2021; 16:1328-1336. [PMID: 34272256 PMCID: PMC8729576 DOI: 10.2215/cjn.01880221] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 06/22/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND OBJECTIVES A preference-based health utility score (PROPr) can be calculated using Patient-Reported Outcomes Measurement Information System domain scores. We assessed the construct validity of PROPr among patients treated with KRT (hemodialysis or kidney transplant). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We performed a secondary analysis of data collected in multicenter, cross-sectional studies of adults treated with KRT, recruited between April 2016 to March 2020 in Toronto, Canada. All participants provided informed consent. The outcome was the PROPr score. Coadministered outcome variables included the Short-Form Six-Domain (SF-6D) and EuroQol Five-Domain Five-Level (EQ-5D-5L) scores. Socioeconomic and clinical variables included age, sex, diabetes, eGFR, serum albumin, hemoglobin, KRT, and Charlson Comorbidity Index. Construct validity was assessed through correlations between PROPr and SF-6D or EQ-5D-5L, and associations between PROPr and other exposure variables. Health-condition impact estimates (coefficients for health conditions compared with a referent category, e.g., dialysis versus kidney transplant) were calculated using multivariable linear regression. RESULTS The mean (SD) age of the 524 participants was 57 (17) years, 58% were male, and 45% were White. Median (interquartile range) score was 0.39 (0.24-0.58) for PROPr, 0.69 (0.58-0.86) for SF-6D, and 0.85 (0.70-0.91) for EQ-5D-5L. Large correlations were observed between PROPr versus SF-6D (0.79; 95% confidence interval [95% CI], 0.76 to 0.82) and EQ-5D-5L (0.71; 95% CI, 0.66 to 0.75). Both PROPr and the other utility indices demonstrated health-condition impact in the expected direction. For example, the estimate for PROPr was -0.17 (95% CI, -0.13 to -0.21) for dialysis (versus kidney transplant), -0.05 (95% CI, -0.11 to 0.01; P=0.08) for kidney transplant recipients with an eGFR of <45 versus ≥45 ml/min per 1.73 m2, and -0.28 (95% CI, -0.22 to -0.33) for moderate/severe versus no/mild depressive symptoms. CONCLUSIONS Our results support the validity of PROPr among patients treated with KRT.
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Affiliation(s)
- Jing Zhang
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Barry Dewitt
- Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Evan Tang
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Daniel Breitner
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Mohammed Saqib
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Dan Li
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Rabail Siddiqui
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Nathaniel Edwards
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois.,Northwestern University Transplant Outcome Research Collaborative, Chicago, Illinois
| | - Ron D Hays
- Department of Medicine, University of California Los Angeles, Los Angeles, California
| | - Janel Hanmer
- Department of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Istvan Mucsi
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
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11
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Clinical factors and comorbidities affecting health-related quality of life in postrenal transplant patients. Porto Biomed J 2021; 6:e131. [PMID: 34136716 PMCID: PMC8202575 DOI: 10.1097/j.pbj.0000000000000131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/25/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Health-related quality of life is different among different transplant cohorts with respect to different variables which predict mortality and graft survival. The aim of this study was to identify the effects of clinical factors on the health-related quality of life in postrenal transplant patients. Methods: This census study was conducted at the Institute of Kidney Diseases Peshawar, Pakistan. Data were collected on a questionnaire “ Kidney Diseases Quality of Life-Short Form-1.3 Urdu version” and were analyzed in the 3 main domains, for example, physical component summary (PCS), mental component summary, and kidney disease component summary using SPSS version 21. Mean scores for patients with diabetes mellitus (DM), hypertension, levels of hemoglobin, and serum creatinine were compared by unpaired t-test. Results: A total of 277 men (87.9%) and 38 (12.1%) women participated in the study. Mean age was 37.26 (±10.14) years (range 18–65 years). Hypertension was reported in 72.2% and DM in 10.8%. Hemoglobin was <12.5g% in 26.0% patients. Patients with DM had significant lower PCS (P = .001) and mental component summary (MCS; P = .001) scores. Patients with hypertension had significant lower MCS score (P = .01). Patients with hemoglobin <12.5g% had significantly lower PCS (P = .001) score than those with hemoglobin >12.5 g%. The PCS score in patients with serum creatinine level >2 mg% was significantly lower (P = .02) than those with serum creatinine <2 mg%. Conclusion: Lower graft function and DM were associated with lower PCS and MCS scores. Hypertension was associated with lower MCS score and anemia with lower PCS score.
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12
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Posselt J, Harbeck B, Rahvar AH, Kropp P, Haas CS. Improved cognitive function after kidney transplantation compared to hemodialysis. Ther Apher Dial 2021; 25:931-938. [PMID: 33497026 DOI: 10.1111/1744-9987.13625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/04/2020] [Accepted: 01/16/2021] [Indexed: 11/30/2022]
Abstract
End-stage renal disease is associated with chronic stress that in turn may result in endocrine changes, affect cognitive, and physical capacities and increase the risk for cardiovascular events. The objective of this study was to evaluate and characterize possible stress parameters and compare cognitive function in those patients. Physiological and biochemical stress parameters as well as cognitive function were assessed in 17 hemodialysis and 18 renal transplant patients and both groups were compared. Serum cortisol and interleukin-6 levels were elevated in both groups but showed no significant difference. Cholesterol and low-density lipoprotein levels were significantly higher in patients following renal transplantation. While heart rate variability was comparable in both groups, most cognitive tests showed better results in renal transplant patients. We showed that: (1) cognitive function may improve following renal transplantation; (2) standard biochemical stress parameters are not useful to discriminate stress in patients with chronic kidney disease; and (3) heart rate variability is unaltered in this setting.
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Affiliation(s)
- Jana Posselt
- Department of Medicine, University of Luebeck, Hamburg, Germany
| | - Birgit Harbeck
- Department of Medicine, University of Luebeck, Hamburg, Germany.,Amedes Experts Hamburg, Hamburg, Germany
| | - Amir-Hossein Rahvar
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Kropp
- Institute of Medical Psychology and Medical Sociology, University of Rostock, Rostock, Germany
| | - Christian Stefan Haas
- Department of Internal Medicine, Nephrology and Intensive Care Medicine, University of Marburg, Marburg, Germany
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13
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Brito DCSD, Machado EL, Reis IA, Cherchiglia ML. Impact of clinical, sociodemographic and quality of life factors on dialysis patient survival: a nine-year follow-up cohort study. CAD SAUDE PUBLICA 2020; 36:e00007320. [PMID: 33331548 DOI: 10.1590/0102-311x00007320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/15/2020] [Indexed: 11/22/2022] Open
Abstract
Although renal replacement therapy has contributed to the survival of chronic kidney failure (CKF) patients, mortality remains a major concern. This study aimed to identify the factors associated with mortality in a prospective cohort of CKF patients. Sociodemographic, clinical, nutritional, lifestyle and quality of life data were collected from 712 patients. The instruments used were the Short-Form Health Survey (SF-36), Global Subjective Assessment (GSA) and Charlson Comorbidity Index (CCI) questionnaires. A total of 444 patients died during the study. After five years of follow-up, factors such as not being married (hazard ratio - HR = 1.289, 95%CI: 1.001; 1.660), a low frequency of leisure activities (HR = 1.321; 95%CI: 1.010; 1.727) and not being transplanted (HR = 7.246; 95%CI: 3.359; 15.630) remained independently associated with the risk of mortality. At the end of the follow-up period, factors such as not being married (HR = 1.337, 95%CI: 1.019; 1.756), not being transplanted (HR = 7.341, 95%CI: 3.829; 14.075) and having a worse nutritional status (HR = 1.363, 95%CI: 1.002; 1.853) remained independently associated with an increased risk of mortality, whereas a high schooling level (10 to 12 years, HR = 0.578, 95%CI: 0.344; 0.972; and over 12 years, HR = 0.561, 95%CI: 0.329; 0.956) and a better SF-36 physical functioning score (HR = 0.992, 95%CI: 0.987; 0.998) were protective factors associated with survival. The survival of patients with CKF is associated with factors not restricted to the clinical spectrum. The following factors were associated with high mortality: not being married, low schooling level, a limited social routine, a longer time on dialysis, worse nutritional status, and worse physical functioning.
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14
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Ranabhat K, Khanal P, Mishra SR, Khanal A, Tripathi S, Sigdel MR. Health related quality of life among haemodialysis and kidney transplant recipients from Nepal: a cross sectional study using WHOQOL-BREF. BMC Nephrol 2020; 21:433. [PMID: 33046010 PMCID: PMC7552453 DOI: 10.1186/s12882-020-02085-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/02/2020] [Indexed: 12/05/2022] Open
Abstract
Background Very less is known about health-related quality of life (HRQOL) among patients with kidney diseases in Nepal. This study examined HRQOL among haemodialysis and kidney transplant recipients in Nepal. Methods The Nepali version of World Health Organization Quality of Life Instruments -(WHOQOL-BREF) questionnaire was administered using face to face interviews among end stage renal disease (ESRD) patients, from two large national referral centers in Nepal. The differences in socio-demographic characteristics among ESRD patients were examined using the Chi-square test. The group differences in quality of life (QOL) were examined using the Mann-Whitney U test and Kruskal-Wallis tests. Results Of the 161 participants, 92 (57.1%) were renal transplant recipients and 69 (42.9%) patients were on maintenance haemodialysis. Hypertension (70.9%) was the most common co-morbidity among ESRD patients. Haemodialysis patients scored significantly lower than the transplant recipients in all four domains as well as in overall perception of quality of life and general health. Ethnicity (p = 0.020), socio-economic status (p < 0.001), educational status (p < 0.001) and employment status (p = 0.009) were significantly associated with the overall QOL in ESRD patients. Across patient groups, educational status (p = 0.012) was positively associated with QOL in dialysis patients, while urban residence (p = 0.023), higher socio-economic status (p < 0.001), higher educational status (p = 0.004) and diabetes status (p = 0.010) were significantly associated with better QOL in transplant recipients. Conclusion The overall QOL of the renal transplant recipients was higher than that of the patients on maintenance haemodialysis; this was true in all four domains of the WHOQOL-BREF. ESRD patients with low HRQOL could benefit from targeted risk modification intervention.
