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Nyokabi P, Youngkong S, Bagepally BS, Okech T, Chaikledkaew U, McKay GJ, Attia J, Thakkinstian A. A systematic review and quality assessment of economic evaluations of kidney replacement therapies in end-stage kidney disease. Sci Rep 2024; 14:23018. [PMID: 39362958 PMCID: PMC11450173 DOI: 10.1038/s41598-024-73735-8] [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: 03/02/2024] [Accepted: 09/20/2024] [Indexed: 10/05/2024] Open
Abstract
End-stage kidney disease (ESKD) is fatal without treatment by kidney replacement therapies (KRTs). However, access to these treatment modalities can be problematic given the high costs. This systematic review (SR) aims to provide an updated economic evaluation of pairwise comparisons of KRTs and the implications for the proportion of patients with access to the KRT modalities, i.e., kidney transplantation (KT), hemodialysis (HD), and peritoneal dialysis (PD). This SR was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020. We searched studies in PubMed, Embase, Scopus, and Cost Effectiveness Analysis (CEA) registry, from inception to March 2023. Thirteen studies were included with pairwise comparisons among three KRTs, with varying proportions of patients for each modality. Seven studies were from high-income countries, including five from Europe. Summary findings are presented on a cost-effectiveness plane and incremental net benefit (INB). KT was the most cost-effective intervention across the pairwise comparisons. KT and PD were both more cost-effective alternatives to HD. HD was more costly and less effective than PD in all studies except one. Concurrent efforts to increase both KT and PD represented the best scenario to improve treatment options for ESKD patients.
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Affiliation(s)
- Patricia Nyokabi
- Mahidol University Health Technology Assessment Graduate Program, Bangkok, Thailand
- Ministry of Health, Nairobi, Kenya
| | - Sitaporn Youngkong
- Mahidol University Health Technology Assessment Graduate Program, Bangkok, Thailand.
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
| | | | - Tabitha Okech
- Mahidol University Health Technology Assessment Graduate Program, Bangkok, Thailand
- Ministry of Health, Nairobi, Kenya
| | - Usa Chaikledkaew
- Mahidol University Health Technology Assessment Graduate Program, Bangkok, Thailand
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Gareth J McKay
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - John Attia
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Ammarin Thakkinstian
- Mahidol University Health Technology Assessment Graduate Program, Bangkok, Thailand
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Haberal HB, Donmez MI, Piana A, Pecoraro A, Prudhomme T, Bañuelos Marco B, López-Abad A, Campi R, Boissier R, Breda A, Territo A. A systematic review of kidney transplantation outcomes in patients with end-stage renal disease due to childhood lower urinary tract malformations. Int Urol Nephrol 2024; 56:3173-3186. [PMID: 38772965 DOI: 10.1007/s11255-024-04079-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 05/11/2024] [Indexed: 05/23/2024]
Abstract
PURPOSE Patients with lower urinary tract malformations (LUTM) were suspended from kidney transplantation (KT) programs in the past due to various concerns. Consequently, only a limited number of studies have explored this topic at hand. In this study, our objective was to perform a systematic review (SR) to evaluate the current evidence regarding KT outcomes as well as patient survival (PS), postoperative complications and urinary tract infections (UTI) in individuals with childhood LUTM. METHODS The search encompassed databases of Web of Science, Medline (via PubMed), and Embase (via Scopus) to identify all studies reporting outcomes on KT for patients with LUTM. The research included articles published in English from January 1995 till September 2023. RESULTS Of the 2634 yielded articles, 15 met the inclusion criteria, enrolling a total of 284,866 KT patients. There was significantly better 5-year graft survival (GS) in recipients with LUTM compared to the control group (RR, 1.04; 95% CI 1.02-1.06); while GS at 1-year and 10-year, and PS at 1-year, 5-year and 10-year were similar between groups. On the other hand, the postoperative UTI rate was significantly higher in the LUTM group (RR: 4.46; 95% CI 1.89-10.51). However, data on serum creatinine and estimated glomerular filtration rate on follow-up were insufficient. CONCLUSION GS and PS rates appear to be similar in patients with childhood LUTM and those with normal lower urinary tract functions. Despite a higher postoperative UTI rate within this patient group, it appears that this has no effect on GS rates.