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Affiliation(s)
- Kamal Ranabhat
- Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal.,Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Pratik Khanal
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
| | | | - Anu Khanal
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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15
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Müller HHO, Lücke C, Englbrecht M, Wiesener MS, Siller T, Eckardt KU, Kornhuber J, Maler JM. Kidney-transplant patients receiving living- or dead-donor organs have similar psychological outcomes (findings from the PI-KT study). Ment Illn 2020; 12:17-22. [PMID: 32742627 PMCID: PMC7370952 DOI: 10.1108/mij-10-2019-0002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose Kidney transplantation (KT) is the treatment of choice for end-stage chronic kidney disease (CKD) and is well known to improve the clinical outcome of patients. However, the impact of KT on comorbid psychological symptoms, particularly depression and anxiety, is less clear, and recipients of living-donor (LD) organs may have a different psychological outcome from recipients of dead-donor (DD) organs. Design/methodology/approach In total, 152 patients were included and analyzed using a cross-sectional design. Of these patients, 25 were pre-KT, 13 were post-KT with a LD transplant and 114 were post-KT with a DD transplant. The patients were tested for a variety of psychometric outcomes using the Hospital Anxiety and Depression Scale, the 12-Item Short Form Health Survey (assessing physical and mental health-related quality of life), the Resilience Scale, the Coping Self-Questionnaire and the Social Support Questionnaire. Findings The mean age of the patients was 51.25 years and 40 per cent of the patients were female. As expected, the post-KT patients had significantly better scores on the physical component of the Short Form Health Survey than the pre-KT patients, and there were no significant differences between the two post-KT groups. There were no significant differences among the groups in any of the other psychometric outcome parameters tested, including anxiety, depression and the mental component of health-related quality of life. Research limitations/implications KT and the origin of the donor organ do not appear to have a significant impact on the psychological well-being of transplant patients with CKD. Although the diagnosis and early treatment of psychological symptoms, such as depression and anxiety, remain important for these patients, decisions regarding KT, including the mode of transplantation, should not be fundamentally influenced by concerns about psychological impairments at the population level. Originality/value CKD is a serious condition involving profound impairment of the physical and psychological well-being of patients. KT is considered the treatment of choice for most of these patients. KT has notable advantages over dialysis with regard to the long-term physical functioning of the renal and cardiovascular system and increases the life expectancy of patients. However, the data on the improvement of psychological impairments after KT are less conclusive.
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Affiliation(s)
- Helge H O Müller
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany; Department of Medical Psychology, University Hospital Bonn, Bonn, Germany and Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Caroline Lücke
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany; Department of Medical Psychology, University Hospital Bonn, Bonn, Germany and Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Englbrecht
- Department of Rheumatology, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
| | - Michael S Wiesener
- Department of Nephrology, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
| | - Teresa Siller
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
| | - Kai Uwe Eckardt
- Department of Nephrology, Charite Medical Faculty Berlin, Berlin, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
| | - J Manuel Maler
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
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16
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Tantisattamo E, Molnar MZ, Ho BT, Reddy UG, Dafoe DC, Ichii H, Ferrey AJ, Hanna RM, Kalantar-Zadeh K, Amin A. Approach and Management of Hypertension After Kidney Transplantation. Front Med (Lausanne) 2020; 7:229. [PMID: 32613001 PMCID: PMC7310511 DOI: 10.3389/fmed.2020.00229] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/04/2020] [Indexed: 12/14/2022] Open
Abstract
Hypertension is one of the most common cardiovascular co-morbidities after successful kidney transplantation. It commonly occurs in patients with other metabolic diseases, such as diabetes mellitus, hyperlipidemia, and obesity. The pathogenesis of post-transplant hypertension is complex and is a result of the interplay between immunological and non-immunological factors. Post-transplant hypertension can be divided into immediate, early, and late post-transplant periods. This classification can help clinicians determine the etiology and provide the appropriate management for these complex patients. Volume overload from intravenous fluid administration is common during the immediate post-transplant period and commonly contributes to hypertension seen early after transplantation. Immunosuppressive medications and donor kidneys are associated with post-transplant hypertension occurring at any time point after transplantation. Transplant renal artery stenosis (TRAS) and obstructive sleep apnea (OSA) are recognized but common and treatable causes of resistant hypertension post-transplantation. During late post-transplant period, chronic renal allograft dysfunction becomes an additional cause of hypertension. As these patients develop more substantial chronic kidney disease affecting their allografts, fibroblast growth factor 23 (FGF23) increases and is associated with increased cardiovascular and all-cause mortality in kidney transplant recipients. The exact relationship between increased FGF23 and post-transplant hypertension remains poorly understood. Blood pressure (BP) targets and management involve both non-pharmacologic and pharmacologic treatment and should be individualized. Until strong evidence in the kidney transplant population exists, a BP of <130/80 mmHg is a reasonable target. Similar to complete renal denervation in non-transplant patients, bilateral native nephrectomy is another treatment option for resistant post-transplant hypertension. Native renal denervation offers promising outcomes for controlling resistant hypertension with no significant procedure-related complications. This review addresses the epidemiology, pathogenesis, and specific etiologies of post-transplant hypertension including TRAS, calcineurin inhibitor effects, OSA, and failed native kidney. The cardiovascular and survival outcomes related to post-transplant hypertension and the utility of 24-h blood pressure monitoring will be briefly discussed. Antihypertensive medications and their mechanism of actions relevant to kidney transplantation will be highlighted. A summary of guidelines from different professional societies for BP targets and antihypertensive medications as well as non-pharmacological interventions, including bilateral native nephrectomy and native renal denervation, will be reviewed.
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Affiliation(s)
- Ekamol Tantisattamo
- Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, United States.,Nephrology Section, Department of Medicine, Tibor Rubin Veterans Affairs Medical Center, VA Long Beach Healthcare System, Long Beach, CA, United States.,Section of Nephrology, Department of Internal Medicine, Multi-Organ Transplant Center, William Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, MI, United States
| | - Miklos Z Molnar
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, United States.,Methodist University Hospital Transplant Institute, Memphis, TN, United States.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Bing T Ho
- Division of Nephrology and Hypertension, Department of Medicine, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Uttam G Reddy
- Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, United States.,Nephrology Section, Department of Medicine, Tibor Rubin Veterans Affairs Medical Center, VA Long Beach Healthcare System, Long Beach, CA, United States
| | - Donald C Dafoe
- Division of Transplantation, Department of Surgery, University of California Irvine School of Medicine, Orange, CA, United States
| | - Hirohito Ichii
- Division of Transplantation, Department of Surgery, University of California Irvine School of Medicine, Orange, CA, United States
| | - Antoney J Ferrey
- Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, United States.,Nephrology Section, Department of Medicine, Tibor Rubin Veterans Affairs Medical Center, VA Long Beach Healthcare System, Long Beach, CA, United States
| | - Ramy M Hanna
- Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, United States
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, United States.,Nephrology Section, Department of Medicine, Tibor Rubin Veterans Affairs Medical Center, VA Long Beach Healthcare System, Long Beach, CA, United States
| | - Alpesh Amin
- Department of Medicine, University of California Irvine School of Medicine, Orange, CA, United States
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17
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Purnajo I, Beaumont JL, Polinsky M, Alemao E, Everly MJ. Trajectories of health-related quality of life among renal transplant patients associated with graft failure and symptom distress: Analysis of the BENEFIT and BENEFIT-EXT trials. Am J Transplant 2020; 20:1650-1658. [PMID: 31874117 DOI: 10.1111/ajt.15757] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/05/2019] [Accepted: 12/08/2019] [Indexed: 01/25/2023]
Abstract
Understanding the correlation between transplant symptoms, health-related quality of life (HRQoL), and graft outcomes is needed to support patient-focused drug development and posttransplant management. A post-hoc analysis of patient-reported outcomes from the Phase III belatacept trials was conducted in order to investigate the interrelationship between trajectories of HRQoL, symptom experience, and allograft outcomes. HRQoL and symptom experience were evaluated using Short-Form 36 Survey (SF-36) and Modified Transplant Symptom Occurrence and Distress Scale (MTSOSD-59R), respectively. HRQoL was captured in 831 eligible renal transplant patients at baseline, 12, 24, and 36 months posttransplant. Following transplantation, patients reported improvements in all SF-36 subscales compared to baseline. Latent class analysis revealed four trajectories in perceived general health, which were associated with graft failure after adjustment. Compared to patients with good perceived health, patients with fair and poor perceived health had 4.7 (95% confidence interval [CI] 1.5-14.8, P < .01) and 19.8 (95% CI 5.9-66.0, P < .01) times the risk of graft failure, respectively. Using multinomial logistic regression, different sets of symptoms were associated with perceived general health at baseline and 12 months posttransplant. The study supports monitoring HRQoL and symptom experience to capture each patient's health perspective, improve drug development, and optimize posttransplant management.
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Affiliation(s)
- Intan Purnajo
- Terasaki Research Institute, Los Angeles, California
| | | | | | - Evo Alemao
- Bristol Myers Squibb, Princeton, New Jersey
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18
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Dano S, Pokarowski M, Liao B, Tang E, Ekundayo O, Li V, Edwards N, Ford H, Novak M, Mucsi I. Evaluating symptom burden in kidney transplant recipients: validation of the revised Edmonton Symptom Assessment System for kidney transplant recipients - a single-center, cross-sectional study. Transpl Int 2020; 33:423-436. [PMID: 31919903 DOI: 10.1111/tri.13572] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/20/2019] [Accepted: 01/06/2020] [Indexed: 12/14/2022]
Abstract
We assessed the validity of the Edmonton Symptom Assessment System (ESAS-r) in kidney transplant recipients (KTR). A cross-sectional sample of 252 KTR was recruited. Individual ESAS-r symptom scores and symptom domain scores were evaluated. Internal consistency, convergent validity, and construct validity were assessed with Cronbach's α, Spearman's rank correlations, and a priori-defined risk group comparisons. Mean (SD) age was 51 (16), 58% were male, and 58% Caucasian. ESAS-r Physical, Emotional, and Global Symptom Scores demonstrated good internal consistency (α > 0.8 for all). ESAS-r Physical and Global Symptom Scores strongly correlated with PHQ-9 scores (0.72, 95% CI: 0.64-0.78 and 0.74, 95% CI: 0.67-0.80). For a priori-defined risk groups, individual ESAS-r symptom score differed between groups with lower versus higher eGFR [pain: 1 (0-3) vs. 0 (0-2), delta = 0.18; tiredness: 3 (1-5) vs. 1.5 (0-4), delta = 0.21] and lower versus higher hemoglobin [tiredness: 3 (1-6) vs. 2 (0-4), delta = 0.27]. ESAS-r Global and Physical Symptom Scores differed between groups with lower versus higher hemoglobin [13 (6-29) vs. 6.5 (0-18.5), delta = 0.3, and 9 (2-19) vs. 4 (0-13), delta = 0.24] and lower versus higher eGFR [11 (4-20) vs. 6.5 (2-13), delta = 0.21, and 7 (2-16) vs. 3 (0-9), delta = 0.26]. These data support reliability and construct validity of ESAS-r in KTR. Future studies should explore its clinical utility for symptom assessment among KTR.
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Affiliation(s)
- Sumaya Dano
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Martha Pokarowski
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Betty Liao
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Evan Tang
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Oladapo Ekundayo
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Vernon Li
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Nathaniel Edwards
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Heather Ford
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Marta Novak
- Centre for Mental Health, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Istvan Mucsi
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
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19
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Association between health related quality of life and progression of chronic kidney disease. Sci Rep 2019; 9:19595. [PMID: 31863079 PMCID: PMC6925203 DOI: 10.1038/s41598-019-56102-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 12/06/2019] [Indexed: 11/08/2022] Open
Abstract
The impact of health-related quality of life (HRQOL) on outcomes remains unclear in chronic kidney disease (CKD) patients despite its importance in socioeconomic aspects and individual health. We aim to identify the relationship between HRQOL and progression of CKD in pre-dialysis patients. A total 1622 patients with CKD were analyzed in the KoreaN cohort Study for Outcomes in patients With Chronic Kidney Disease, a prospective cohort study. CKD progression was defined as one or more of the following: initiation of dialysis or transplantation, a two-fold increase in baseline serum creatinine levels, or a 50% decline in the estimated glomerular filtration rate during the follow-up period. The group with CKD progression had lower scores of HRQOL than the group without CKD progression. A fully adjusted Cox proportional hazard ratio model showed that each low baseline physical and mental component summary score was associated with a higher risk of CKD progression. In Kaplan-Meier survival analysis using propensity score matched data, only low physical component summary scores showed statistical significance with CKD progression. Our study highlights low physical component summary score for an important prognostic factor of CKD progression. Risk-modification interventions for high-risk patients may provide benefits to individuals.
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The Symptoms and Impact of Recurrent Focal Segmental Glomerulosclerosis in Kidney Transplant Recipients: A Conceptual Model of the Patient Experience. Adv Ther 2019; 36:3390-3408. [PMID: 31612357 PMCID: PMC6860472 DOI: 10.1007/s12325-019-01110-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Indexed: 12/25/2022]
Abstract
Introduction We qualitatively examined the symptoms and impact of recurrent primary focal segmental glomerulosclerosis (rpFSGS) in kidney transplant recipients, compared with two related FSGS populations, to characterize the experience of patients with rpFSGS. Methods A literature review identified 58 articles concerning the experience of patients with pFSGS and/or rpFSGS in three groups: pre-transplant pFSGS, post-transplant rpFSGS, or post-transplant non-recurrent pFSGS. Literature findings were used to construct a preliminary conceptual model incorporating the symptoms and impact of rpFSGS, which was refined on the basis of qualitative interviews with clinicians. Twenty-five patients (rpFSGS: n = 15; pre-transplant pFSGS: n = 5; post-transplant non-recurrent pFSGS: n = 5) were interviewed to characterize the experience of patients with rpFSGS and compare it with other FSGS populations, and findings were used to finalize the conceptual model. Results The impact of pFSGS/rpFSGS described in the literature was diverse. Treatment-related symptoms, along with anxiety and depression, were considered important features of rpFSGS in addition to the findings from the literature review, according to clinicians. Patient-reported tiredness and swelling were the most common/disturbing symptoms associated with rpFSGS, while physical activity restrictions and adverse effects on work/social life were considered the most profound impact concepts. The collective disease experience was different for patients with rpFSGS and non-recurrent pFSGS, although psychological impact, including treatment-related anxiety and depression, were common to both groups. Conclusions Post-transplant recipients with rpFSGS display a greater symptom burden and experience a more diverse impact than those with non-recurrent pFSGS, highlighting the importance of effective patient monitoring and introducing effective treatments for the prevention and management of pFSGS recurrence. Funding Astellas Pharma Global Development, Inc. Electronic Supplementary Material The online version of this article (10.1007/s12325-019-01110-5) contains supplementary material, which is available to authorized users.
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Nair D, Wilson FP. Patient-Reported Outcome Measures for Adults With Kidney Disease: Current Measures, Ongoing Initiatives, and Future Opportunities for Incorporation Into Patient-Centered Kidney Care. Am J Kidney Dis 2019; 74:791-802. [PMID: 31492487 PMCID: PMC6875620 DOI: 10.1053/j.ajkd.2019.05.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/11/2019] [Indexed: 01/21/2023]
Abstract
Tools that measure patients' experiences and perceptions of disease are increasingly being recognized as important components of a multidisciplinary personalized approach to care. These patient-reported outcome measures (PROMs) have the ability to provide clinicians, researchers, and policymakers with valuable insights into patients' symptoms and experiences that are unable to be ascertained by laboratory markers alone. If developed rigorously, studied systematically, and used judiciously, PROMs can effectively incorporate the patient voice into clinical care, clinical trials, and health care policy. PROMs have continued to gain attention and interest within the nephrology community, but key challenges and opportunities for their seamless uptake and integration remain. In this narrative overview, we provide nephrologists with a comprehensive list of existing PROMs developed for adults with kidney disease with information on their gaps and limitations; a rationale to support the continued incorporation of PROMs into nephrology clinical trials, clinical care, and health care policy; and a summary of ongoing initiatives and future opportunities to do so.
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Affiliation(s)
- Devika Nair
- Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Center for Kidney Disease, Nashville, TN
| | - F Perry Wilson
- Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT.
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Peipert JD, Nair D, Klicko K, Schatell DR, Hays RD. Kidney Disease Quality of Life 36-Item Short Form Survey (KDQOL-36) Normative Values for the United States Dialysis Population and New Single Summary Score. J Am Soc Nephrol 2019; 30:654-663. [PMID: 30898868 PMCID: PMC6442334 DOI: 10.1681/asn.2018100994] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/28/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The Kidney Disease Quality of Life 36-item short form survey (KDQOL-36) is a widely used, patient-reported outcome measure for patients on dialysis. Efforts to aid interpretation are needed. METHODS We used a sample of 58,851 dialysis patients participating in the Medical Education Institute (MEI) KDQOL Complete program, and 443,947 patients from the US Renal Data System (USRDS) to develop the KDQOL-36 Summary Score (KSS) for the kidney-targeted KDQOL-36 scales (Burdens of Kidney Disease [BKD], Symptoms and Problems of Kidney Disease [SPKD], and Effects of Kidney Disease [EKD]). We also used the MEI and USRDS data to calculate normative values for the Short Form-12 Health Survey's Physical Component Summary (PCS) and Mental Component Summary (MCS), and the KDQOL-36's BKD, SPKD, and EKD scales for the United States dialysis population. We used confirmatory factor analysis (CFA) models for KDQOL-36 kidney-targeted items, evaluated model fit with the comparative fit index (CFI; >0.95 indicates good fit) and root-mean-squared error of approximation (RMSEA; <0.06 indicates good fit), and estimated norms by matching the joint distribution of patient characteristics in the MEI sample to those of the USRDS sample. RESULTS A bifactor CFA model fit the data well (RMSEA=0.046, CFI=0.990), supporting the KSS (α=0.91). Mean dialysis normative scores were PCS=37.8 and MCS=50.9 (scored on a T-score metric); and KSS=73.0, BKD=52.8, SPKD=79.0, and EKD=74.1 (0-100 possible scores). CONCLUSIONS The KSS is a reliable summary of the KDQOL-36. The United States KDQOL-36 normative facilitate interpretation and incorporation of patient-related outcome measures into kidney disease care.
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Affiliation(s)
- John D Peipert
- Department of Medical Social Sciences and
- Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Devika Nair
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kristi Klicko
- Medical Education Institute, Inc., Madison, Wisconsin; and
| | | | - Ron D Hays
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, California
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de Brito DCS, Machado EL, Reis IA, Moreira DP, Nébias THM, Cherchiglia ML. Modality transition on renal replacement therapy and quality of life of patients: a 10-year follow-up cohort study. Qual Life Res 2019; 28:1485-1495. [PMID: 30666548 DOI: 10.1007/s11136-019-02113-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Despite advance in renal replacement therapy (RRT), patients with chronic end-stage renal disease (ESRD) face various limitations, and renal transplantation (Tx) is the treatment that impacts most on quality of life (QoL). This study aimed to assess changes in QoL in a cohort of ESRD dialysis patients. METHODS Sociodemographic, clinical, nutritional, lifestyle, and QoL data were collected from 712 patients at baseline (time 1) and after 10 years of follow-up (time 2) for patients surviving. The QoL was assessed through the 36-Item Short Form Health Survey (SF-36) and the multiple linear regression model was used to analyze the factors associated with change in QoL. RESULTS A total of 205 survivors were assessed and distributed into three groups according to current RRT (Dialysis-Dialysis, Dialysis-Tx, and Dialysis-Tx-Dialysis). At time 1, only age was significantly different among groups; at time 2, transplant patients sustained greater social participation, job retention, and improvement in SF-36 scores. The factors associated with change in QoL were more time on dialysis interfering negatively on physical functioning (p = 0.002), role-physical limitations (p = 0.002), general health (p = 0.007), social functioning (p = 0.02), role-emotional (p = 0.003), and physical components ( p = 0.002); non-participation in social groups at times 1 and 2 reducing vitality (p = 0.02) scores; and having work at time 2, increasing vitality (p = 0.02) and mental health (p = 0.02) scores. CONCLUSIONS QoL was shown to be dynamic throughout the years of RRT, transplantation being the treatment with more benefits to the ESRD. More time on dialysis and limited social and occupational routine were associated with a reduction in QoL.
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Affiliation(s)
| | - Elaine Leandro Machado
- Grupo de Pesquisa em Economia e Saúde, Belo Horizonte, Minas Gerais, Brazil.,Department of Family Medicine, Mental Health and Public Health, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Ilka Afonso Reis
- Grupo de Pesquisa em Economia e Saúde, Belo Horizonte, Minas Gerais, Brazil.,Department of Statistics, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Mariângela Leal Cherchiglia
- Grupo de Pesquisa em Economia e Saúde, Belo Horizonte, Minas Gerais, Brazil. .,Department of Preventive and Social Medicine, Medical School, Universidade Federal de Minas Gerais, Av. Alfredo Balena, 190, Sala 706, Belo Horizonte, 30130-100, Minas Gerais, Brazil.
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24
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Tang E, Ekundayo O, Peipert JD, Edwards N, Bansal A, Richardson C, Bartlett SJ, Howell D, Li M, Cella D, Novak M, Mucsi I. Validation of the Patient-Reported Outcomes Measurement Information System (PROMIS)-57 and -29 item short forms among kidney transplant recipients. Qual Life Res 2018; 28:815-827. [DOI: 10.1007/s11136-018-2058-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2018] [Indexed: 12/20/2022]
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25
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Health-related quality of life compared between kidney transplantation and nocturnal hemodialysis. PLoS One 2018; 13:e0204405. [PMID: 30235331 PMCID: PMC6147724 DOI: 10.1371/journal.pone.0204405] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 09/07/2018] [Indexed: 11/19/2022] Open
Abstract
Background Health-related quality of life (HRQOL) is an important outcome measure in patients with end-stage renal disease. HRQOL is assumed to improve with kidney transplantation and also with nocturnal hemodialysis compared to conventional hemodialysis. However, there is no evidence regarding HRQOL to support the optimal treatment choice for patients on nocturnal hemodialysis who hesitate opting for transplantation. We therefore compared HRQOL between patients who were treated with kidney transplantation or nocturnal hemodialysis for one year. Methods We assessed HQROL using the Kidney Disease Quality of Life–Short Form questionnaire in a cross-sectional sample of patients who were treated with kidney transplantation (n = 41) or nocturnal hemodialysis (n = 31) for one year. All patients on nocturnal hemodialysis were transplantation candidates. Using linear regression, we compared HRQOL between kidney transplantation and nocturnal hemodialysis, and adjusted for age, sex, dialysis duration, cardiovascular disease, and presence of residual urine production. Results At one year follow-up, mean age of the study population was 54 ±13 years, and median dialysis duration was 3.2 (IQR 2.1–5.0) years. Kidney transplantation was associated with significantly higher HRQOL on the domain “effects” compared to nocturnal hemodialysis (adjusted difference 12.0 points, 95% CI 3.9; 20.1). There were potentially clinically relevant differences between kidney transplantation and nocturnal hemodialysis on the domains “burden” (adjusted difference 11.1 points, 95% CI -2.6; 24.8), “social support” (adjusted difference 6.2, 95% CI -6.6; 19.1), and the physical composite score (adjusted difference 3.0, 95% CI -2.0; 8.1), but these were not significant. Conclusions After kidney transplantation, HRQOL is especially higher on the domain “effects of kidney disease” compared to nocturnal hemodialysis. This can be useful when counseling patients on nocturnal hemodialysis who may opt for transplantation.