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Affiliation(s)
- Hakan Bahadir Haberal
- Department of Urology, Ankara Ataturk Sanatorium Training and Research Hospital, Ministry of Health, University of Health Sciences, 06290, Ankara, Turkey.
| | - Muhammet Irfan Donmez
- Department of Urology, Division of Pediatric Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Alberto Piana
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Thomas Prudhomme
- Department of Urology and Kidney Transplantation, Rangueil University Hospital, Toulouse, France
| | - Beatriz Bañuelos Marco
- Department of Urology, Renal Transplant Division, University Hospital Clínico San Carlos, Madrid, Spain
| | - Alicia López-Abad
- Department of Urology, Virgen de La Arrixaca University Hospital, Murcia, Spain
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Romain Boissier
- Department of Urology and Renal Transplantation, La Conception University Hospital, Marseille, France
| | - Alberto Breda
- Uro-Oncology and Kidney Transplant Unit, Department of Urology at "Fundació Puigvert" Hospital, Autonoma University of Barcelona, Barcelona, Spain
| | - Angelo Territo
- Uro-Oncology and Kidney Transplant Unit, Department of Urology at "Fundació Puigvert" Hospital, Autonoma University of Barcelona, Barcelona, Spain
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Piñon-Ruiz MJ, Huerta-Franco MR, Vargas-Luna FM, Apolinar-Jimenez E, Soel Encalada JM. Assessment of body composition by dual-energy X-Ray absorptiometry in renal transplant patients, hemodialysis patients, and a control group of healthy subjects. Clinics (Sao Paulo) 2024; 79:100505. [PMID: 39341026 PMCID: PMC11467545 DOI: 10.1016/j.clinsp.2024.100505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 08/08/2024] [Accepted: 08/25/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND The clinical findings of patients with Chronic Kidney Disease (CKD), which is characterized by malnutrition, sedentary lifestyle, uremia, and catabolism associated with dialysis produce changes in Body Composition (BC), causing increased Fat Mass (FM), decreased in both Lean Mass (LM) and Body Mineral Density (BMD), even despite uremic reversal after a Kidney Transplant (KT); immunosuppressive medications alter BC, increasing the risk of loss of the kidney transplant and cardiovascular diseases. OBJECTIVE To demonstrate whether there are differences in BC between a group of patients with KT and a group of patients on Hemodialysis (HD), when comparing them with a control group without the disease. MATERIALS AND METHODS In the present observational study, with a comparative design; 125 patients were evaluated (46 with KT, 47 on HD, and 32 from the healthy control group). The BC was evaluated with the full-body Dual-Energy X-Ray Absorptiometry (DEXA) method. RESULTS The mean age and standard deviation (X±SD) of the study subjects were: 28.89 ± 5.76, 27.39 ± 5.04, and 29.63 ± 6.34 years for the HD, KT, and control subjects, respectively. The HD patients presented a total FM of 14.98 ± 6.96 kg in comparison with 20.1 ± 6.5 kg for the control group (p = 0.007), and 19.06 ± 7.94 kg for the group with KT (p = 0.02). The total LM was lower in the KT patients in comparison with the control group (p = 0.023). The content and total BMD were lower in both groups of patients with KT and HD. CONCLUSIONS Although a comprehensive improvement in BC was expected after kidney transplantation, the results are not close to "normal' values, when compared with those of healthy subjects of the same age.
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Affiliation(s)
| | - Maria-Raquel Huerta-Franco
- Department of Sciences Applied to Work, Division of Health Sciences, University of Guanajuato - Campus León, Gto, Mexico.
| | - Francisco-Miguel Vargas-Luna
- Department of Physical Engineering, Division of Sciences and Engineering, University of Guanajuato - Campus Leon, Gto, Mexico.
| | - Evelia Apolinar-Jimenez
- Metabolism and Nutrition Unit, Regional Hospital of High Specialty of Bajio, Instituto Mexicano del Seguro Social para el Bienestar, Mexico.