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Abstract
BACKGROUND Health-related quality of life (HRQOL) reflects a patient's disease burden, treatment effectiveness, and health status and is summarized by physical, mental, and kidney disease-specific scales among end-stage renal disease patients. Although on average HRQOL improves postkidney transplant (KT), the degree of change depends on the ability of the patient to withstand the stressor of dialysis versus the ability to tolerate the intense physiologic changes of KT. Frail KT recipients may be extra vulnerable to either of these stressors, thus affecting change in HRQOL after KT. METHODS We ascertained frailty, as well as physical, mental, and kidney disease-specific HRQOL in a multicenter prospective cohort of 443 KT recipients (May 2014 to May 2017) using Kidney Disease Quality of Life Instrument Short Form. We quantified the short-term (3 months) rate of post-KT HRQOL change by frailty status using adjusted mixed-effects linear regression models. RESULTS Mean HRQOL scores at KT were 43.3 (SD, 9.6) for physical, 52.8 (SD, 8.9) for mental, and 72.6 (SD, 12.8) for kidney disease-specific HRQOL; frail recipients had worse physical (P < 0.001) and kidney disease-specific HRQOL (P = 0.001), but similar mental HRQOL (P = 0.43). Frail recipients experienced significantly greater rates of improvement in physical HRQOL (frail, 1.35 points/month; 95% confidence interval [CI], 0.65-2.05; nonfrail, 0.34 points/month; 95% CI, -0.17-0.85; P = 0.02) and kidney disease-specific HRQOL (frail, 3.75 points/month; 95% CI, 2.89-4.60; nonfrail, 2.41 points/month; 95% CI, 1.78-3.04; P = 0.01), but no difference in mental HRQOL (frail, 0.54 points/month; 95% CI, -0.17-1.25; nonfrail, 0.46 points/month; 95% CI, -0.06-0.98; P = 0.85) post-KT. CONCLUSIONS Despite decreased physiologic reserve, frail recipients experience improvement in post-KT physical and kidney disease-specific HRQOL better than nonfrail recipients.
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27
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MacKinnon HJ, Wilkinson TJ, Clarke AL, Gould DW, O'Sullivan TF, Xenophontos S, Watson EL, Singh SJ, Smith AC. The association of physical function and physical activity with all-cause mortality and adverse clinical outcomes in nondialysis chronic kidney disease: a systematic review. Ther Adv Chronic Dis 2018; 9:209-226. [PMID: 30364521 DOI: 10.1177/2040622318785575] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/30/2018] [Indexed: 12/15/2022] Open
Abstract
Objective People with nondialysis-dependent chronic kidney disease (CKD) and renal transplant recipients (RTRs) have compromised physical function and reduced physical activity (PA) levels. Whilst established in healthy older adults and other chronic diseases, this association remains underexplored in CKD. We aimed to review the existing research investigating poor physical function and PA with clinical outcome in nondialysis CKD. Data sources Electronic databases (PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials) were searched until December 2017 for cohort studies reporting objective or subjective measures of PA and physical function and the associations with adverse clinical outcomes and all-cause mortality in patients with nondialysis CKD stages 1-5 and RTRs. The protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42016039060). Review methods Study quality was assessed using the Newcastle-Ottawa Scale and the Agency for Healthcare and Research Quality (AHRQ) standards. Results A total of 29 studies were included; 12 reporting on physical function and 17 on PA. Only eight studies were conducted with RTRs. The majority were classified as 'good' according to the AHRQ standards. Although not appropriate for meta-analysis due to variance in the outcome measures reported, a coherent pattern was seen with higher mortality rates or prevalence of adverse clinical events associated with lower PA and physical function levels, irrespective of the measurement tool used. Sources of bias included incomplete description of participant flow through the study and over reliance on self-report measures. Conclusions In nondialysis CKD, survival rates correlate with greater PA and physical function levels. Further trials are required to investigate causality and the effectiveness of physical function and PA interventions in improving outcomes. Future work should identify standard assessment protocols for PA and physical function.
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Affiliation(s)
- Heather J MacKinnon
- Leicester Kidney Lifestyle Team, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Thomas J Wilkinson
- Leicester Kidney Lifestyle Team, Department of Infection, Immunity and Inflammation, University of Leicester, LE1 7RH Leicester, UK
| | - Amy L Clarke
- Leicester Kidney Lifestyle Team, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Douglas W Gould
- Leicester Kidney Lifestyle Team, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Thomas F O'Sullivan
- Leicester Kidney Lifestyle Team, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Soteris Xenophontos
- Leicester Kidney Lifestyle Team, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Emma L Watson
- Leicester Kidney Lifestyle Team, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Sally J Singh
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Alice C Smith
- Leicester Kidney Lifestyle Team, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
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Mouelhi Y, Jouve E, Alessandrini M, Pedinielli N, Moal V, Meurette A, Cassuto E, Mourad G, Durrbach A, Dussol B, Gentile S. Factors associated with Health-Related Quality of Life in Kidney Transplant Recipients in France. BMC Nephrol 2018; 19:99. [PMID: 29703170 PMCID: PMC5921567 DOI: 10.1186/s12882-018-0893-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 04/11/2018] [Indexed: 02/07/2023] Open
Abstract
Background Health-Related Quality of Life (HRQoL) assessment after kidney transplantation has become an important tool in evaluating outcomes. This study aims to identify the associated factors with HRQoL among a representative sample size of Kidney Transplant Recipients (KTR) at the time of their inclusion in the study. Methods Data of this cross-sectional design is retrieved from a longitudinal study conducted in five French kidney transplant centers in 2011, and included KTR aged 18 years with a functioning graft for at least 1 year. Measures include demographic, psycho-social and clinical characteristics. To evaluate HRQoL, the Short Form-36 Health Survey (SF-36) and a HRQoL instrument for KTR (ReTransQol) were administered. Multivariate linear regression models were performed. Results A total of 1424 patients were included, with 61.4% males, and a mean age of 55.7 years (±13.1). Demographic and clinical characteristics were associated with low HRQoL scores for both questionnaires. New variables were found in our study: perceived poor social support and being treated by antidepressants were associated with low scores of Quality of Life (QoL), while internet access was associated with high QoL scores. Conclusion The originality of our study’s findings was that psycho-social variables, particularly KTR treated by antidepressants and having felt unmet needs for any social support, have a negative effect on their QoL. It may be useful to organize a psychological support specifically adapted for patients after kidney transplantation.
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Affiliation(s)
- Yosra Mouelhi
- Laboratoire de Santé Publique, Faculté de Médecine, Université Aix-Marseille, 3279, Marseille, EA, France.
| | - Elisabeth Jouve
- Service Santé Publique et Information Médicale, CHU Marseille, Marseille, France
| | - Marine Alessandrini
- Laboratoire de Santé Publique, Faculté de Médecine, Université Aix-Marseille, 3279, Marseille, EA, France
| | - Nathalie Pedinielli
- Service Santé Publique et Information Médicale, CHU Marseille, Marseille, France
| | - Valérie Moal
- Centre de Néphrologie et de Transplantation Rénale, CHU Marseille, Marseille, France
| | - Aurélie Meurette
- Transplantation, Urology and Nephrology Institute (ITUN), CHU Nantes, Nantes, France
| | | | - Georges Mourad
- Département de Néphrologie, Dialyse et Transplantation, CHU Montpellier, Montpellier, France
| | | | - Bertrand Dussol
- Centre de Néphrologie et de Transplantation Rénale, CHU Marseille, Marseille, France
| | - Stéphanie Gentile
- Laboratoire de Santé Publique, Faculté de Médecine, Université Aix-Marseille, 3279, Marseille, EA, France.,Service Santé Publique et Information Médicale, CHU Marseille, Marseille, France
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Tang E, Bansal A, Novak M, Mucsi I. Patient-Reported Outcomes in Patients with Chronic Kidney Disease and Kidney Transplant-Part 1. Front Med (Lausanne) 2018; 4:254. [PMID: 29379784 PMCID: PMC5775264 DOI: 10.3389/fmed.2017.00254] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 12/21/2017] [Indexed: 01/31/2023] Open
Abstract
Chronic kidney disease (CKD) is a complex medical condition that is associated with several comorbidities and requires comprehensive medical management. Given the chronic nature of the condition, its frequent association with psychosocial distress, and its very significant symptom burden, the subjective patient experience is key toward understanding the true impact of CKD on the patients’ life. Patient-reported outcome measures are important tools that can be used to support patient-centered care and patient engagement during the complex management of patients with CKD. The routine collection and use of patient-reported outcomes (PROs) in clinical practice may improve quality of care and outcomes, and may provide useful data to understand the disease from both an individual and a population perspective. Many tools used to measure PROs focus on assessing health-related quality of life, which is significantly impaired among patients with CKD. Health-related quality of life, in addition to being an important outcome itself, is associated with clinical outcomes such as health care use and mortality. In Part 1 of this review, we provide an overview of PROs and implications of their use in the context of CKD. In Part 2, we will review the selection of appropriate measures and the relevant domains of interest for patients with CKD.
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Affiliation(s)
- Evan Tang
- Multi-Organ Transplant Program, Division of Nephrology, University Health Network, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Aarushi Bansal
- Multi-Organ Transplant Program, Division of Nephrology, University Health Network, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Marta Novak
- Centre for Mental Health, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Istvan Mucsi
- Multi-Organ Transplant Program, Division of Nephrology, University Health Network, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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Mahr B, Granofszky N, Muckenhuber M, Wekerle T. Transplantation Tolerance through Hematopoietic Chimerism: Progress and Challenges for Clinical Translation. Front Immunol 2017; 8:1762. [PMID: 29312303 PMCID: PMC5743750 DOI: 10.3389/fimmu.2017.01762] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 11/27/2017] [Indexed: 02/06/2023] Open
Abstract
The perception that transplantation of hematopoietic stem cells can confer tolerance to any tissue or organ from the same donor is widely accepted but it has not yet become a treatment option in clinical routine. The reasons for this are multifaceted but can generally be classified into safety and efficacy concerns that also became evident from the results of the first clinical pilot trials. In comparison to standard immunosuppressive therapies, the infection risk associated with the cytotoxic pre-conditioning necessary to allow allogeneic bone marrow engraftment and the risk of developing graft-vs.-host disease (GVHD) constitute the most prohibitive hurdles. However, several approaches have recently been developed at the experimental level to reduce or even overcome the necessity for cytoreductive conditioning, such as costimulation blockade, pro-apoptotic drugs, or Treg therapy. But even in the absence of any hazardous pretreatment, the recipients are exposed to the risk of developing GVHD as long as non-tolerant donor T cells are present. Total lymphoid irradiation and enriching the stem cell graft with facilitating cells emerged as potential strategies to reduce this peril. On the other hand, the long-lasting survival of kidney allografts, seen with transient chimerism in some clinical series, questions the need for durable chimerism for robust tolerance. From a safety point of view, loss of chimerism would indeed be favorable as it eliminates the risk of GVHD, but also complicates the assessment of tolerance. Therefore, other biomarkers are warranted to monitor tolerance and to identify those patients who can safely be weaned off immunosuppression. In addition to these safety concerns, the limited efficacy of the current pilot trials with approximately 40-60% patients becoming tolerant remains an important issue that needs to be resolved. Overall, the road ahead to clinical routine may still be rocky but the first successful long-term patients and progress in pre-clinical research provide encouraging evidence that deliberately inducing tolerance through hematopoietic chimerism might eventually make it from dream to reality.
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Affiliation(s)
- Benedikt Mahr
- Department of Surgery, Section of Transplantation Immunology, Medical University of Vienna, Vienna, Austria
| | - Nicolas Granofszky
- Department of Surgery, Section of Transplantation Immunology, Medical University of Vienna, Vienna, Austria
| | - Moritz Muckenhuber
- Department of Surgery, Section of Transplantation Immunology, Medical University of Vienna, Vienna, Austria
| | - Thomas Wekerle
- Department of Surgery, Section of Transplantation Immunology, Medical University of Vienna, Vienna, Austria
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Wong D, Cao S, Ford H, Richardson C, Belenko D, Tang E, Ugenti L, Warsmann E, Sissons A, Kulandaivelu Y, Edwards N, Novak M, Li M, Mucsi I. Exploring the use of tablet computer-based electronic data capture system to assess patient reported measures among patients with chronic kidney disease: a pilot study. BMC Nephrol 2017; 18:356. [PMID: 29212466 PMCID: PMC5719517 DOI: 10.1186/s12882-017-0771-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 11/21/2017] [Indexed: 11/17/2022] Open
Abstract
Background Collecting patient reported outcome measures (PROMs) via computer-based electronic data capture system may improve feasibility and facilitate implementation in clinical care. We report our initial experience about the acceptability of touch-screen tablet computer-based, self-administered questionnaires among patients with chronic kidney disease (CKD), including stage 5 CKD treated with renal replacement therapies (RRT) (either dialysis or transplant). Methods We enrolled a convenience sample of patients with stage 4 and 5 CKD (including patients on dialysis or after kidney transplant) in a single-centre, cross-sectional pilot study. Participants completed validated questionnaires programmed on an electronic data capture system (DADOS, Techna Inc., Toronto) on tablet computers. The primary objective was to evaluate the acceptability and feasibility of using tablet-based electronic data capture in patients with CKD. Descriptive statistics, Fischer’s exact test and multivariable logistic regression models were used for data analysis. Results One hundred and twenty one patients (55% male, mean age (± SD) of 58 (±14) years, 49% Caucasian) participated in the study. Ninety-two percent of the respondents indicated that the computer tablet was acceptable and 79% of the participants required no or minimal help for completing the questionnaires. Acceptance of tablets was lower among patients 70 years or older (75% vs. 95%; p = 0.011) and with little previous computer experience (81% vs. 96%; p = 0.05). Furthermore, a greater level of assistance was more frequently required by patients who were older (45% vs. 15%; p = 0.009), had lower level of education (33% vs. 14%; p = 0.027), low health literacy (79% vs. 12%; p = 0.027), and little previous experience with computers (52% vs. 10%; p = 0.027). Conclusions Tablet computer-based electronic data capture to administer PROMs was acceptable and feasible for most respondents and could therefore be used to systematically assess PROMs among patients with CKD. Special consideration should focus on elderly patients with little previous computer experience, since they may require more assistance with completion. Electronic supplementary material The online version of this article (10.1186/s12882-017-0771-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dorothy Wong
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Shen Cao
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Heather Ford
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Candice Richardson
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Dmitri Belenko
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Evan Tang
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Luca Ugenti
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Eleanor Warsmann
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Amanda Sissons
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Yalinie Kulandaivelu
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Nathaniel Edwards
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Marta Novak
- Centre for Mental Health, University Health Network and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Hospital, Toronto, ON, Canada
| | - Istvan Mucsi
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada. .,Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 11-PMB-188, Toronto, ON, M5G 2N2, Canada.
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Tsampalieros A, Knoll GA, Fergusson N, Bennett A, Taljaard M, Fergusson D. Center Variation and the Effect of Center and Provider Characteristics on Clinical Outcomes in Kidney Transplantation: A Systematic Review of the Evidence. Can J Kidney Health Dis 2017; 4:2054358117735523. [PMID: 29270300 PMCID: PMC5731624 DOI: 10.1177/2054358117735523] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/04/2017] [Indexed: 11/16/2022] Open
Abstract
Background Kidney transplantation is the best treatment option for patients with end-stage renal disease. While patient-level factors affecting survival are established, the presence of variation in the management of transplant recipients remains unknown. Objective The objective of this study was to examine center variation in kidney transplantation and identify center and provider characteristics that may be associated with clinical outcomes. Design This is a systematic review. Data sources Ovid Medline, Embase, and Cochrane library from inception to June 2016 were used. Study eligibility Any study examining the association between center or provider characteristics and graft or patient survival, quality of life, or functional status were included. Results We identified 6327 records and 24 studies met eligibility. Most studies used data registries. Characteristics evaluated include center volume (n = 17), provider volume (n = 2), provider experience (n = 1), center type (n = 2), and location of follow-up (n = 1). Outcomes assessed included graft survival (n = 24) and patient survival (n = 9). Significant center variation was described in 12 of 15 and 5 of 7 studies for graft and patient survival. There was a significant and positive association between center volume and graft and patient survival in 8 and 2 studies, respectively. Provider experience and volume were significantly associated with less allograft loss and provider volume with lower risk of death. There was no association between graft survival and location of follow-up or center type. Limitations There was substantial heterogeneity in the variables assessed and methodology used to analyze associations. Conclusion This systematic review found center variation in kidney transplantation. Future studies in the current era are necessary to better evaluate this important topic.
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Affiliation(s)
- Anne Tsampalieros
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada.,Division of Nephrology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Gregory A Knoll
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada.,Division of Nephrology, Department of Medicine, Kidney Research Center, University of Ottawa, Ontario, Canada
| | - Nicholas Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada
| | - Alexandria Bennett
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada
| | - Dean Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada
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Abstract
BACKGROUND Most current scoring tools to predict allograft and patient survival upon kidney transplantion are based on variables collected posttransplantation. We developed a novel score to predict posttransplant outcomes using pretransplant information including routine laboratory data available before or at the time of transplantation. METHODS Linking the 5-year patient data of a large dialysis organization to the Scientific Registry of Transplant Recipients, we identified 15 125 hemodialysis patients who underwent first deceased transplantion. Prediction models were developed using Cox models for (a) mortality, (b) allograft loss (death censored), and (c) combined death or transplant failure. The cohort was randomly divided into a two thirds set (Nd = 10 083) for model development and a one third set (Nv = 5042) for validation. Model predictive discrimination was assessed using the index of concordance, or C statistic, which accounts for censoring in time-to-event models (a-c). We used the bootstrap method to assess model overfitting and calibration using the development dataset. RESULTS Patients were 50 ± 13 years of age and included 39% women, 15% African Americans, and 36% persons with diabetes. For prediction of posttransplant mortality and graft loss, 10 predictors were used (recipients' age, cause and length of end-stage renal disease, hemoglobin, albumin, selected comorbidities, race and type of insurance as well as donor age, diabetes status, extended criterion donor kidney, and number of HLA mismatches). The new model (www.TransplantScore.com) showed the overall best discrimination (C-statistics, 0.70; 95% confidence interval [95% CI], 0.67-0.73 for mortality; 0.63; 95% CI, 0.60-0.66 for graft failure; 0.63; 95% CI, 0.61-0.66 for combined outcome). CONCLUSIONS The new prediction tool, using data available before the time of transplantation, predicts relevant clinical outcomes and may perform better to predict patients' graft survival than currently used tools.
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[Manualized psychotherapy for the optimization of immunosuppressant adherence following kidney transplantation: Results of a feasibility study]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2017; 63:189-201. [PMID: 28585505 DOI: 10.13109/zptm.2017.63.2.189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sherwood A, Blumenthal JA, Koch GG, Hoffman BM, Watkins LL, Smith PJ, O'Connor CM, Adams KF, Rogers JG, Sueta C, Chang PP, Johnson KS, Schwartz J, Hinderliter AL. Effects of Coping Skills Training on Quality of Life, Disease Biomarkers, and Clinical Outcomes in Patients With Heart Failure: A Randomized Clinical Trial. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.116.003410. [PMID: 28062537 DOI: 10.1161/circheartfailure.116.003410] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 12/09/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Heart failure (HF) is a chronic disease that compromises patients' quality of life (QoL). Interventions designed to reduce distress and improve disease self-management are needed. We evaluated the efficacy of a telephone-based coping skills training (CST) intervention. METHODS AND RESULTS This randomized clinical trial involved 180 HF outpatients with reduced ejection fraction. Participants ranged in age from 29 to 87 years (mean=58 years); 27% were women, and 47% were nonwhite. Participants were randomized to either a CST intervention or heart failure education, both delivered over 16 weeks. The primary outcomes were (1) postintervention effects on QoL and HF disease biomarkers (both with α=0.01), and (2) a composite measure of time to death or first hospitalization (with α=0.03) over a median follow-up period of 3 years. CST resulted in greater improvements in QoL compared with heart failure education (P<0.01), including the Kansas City Cardiomyopathy Questionnaire (P=0.009), depressive symptoms (P=0.027), and the 6-minute walk test (P=0.012). However, it did not differentially improve HF disease biomarkers or reduce risk of all-cause hospitalizations or death (hazard ratio=0.84 [95% confidence interval, 0.59-1.12]). Interestingly, exploratory analyses showed that participants randomized to CST experienced a reduction in the composite end point of worsening HF hospitalization or death during the 3-year follow-up period (hazard ratio=0.65 [95% confidence interval, 0.44-0.98]; P=0.040). CONCLUSIONS CST improved QoL in patients with HF. Monitoring and improving QoL is emerging as an important aspect of the clinical management of HF that can reduce disease burden and may help improve clinical outcomes in this vulnerable patient population. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT00873418.
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Affiliation(s)
- Andrew Sherwood
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.).
| | - James A Blumenthal
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
| | - Gary G Koch
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
| | - Benson M Hoffman
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
| | - Lana L Watkins
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
| | - Patrick J Smith
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
| | - Christopher M O'Connor
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
| | - Kirkwood F Adams
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
| | - Joseph G Rogers
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
| | - Carla Sueta
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
| | - Patricia P Chang
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
| | - Kristy S Johnson
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
| | - Jeanne Schwartz
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
| | - Alan L Hinderliter
- From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.)
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Mauthner O, Claes V, Walston J, Engberg S, Binet I, Dickenmann M, Golshayan D, Hadaya K, Huynh-Do U, Calciolari S, De Geest S. ExplorinG frailty and mild cognitive impairmEnt in kidney tRansplantation to predict biomedicAl, psychosocial and health cost outcomeS (GERAS): protocol of a nationwide prospective cohort study. J Adv Nurs 2016; 73:716-734. [DOI: 10.1111/jan.13179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2016] [Indexed: 01/25/2023]
Affiliation(s)
- Oliver Mauthner
- Institute of Nursing Science; University of Basel; Switzerland
| | - Veerle Claes
- Institute of Nursing Science; University of Basel; Switzerland
| | - Jeremy Walston
- Center on Aging and Health; Johns Hopkins University; Baltimore Maryland USA
| | - Sandra Engberg
- Institute of Nursing Science; University of Basel; Switzerland
- School of Nursing; University of Pittsburgh; Pennsylvania USA
| | - Isabelle Binet
- Clinic of Nephrology and Transplantation Medicine; Cantonal Hospital St Gallen; Switzerland
| | - Michael Dickenmann
- Department for Transplantation-Immunology and Nephrology; University Hospital Basel; Switzerland
| | - Déla Golshayan
- Transplantation Centre and Transplantation Immunopathology Laboratory; University Hospital Lausanne; Switzerland
| | - Karine Hadaya
- Department of Nephrology; University Hospital Geneva; Switzerland
| | - Uyen Huynh-Do
- University Clinic for Nephrology, Hypertension and Clinical Pharmacology; University Hospital Bern; Switzerland
| | | | - Sabina De Geest
- Institute of Nursing Science; University of Basel; Switzerland
- Academic Center for Nursing and Midwifery; KU Leuven; Belgium
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De Geest S, Burkhalter H, Berben L, Bogert LJ, Denhaerynck K, Glass TR, Goetzmann L, Kirsch M, Kiss A, Koller MT, Piot-Ziegler C, Schmidt-Trucksäss A. The Swiss Transplant Cohort Study's Framework for Assessing Lifelong Psychosocial Factors in Solid-Organ Transplants. Prog Transplant 2016; 23:235-46. [DOI: 10.7182/pit2013250] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Understanding outcomes after transplant requires a biopsychosocial model that includes biomedical and psychosocial factors. The latter, to date, are assessed only in a limited way as part of transplant registries or cohort studies. The Swiss Transplant Cohort Study (STCS) is a nationwide open cohort study (starting May 2008) to systematically and prospectively assess psychosocial factors. This article describes the framework underpinning STCS's psychosocial assessment. Methods The STCS framework was adapted from the multidimensional conceptual perspective of Dew et al to describe transplant psychosocial domains and specific outcomes by adding a time perspective, a system perspective, and interaction among domains. Results We propose a multidimensional, multilevel biopsychosocial framework representing mutually influencing domains from before to after transplant, and exemplify each domain by factors included in STCS and their measurement. The transplant patient, centrally positioned, is described by clinical and sociodemographic characteristics (eg, socioeconomic status, educational, professional, and relationship status). The following psychosocial domains further describe the patient: (1) physical/functional (eg, perceived health status, sleep quality, daytime sleepiness), (2) psychological (eg, depression, stress), (3) behavioral (eg, medication adherence, smoking, drug use, physical activity, sun protection), (4) social (eg, work capacity/return to work), and (5) global quality of life. Factors associated with health care system level (eg, trust in transplant team) are also included in the model. Conclusion The STCS's psychosocial framework provides a basis for studying the interplay of biomedical, sociodemographic, psychosocial, behavioral, and health care system factors in view of transplant outcomes and therefore has the potential to guide biopsychosocial transplant research.
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Affiliation(s)
- Sabina De Geest
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Hanna Burkhalter
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Lut Berben
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Laura Jane Bogert
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Kris Denhaerynck
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Tracy R. Glass
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Lutz Goetzmann
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Monika Kirsch
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Alexander Kiss
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Michael T. Koller
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Chantal Piot-Ziegler
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
| | - Arno Schmidt-Trucksäss
- University of Basel (SDG, HB, LB, LJB, KD, TRG, MK, AST), University Hospital Basel (HB, TRG, AK, MTK), University Hospital Zurich (LG), University of Lausanne (CPZ), Switzerland
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Molnar MZ, Ravel V, Streja E, Kovesdy CP, Rivara MB, Mehrotra R, Kalantar-Zadeh K. Survival of Elderly Adults Undergoing Incident Home Hemodialysis and Kidney Transplantation. J Am Geriatr Soc 2016; 64:2003-2010. [PMID: 27612017 DOI: 10.1111/jgs.14321] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare the mortality of elderly adults with end-stage renal disease (ESRD) treated with home hemodialysis (HD) with that of those receiving a kidney transplant (KTx). DESIGN Prospective cohort. SETTING Pertinent data for the two groups were obtained from electronic medical records from a large dialysis provider and the U.S. Renal Data System. PARTICIPANTS Using data from elderly adults (aged ≥65) who started home HD and underwent KTx in the US between 2007 and 2011, a 1:1 propensity score (PS)-matched cohort of 960 elderly adults was created, and the association between treatment modality and all-cause mortality was examined using Cox proportional hazards and competing risk regression survival models using modality failure as a competing event. MEASUREMENTS Modality of renal replacement therapy. RESULTS The baseline mean age ± standard deviation of the PS-matched individuals undergoing home HD was 71 ± 6, and that of KTx recipients was 71 ± 5, 69% of both groups were male, 81% of those undergoing home HD and 79% of KTx recipients were white, and 11% and 12%, respectively, were African American. Median follow-up time was 205 days (interquartile range (IQR) 78-364 days) for those undergoing home HD and 795 days (IQR 366-1,221 days) for KTx recipients. There were 97 deaths (20%, 253/1,000 patient-years, 95% confidence interval (CI) = 207-309/1,000 patient-years) in the home HD group and 48 deaths (10%, 45/1,000 patient-years, 95% CI = 34-60/1,000 patient-years) in the KTx group. Elderly adults undergoing home HD had a risk of mortality that was almost five times as high as that of KTx recipients (hazard ratio = 4.74, 95% CI = 3.25-6.91). Similar results were seen in competing risk regression analyses (subhazard ratio = 4.71, 95% CI = 3.27-6.79). Results were consistent across different types of kidney donors and subgroups divided according to various recipient characteristics. CONCLUSION Elderly adults with ESRD who receive a KTx have greater survival than those who undergo home HD. Further studies are needed to assess whether KTx receipt is associated with other benefits such as better quality of life and lower hospitalization rates.
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Affiliation(s)
- Miklos Z Molnar
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
| | - Vanessa Ravel
- Division of Nephrology, University of California, Irvine, California
| | - Elani Streja
- Division of Nephrology, University of California, Irvine, California
| | - 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
| | - Matthew B Rivara
- Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington
| | - Rajnish Mehrotra
- Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington
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Bożek-Pająk D, Ziaja J, Kowalik A, Farnik M, Kolonko A, Kujawa-Szewieczek A, Kamińska D, Kuriata-Kordek M, Król R, Więcek A, Klinger M, Cierpka L. Past Cardiovascular Episodes Deteriorate Quality of Life of Patients With Type 1 Diabetes and End-stage Kidney Disease After Kidney or Simultaneous Pancreas and Kidney Transplantation. Transplant Proc 2016; 48:1667-72. [PMID: 27496468 DOI: 10.1016/j.transproceed.2015.10.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 10/07/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The beneficial influence of kidney (KTx) or simultaneous pancreas and kidney transplantation (SPK) on quality of life (QOL) in patients with end-stage kidney disease caused by type 1 diabetes mellitus was confirmed in many studies. The aim of this study was to identify factors that influence QOL of patients in long-term follow-up after SPK or KTx. METHODS Twenty-seven SPK and 26 KTx patients with good function of transplanted organs at least 1 year after transplantation were enrolled into the analysis. To estimate QOL of the recipients the Kidney Disease and Quality of Life Short Form was applied. RESULTS Within the whole analyzed group, the necessity of exogenous insulin administration correlated (P < .05) with symptom/problem list (γ = -0.35), effects of kidney disease (-0.38), cognitive function (-0.47), sleep (-0.42), overall health (-0.47), physical functioning (-0.61), role-physical (-0.32), pain (-0.50), general health (-0.32), emotional well-being (-0.31), role-emotional (-0.36), social function (-0.33), energy/fatigue (-0.44), and the SF-12 physical composite (-0.44). History of cardiovascular episode correlated (P < .05) with symptom/problem list (γ = -0.59), effects of kidney disease (-0.46), burden of kidney disease (-0.56), sleep (-0.54), social support (-0.51), physical functioning (-0.55), role-physical (-0.70), pain (-0.60), general health (-0.57), emotional well-being (-0.45), role-emotional (-0.95), social function (-0.58), energy/fatigue (-0.59), SF-12 physical composite (-0.45), and SF-12 mental composite (-0.83). CONCLUSIONS Exogenous insulin administration and history of cardiovascular episode are the most important factors influencing QOL in patients after SPK or KTx, particularly worsening its physical components.
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Affiliation(s)
- D Bożek-Pająk
- Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland
| | - J Ziaja
- Department of Pulmonology, Medical University of Silesia, Katowice, Poland.
| | - A Kowalik
- Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland
| | - M Farnik
- Department of Pulmonology, Medical University of Silesia, Katowice, Poland
| | - A Kolonko
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - A Kujawa-Szewieczek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - D Kamińska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - M Kuriata-Kordek
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - R Król
- Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland
| | - A Więcek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - M Klinger
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - L Cierpka
- Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland
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von der Lippe N, Waldum-Grevbo B, Varberg Reisæter A, Os I. Is HRQOL in dialysis associated with patient survival or graft function after kidney transplantation? BMC Nephrol 2016; 17:94. [PMID: 27456506 PMCID: PMC4960875 DOI: 10.1186/s12882-016-0316-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 07/19/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Health related quality of life (HRQOL) is patient-reported, and an important treatment outcome for patients undergoing renal replacement therapy. Whether HRQOL in dialysis can affect mortality or graft survival after renal transplantation (RTX) is not determined. The aims of the present study were to investigate whether pretransplant HRQOL is associated with post-RTX patient survival or graft function, and to assess whether improvement in HRQOL from dialysis to RTX is associated with patient survival. METHODS In a longitudinal prospective study, HRQOL was measured in 142 prevalent dialysis patients (67 % males, mean age 51 ± 15.5 years) who subsequent underwent renal transplantation. HRQOL could be repeated in 110 transplant patients 41 (IQR 34-51) months after RTX using the self-administered Kidney Disease and Quality of Life Short Form (KDQOL-SF) measure. Kaplan-Meier plots were utilized for survival analyses, and linear regression models were used to address HRQOL and effect on graft function. RESULTS Follow-up time was 102 (IQR 97-108) months after RTX. Survival after RTX was higher in patients who perceived good physical function (PF) in dialysis compared to patients with poorer PF (p = 0.019). Low scores in the domain mental health measured in dialysis was associated with accelerated decline in graft function (p = 0.048). Improvements in the kidney-specific domains "symptoms" and "effect of kidney disease" in the trajectory from dialysis to RTX were associated with a survival benefit (p = 0.007 and p = 0.02, respectively). CONCLUSION HRQOL measured in dialysis patients was associated with survival and graft function after RTX. These findings may be useful in clinical pretransplant evaluations. Improvements in some of the kidney-specific HRQOL domains from dialysis to RTX were associated with lower mortality. Prospective and interventional studies are warranted.
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Affiliation(s)
| | - Bård Waldum-Grevbo
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Nephrology, Oslo University Hospital, Oslo, Norway
| | - Anna Varberg Reisæter
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- The Norwegian Renal Registry, Oslo, Norway
| | - Ingrid Os
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Nephrology, Oslo University Hospital, Oslo, Norway
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Madariaga MLL, Spencer PJ, Shanmugarajah K, Crisalli KA, Chang DC, Markmann JF, Elias N, Cosimi AB, Sachs DH, Kawai T. Effect of tolerance versus chronic immunosuppression protocols on the quality of life of kidney transplant recipients. JCI Insight 2016; 1. [PMID: 27336062 DOI: 10.1172/jci.insight.87019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Kidney transplant patients on tolerance protocols avoid the morbidity associated with the use of conventional chronic immunosuppressive regimens. However, the impact of tolerance versus conventional regimens on the quality of life (QOL) of kidney transplant patients is unknown. METHODS Five patients who achieved long-term immunosuppression-free renal allograft survival after combined kidney and bone marrow transplantation (tolerant group) were compared with thirty-two comparable kidney transplant recipients on conventional immunosuppression (conventional group). QOL was compared with 16 conventional recipients using the Kidney Disease Quality of Life Short Form 36 (KDQOL SF-36) and the Modified Transplant Symptom Occurrence and Symptom Distress Scale (MTSOSD-59R). RESULTS Patients in the tolerant group required significantly less treatment after transplant for hypertension and no medications for diabetes (P < 0.01). There was no incidence of diabetes, dyslipidemia, or malignancies in the tolerant group, while these were observed in 12.5%, 40.6%, and 11.8% of the conventional group, respectively. Tolerant patients experienced better overall health (P < 0.01) and scored higher on kidney transplant-targeted scales and healthy survey scales than patients in the conventional group according to the KDQOL SF-36 (P < 0.05). Tolerant patients were less likely to experience depression, dyspnea, excessive appetite/thirst, flatulence, hearing loss, itching, joint pain, lack of energy, muscle cramps, and lack of libido than conventional patients according to the MTSOSD-59R (P < 0.05). CONCLUSION Kidney transplant recipients who achieved tolerance experience significantly fewer incidences of complications, improved QOL, and fewer comorbid symptoms compared with patients on conventional immunosuppression. These results support the expanded use of tolerance protocols in kidney transplantation.
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Affiliation(s)
- Maria Lucia L Madariaga
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Philip J Spencer
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kumaran Shanmugarajah
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kerry A Crisalli
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David C Chang
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James F Markmann
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nahel Elias
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - A Benedict Cosimi
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David H Sachs
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tatsuo Kawai
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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42
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Gremigni P, Cappelli G. Psychosocial well-being after kidney transplantation: A matched-pair case-control study. J Health Psychol 2016; 21:599-606. [DOI: 10.1177/1359105314532506] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
A number of outcome studies showed that kidney transplantation is associated with improvements in health-related quality of life relative to the pre-transplant period, but comparisons with the general population produced mixed results. This study aimed to compare 30 successful (>1 year) kidney transplantation recipients with 30 matched-pair healthy controls on psychosocial well-being. Independent of gender, age and time since transplantation, transplanted patients equalled healthy people in the intrapersonal domains but scored worse in the interpersonal domains of psychosocial well-being. Identifying aspects of life that remain impaired after kidney transplantation may assist the development of interventions targeted at improving patients’ adjustment.
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Beauger D, Fruit D, Villeneuve C, Laroche ML, Jouve E, Rousseau A, Boyer L, Gentile S. Validation of the psychometrics properties of a French quality of life questionnaire among a cohort of renal transplant recipients less than one year. Qual Life Res 2016; 25:2347-59. [PMID: 27016945 DOI: 10.1007/s11136-016-1271-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Renal transplantation is considered as the treatment of choice for patients with end-stage renal disease. Health-related quality of life (HRQoL) of renal transplant recipients (RTR) is very important to assess, especially during the first year after transplantation. To provide new evidence about the suitability of HRQoL measures in RTR during the first post-transplant year, we explored the internal structure, reliability and external validity of a French specific HRQoL instrument, the Renal Transplant Quality of life Questionnaire Second Version (RTQ V2). METHODS The data were issued from the French multicenter cohort of renal transplant patients followed during 4 years (EPIGREN). The HRQoL of RTR was assessed five times (at 1, 3, 6, 9 and 12 months after transplantation) with the RTQ V2, a specific instrument consisting of 32 items describing five dimensions. Socio-demographic information, clinical characteristics and HRQoL (i.e., RTQ V2 and SF-36) were collected. For the five times, psychometric properties of the RTQ V2 were compared to those reported from the reference population assessed in the validation study. RESULTS Three hundred and thirty-four patients were enrolled. The proportions of well-projected items, item-internal consistency, item-discriminant validity, floor and ceiling effects, Cronbach's alpha coefficients and item goodness-of-fit statistics were satisfactory for each dimension at the five times of the study. The suitability indices of construct validity were higher than 90 % for each time (minimum-maximum: 90.8-97.4 %). The external validity was less satisfactory, with a suitability indices ranged from 46.7 % at M1 to 66.7 % at M12. However, the discrepancies with the reference population (mainly for the gender) appeared logical considering the scientific literature on HRQoL of RTR during the first post-transplant year and may not compromise the external validity. CONCLUSION These results support the validity and reliability of the RTQ V2 for evaluating HRQoL in RTR during the first post-transplant year, and confirm that the RTQ V2 is a useful tool to assess the HRQoL precociously after transplant.
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Affiliation(s)
- Davy Beauger
- EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Aix-Marseille University, 13005, Marseille, France.
| | - Dorothée Fruit
- Department of Pharmacology, Toxicology and Centre of Pharmacovigilance, CHU Limoges, Limoges, France.,INSERM, UMR-S850, Limoges, France.,Faculty of Medicine, Laboratory of Clinical Pharmacology, Univ Limoges, Limoges, France
| | - Claire Villeneuve
- Department of Pharmacology, Toxicology and Centre of Pharmacovigilance, CHU Limoges, Limoges, France.,INSERM, UMR-S850, Limoges, France
| | - Marie-Laure Laroche
- Department of Pharmacology, Toxicology and Centre of Pharmacovigilance, CHU Limoges, Limoges, France.,Faculty of Medicine, Laboratory of Clinical Pharmacology, Univ Limoges, Limoges, France
| | - Elisabeth Jouve
- Medical Evaluation and Public Health Department, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Annick Rousseau
- INSERM, UMR-S850, Limoges, France.,Faculty of Pharmacy, Department of Biophysics, Univ Limoges, Limoges, France
| | - Laurent Boyer
- EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Aix-Marseille University, 13005, Marseille, France
| | - Stéphanie Gentile
- EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Aix-Marseille University, 13005, Marseille, France
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Depression, Anxiety, Resilience and Coping Pre and Post Kidney Transplantation - Initial Findings from the Psychiatric Impairments in Kidney Transplantation (PI-KT)-Study. PLoS One 2015; 10:e0140706. [PMID: 26559531 PMCID: PMC4641724 DOI: 10.1371/journal.pone.0140706] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/28/2015] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Depression/anxiety, impaired Health-Related Quality of Life (HRQoL) and coping and resilience structures, are associated with increased mortality/poor outcome in chronic kidney disease (CKD) patients before (CKD/pre-KT) and after kidney (CKD-T) transplantation. Less is known about prevalence rates of psychiatric symptoms and impaired HRQoL of non-transplanted compared with transplanted patients. METHODS In a cross-sectional study comparing 101 CKD/pre-KT patients with 151 cadaveric-transplanted (CKD-T) patients, we examined prevalence of depression/anxiety (HADS questionnaire) and coping, resilience and HRQoL (SF-12, Resilience-Scale and FKV-questionnaire). RESULTS The prevalence of both depressive and anxiety symptoms was not significantly different between different pre-/and CKD-T patient groups. In CKD-T no significant relations of coping strategies with kidney function were identified. Furthermore, the Resilience Scales for acceptance and competence did not suggest any differences between the CKD/pre-KT and CKD-T subgroup. In the CKD/pre-KT patients, significant correlations were identified between the acceptance subscale and partnership, as well as between the competence subscale and older age/partnership. CONCLUSIONS Both the CKD/pre-KT and CKD-T patients exhibited notable impairments in the HRQoL which which showed a comparable pattern of results. KT itself does not appear to be the main risk factor for the development of mental impairments.
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Olson KL, Stiefel M, Ross C, Stadler S, Hornak R, Sandhoff B, Merenich JA. Self-Rated Health Among Patients with Coronary Artery Disease Enrolled in a Cardiovascular Risk Reduction Service. Popul Health Manag 2015; 19:24-30. [PMID: 26237495 DOI: 10.1089/pop.2014.0178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Little is known about the use of the single self-rated health (SRH) status item measuring health-related quality of life among people with coronary artery disease (CAD). The objective of this study was to assess relationships between SRH and recurrent coronary events, mortality, health care utilization, and intermediate clinical outcomes and to assess predictors of fair/poor SRH. A total of 5573 patients enrolled in a comprehensive cardiac risk reduction service managed by clinical pharmacy specialists were evaluated over a 2-year period. Regression modeling explored relationships among variables, modeling SRH separately as an independent and a dependent variable. The 1374 (24.7%) respondents reporting fair/poor SRH differed statistically from 4199 (75.3%) respondents reporting good/very good/excellent SRH in terms of age, sex, ethnicity, number of comorbid conditions, DxCG scores, lifestyle behaviors, blood pressure control, and inpatient and emergency department (ED) utilization. Respondents reporting fair/poor health were more likely to have recurrent major coronary events (MCE), including death. Fair/poor SRH was consistently statistically significant when it was included as a predictor in regression modeling for poor blood pressure control, health care utilization, MCE, and all-cause mortality. Variables associated with fair/poor SRH in regression modeling included females, Hispanic ethnicity, ≥1 baseline ED visit, and DxCG score. Exercising <30 minutes per week was strongly associated with fair/poor SRH. Single-item SRH status may help identify patients with CAD at higher risk of poor blood pressure control, recurrent MCE, and death and those who may benefit from interventions to increase physical activity.
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Affiliation(s)
- Kari L Olson
- 1 Kaiser Permanente Colorado , Pharmacy Department, Aurora, Colorado
| | - Matt Stiefel
- 2 Center for Population Health, Care Management Institute , Kaiser Permanente, Oakland, California
| | - Colleen Ross
- 3 Institute for Health Research , Kaiser Permanente Colorado, Denver, Colorado
| | - Sheila Stadler
- 1 Kaiser Permanente Colorado , Pharmacy Department, Aurora, Colorado
| | - Roseanne Hornak
- 1 Kaiser Permanente Colorado , Pharmacy Department, Aurora, Colorado
| | - Brian Sandhoff
- 1 Kaiser Permanente Colorado , Pharmacy Department, Aurora, Colorado
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Dew MA, Rosenberger EM, Myaskovsky L, DiMartini AF, DeVito Dabbs AJ, Posluszny DM, Steel J, Switzer GE, Shellmer DA, Greenhouse JB. Depression and Anxiety as Risk Factors for Morbidity and Mortality After Organ Transplantation: A Systematic Review and Meta-Analysis. Transplantation 2015; 100:988-1003. [PMID: 26492128 PMCID: PMC4840103 DOI: 10.1097/tp.0000000000000901] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Depression and anxiety are common mental health problems in transplant populations. There is mixed evidence concerning whether they increase morbidity and mortality risks after transplantation. If such associations exist, additional risk reduction strategies may be needed. METHODS Four bibliographic databases were searched from 1981 through September 2014 for studies prospectively examining whether depression or anxiety (determined with diagnostic evaluations or standardized symptom scales) affected risk for posttransplant mortality, graft loss, acute graft rejection, chronic rejection, cancer, infection, and rehospitalization. RESULTS Twenty-seven studies (10 heart, total n = 1738; 6 liver, n = 1063; 5 kidney, n = 49515; 4 lung, n = 584; 1 pancreas, n = 80; 1 mixed recipient sample, n = 205) were identified. In each, depression and/or anxiety were typically measured before or early after transplantation. Follow-up for outcomes was a median of 5.8 years (range, 0.50-18.0). Depression increased the relative risk (RR) of mortality by 65% (RR, 1.65; 95% confidence interval [95% CI], 1.34-2.05; 20 studies). Meta-regression indicated that risk was stronger in studies that did (vs did not) control for potential confounders (P = .032). Risk was unaffected by type of transplant or other study characteristics. Depression increased death-censored graft loss risk (RR, 1.65; 95% CI, 1.21-2.26, 3 studies). Depression was not associated with other morbidities (each morbidity was assessed in 1-4 studies). Anxiety did not significantly increase mortality risk (RR, 1.39; 95% CI, 0.85-2.27, 6 studies) or morbidity risks (assessed in single studies). CONCLUSIONS Depression increases risk for posttransplant mortality. Few studies considered morbidities; the depression-graft loss association suggests that linkages with morbidities deserve greater attention. Depression screening and treatment may be warranted, although whether these activities would reduce posttransplant mortality requires study.
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Affiliation(s)
- Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology, Biostatistics,
and Clinical and Translational Science, University of Pittsburgh
| | - Emily M. Rosenberger
- Clinical and Translational Science Institute, and Department of
Medicine, University of Pittsburgh
| | - Larissa Myaskovsky
- Department of Medicine, University of Pittsburgh, and Center for
Health Equity Research and Promotion, Veterans Administration Pittsburgh
Healthcare System
| | | | | | | | - Jennifer Steel
- Departments of Surgery, Psychiatry and Psychology, University of
Pittsburgh
| | - Galen E. Switzer
- Department of Medicine, University of Pittsburgh, and Center for
Health Equity Research and Promotion, Veterans Administration Pittsburgh
Healthcare System
| | | | - Joel B. Greenhouse
- Department of Statistics, Carnegie Mellon University Department of
Psychiatry, University of Pittsburgh
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Burkhalter H, Wirz-Justice A, Denhaerynck K, Fehr T, Steiger J, Venzin RM, Cajochen C, Weaver TE, De Geest S. The effect of bright light therapy on sleep and circadian rhythms in renal transplant recipients: a pilot randomized, multicentre wait-list controlled trial. Transpl Int 2014; 28:59-70. [PMID: 25182079 DOI: 10.1111/tri.12443] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 06/08/2014] [Accepted: 08/27/2014] [Indexed: 12/15/2022]
Abstract
This study assessed the effect and feasibility of morning bright light therapy (BLT) on sleep, circadian rhythms, subjective feelings, depressive symptomatology and cognition in renal transplant recipients (RTx) diagnosed with sleep-wake disturbances (SWD). This pilot randomized multicentre wait-list controlled trial included 30 home-dwelling RTx randomly assigned 1:1 to either 3 weeks of BLT or a wait-list control group. Morning BLT (10 000 lux) was individually scheduled for 30 min daily for 3 weeks. Wrist actimetry (measuring sleep and circadian rhythms), validated instruments (subjective feelings and cognition) and melatonin assay (circadian timing) were used. Data were analysed via a random-intercept regression model. Of 30 RTx recipients (aged 58 ± 15, transplanted 15 ± 6 years ago), 26 completed the study. While BLT had no significant effect on circadian and sleep measures, sleep timing improved significantly. The intervention group showed a significant get-up time phase advance from baseline to intervention (+24 min) [(standardized estimates (SE): -0.23 (-0.42; -0.03)] and a small (+14 min) but significant bedtime phase advance from intervention to follow-up (SE: -0.25 (-0.41; -0.09). Improvement in subjective feelings and depressive symptomatology was observed but was not statistically significant. Bright light therapy showed preliminary indications of a beneficial effect in RTx with sleep-wake disturbances. (ClinicalTrials.gov number: NCT01256983).
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Affiliation(s)
- Hanna Burkhalter
- Institute of Nursing Science, University of Basel, Basel, Switzerland; Division of Transplant Immunology & Nephrology, University Hospital Basel, Basel, Switzerland
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Health-related quality of life 3 months after kidney transplantation as a predictor of survival over 10 years: a longitudinal study. Transplantation 2014; 97:1139-45. [PMID: 24553619 DOI: 10.1097/01.tp.0000441092.24593.1e] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIM This study explores the association between kidney function, side effects of immunosuppressive treatment, coping self-efficacy, and physical and mental HRQoL at 3 months (baseline) after kidney transplantation (KT) and their impact on patient and graft survival for up to 10 years (follow-up). METHODS A group of 151 patients provided at baseline their socioeconomic and medical (CKD-EPI) data and completed the End-Stage Renal Disease Symptom Checklist (perceived side effects), the coping self-efficacy scale, and the SF-36. At follow-up, patients' health status was noted. Univariate GLM exploring the main effects of the independent variables on physical and mental HRQoL was performed; furthermore, Cox regression analyses were performed to determine whether the early posttransplantation factors predicted patient and graft survival. RESULTS Less severe side effects of immunosuppressive treatment and higher efficacy in stopping unpleasant emotions were associated with both higher physical and mental HRQoL at baseline. Younger age was associated with higher physical HRQoL and older age, and lower efficacy in getting support from family and friend were associated with higher mental HRQoL. Patients reporting higher physical and mental HRQoL at 3 months and with higher age and better kidney function had higher odds of surviving with a functioning graft. CONCLUSION Older age, higher kidney function, and higher physical and mental HRQoL at baseline significantly improved the odds of graft and patient survival over 10 years. These results show the importance of close monitoring of early posttransplantation HRQoL along with kidney function and reported side effects because of their effect on long-term patient outcomes.
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Kugler C, Gottlieb J, Warnecke G, Schwarz A, Weissenborn K, Barg-Hock H, Bara C, Einhorn I, Haverich A, Haller H. Health-related quality of life after solid organ transplantation: a prospective, multiorgan cohort study. Transplantation 2014; 96:316-23. [PMID: 23715048 DOI: 10.1097/tp.0b013e31829853eb] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Short-term posttransplantation survival and health-related quality of life (HRQoL) is exceptionally high for all patients after organ transplantation; however, predictors of the HRQoL outcome are not well understood. Trajectories of patients' perceived benefit/burden ratio associated with the transplant procedure may differ when taking the organ type for transplantation into account. METHODS A prospective, single-center cohort study assessed the trajectories of 354 patients after kidney (n=165), liver (n=53), heart (n=24), and lung (n=112) transplantation at 2, 6, 12, and 24 months with respect to psychosocial outcomes (HRQoL, anxiety, depression, social support, and work performance). RESULTS Mean age was 50±13 years, and 61.6% were male in the overall sample. Demographics differed with respect to organ type. HRQoL measured by the mean SF-36 Physical Component Scale was 36.8 (95% confidence interval, 35.7-37.8) and 48.9 (95% confidence interval, 47.2-49.7) for the Psychosocial Component Scale for the entire sample at 2 months and showed a marginal decrease until 24 months after transplantation. Overall, HRQoL increased for all organ types with differing trajectories. Liver patients reported the lowest HRQoL benefit for the majority of the physical (P≤0.01) and psychosocial (P≤0.01) SF-36 subscales. Anxiety (17.4%) and depression (13.8%) were prevalent in the overall sample. Depression symptoms impaired HRQoL outcomes in both SF-36 components and unemployment impacted the SF-36 psychosocial outcomes. CONCLUSIONS HRQoL improved after transplantation for all four types of transplant, but the trajectories were different. Regular screening for depression symptoms may diminish psychologic disorders and distress after transplantation and thus may further improve outcomes.
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Affiliation(s)
- Christiane Kugler
- Hannover Thoracic Transplant Program, Division of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany.
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50
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Yang J, Lee J, Huh KH, Park JB, Cho JH, Lee S, Ro H, Han SY, Kim YH, Jeong JC, Park BJ, Han DJ, Park SB, Chung W, Park SK, Kim CD, Kim SJ, Kim YS, Ahn C. KNOW-KT (KoreaN cohort study for outcome in patients with kidney transplantation: a 9-year longitudinal cohort study): study rationale and methodology. BMC Nephrol 2014; 15:77. [PMID: 24884405 PMCID: PMC4022441 DOI: 10.1186/1471-2369-15-77] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Asian patients undergoing kidney transplantation (KT) generally have better renal allograft survival and a lower burden of cardiovascular disease than those of other racial groups. The KNOW-KT aims to explore allograft survival rate, cardiovascular events, and metabolic profiles and to elucidate the risk factors in Korean KT patients. METHODS KNOW-KT is a multicenter, observational cohort study encompassing 8 transplant centers in the Republic of Korea. KNOW-KT will enroll 1,000 KT recipients between 2012 and 2015 and follow them up to 9 years. At the time of KT and at pre-specified intervals, clinical information, laboratory test results, and functional and imaging studies on cardiovascular disease and metabolic complications will be recorded. Comorbid status will be assessed by the age-adjusted Charlson co-morbidity index. Medication adherence and information on quality of life (QoL) will be monitored periodically. The QoL will be assessed by the Kidney Disease Quality of Life Short Form. Donors will include both living donors and deceased donors whose status will be assessed by the Kidney Donor Risk Index. Primary endpoints include graft loss and patient mortality. Secondary endpoints include renal functional deterioration (a decrease in eGFR to <30 mL/min/1.73 m2), acute rejection, cardiovascular event, albuminuria, new-onset diabetes after transplant, and QoL. Data on other adverse outcomes including episodes of infection, malignancy, recurrence of original renal disease, fracture, and hospitalization will also be collected. A bio-bank has been established for the acquisition of DNA, RNA, and protein from serum and urine samples of recipients at regular intervals. Bio-samples from donors will also be collected at the time of KT. KNOW-KT was registered in an international clinical trial registry (NCT02042963 at http://www.clinicaltrials.gov) on January 20th, 2014. CONCLUSION The KNOW-KT, the first large-scale cohort study in Asian KT patients, is expected to represent the Asian KT population and provide information on their natural course, complications, and risk factors for complications.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Curie Ahn
- Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea.
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