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Husain SA, Khanna S, Yu M, Adler JT, Cron DC, King KL, Schold JD, Mohan S. Cold Ischemia Time and Delayed Graft Function in Kidney Transplantation: A Paired Kidney Analysis. Transplantation 2024; 108:e245-e253. [PMID: 38557641 PMCID: PMC11338744 DOI: 10.1097/tp.0000000000005006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND We aimed to understand the association between cold ischemia time (CIT) and delayed graft function (DGF) after kidney transplantation and the impact of organ pumping on that association. METHODS Retrospective cohort study using US registry data. We identified kidney pairs from the same donor where both kidneys were transplanted but had a CIT difference >0 and ≤20 h. We determined the frequency of concordant (both kidneys with/without DGF) or discordant (only 1 kidney DGF) DGF outcomes. Among discordant pairs, we computed unadjusted and adjusted relative risk of DGF associated with longer-CIT status, when then repeated this analysis restricted to pairs where only the longer-CIT kidney was pumped. RESULTS Among 25 831 kidney pairs included, 71% had concordant DGF outcomes, 16% had only the longer-CIT kidney with DGF, and 13% had only the shorter-CIT kidney with DGF. Among discordant pairs, longer-CIT status was associated with a higher risk of DGF in unadjusted and adjusted models. Among pairs where only the longer-CIT kidney was pumped, longer-CIT kidneys that were pumped had a lower risk of DGF than their contralateral shorter-CIT kidneys that were not pumped regardless of the size of the CIT difference. CONCLUSIONS Most kidney pairs have concordant DGF outcomes regardless of CIT difference, but even small increases in CIT raise the risk of DGF. Organ pumping may mitigate and even overcome the adverse consequences of prolonged CIT on the risk of DGF, but prospective studies are needed to better understand this relationship.
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Affiliation(s)
- Syed Ali Husain
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY
- The Columbia University Renal Epidemiology Group, New York, NY
| | - Sohil Khanna
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY
| | - Miko Yu
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY
- The Columbia University Renal Epidemiology Group, New York, NY
| | - Joel T Adler
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX
| | - David C Cron
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Kristen L King
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY
- The Columbia University Renal Epidemiology Group, New York, NY
| | - Jesse D Schold
- Department of Surgery, University of Colorado-Anschutz Medical Campus, Aurora, CO
- Department of Epidemiology, School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY
- The Columbia University Renal Epidemiology Group, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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Shaban RA, Abdulgalil AE, Bahie A. Post-COVID anxiety, depression, and quality of life among Egyptian hemodialysis patients. Ther Apher Dial 2024; 28:608-619. [PMID: 38629237 DOI: 10.1111/1744-9987.14128] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/30/2023] [Accepted: 04/01/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION This study examined the impact of Coronavirus disease 2019 on anxiety, depression, and health-related quality of life (HRQOL) among Egyptian hemodialysis (HD) patients. METHODS This multicenter cross-sectional study was carried out in Egypt in the years 2021-2022, where 300 HD patients from four HD centers were allocated into two groups: post-COVID and non-COVID. The Hospital Anxiety and Depression Scale (HADS) and the Kidney Disease QOL-36 questionnaire were used to assess anxiety, depression, and QOL of the included patients. RESULTS In the post-COVID group, abnormal and borderline cases of anxiety and depression were detected in 38.6% and 62.5% of patients, respectively, with no statistically significant difference between both groups. The post-COVID group showed higher work status and lower sexual and physical functioning, which correlated negatively with anxiety and depression scores. CONCLUSION Past-COVID infection did not influence depression and anxiety symptoms in HD patients. Sexual and physical functioning were more affected among COVID-survivors.
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Affiliation(s)
| | - Ahmed E Abdulgalil
- Mansoura Nephrology and Dialysis Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Bahie
- Mansoura Nephrology and Dialysis Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Li Y, Menon G, Kim B, Clark-Cutaia MN, Long JJ, Metoyer GT, Mohottige D, Strauss AT, Ghildayal N, Quint EE, Wu W, Segev DL, McAdams-DeMarco MA. Components of Residential Neighborhood Deprivation and Their Impact on the Likelihood of Live-Donor and Preemptive Kidney Transplantation. Clin Transplant 2024; 38:e15382. [PMID: 38973768 PMCID: PMC11232925 DOI: 10.1111/ctr.15382] [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: 04/19/2024] [Revised: 05/30/2024] [Accepted: 06/05/2024] [Indexed: 07/09/2024]
Abstract
INTRODUCTION Adults residing in deprived neighborhoods face various socioeconomic stressors, hindering their likelihood of receiving live-donor kidney transplantation (LDKT) and preemptive kidney transplantation (KT). We quantified the association between residential neighborhood deprivation index (NDI) and the likelihood of LDKT/preemptive KT, testing for a differential impact by race and ethnicity. METHODS We studied 403 937 adults (age ≥ 18) KT candidates (national transplant registry; 2006-2021). NDI and its 10 components were averaged at the ZIP-code level. Cause-specific hazards models were used to quantify the adjusted hazard ratio (aHR) of LDKT and preemptive KT across tertiles of NDI and its 10 components. RESULTS Candidates residing in high-deprivation neighborhoods were more likely to be female (40.1% vs. 36.2%) and Black (41.9% vs. 17.7%), and were less likely to receive both LDKT (aHR = 0.66, 95% confidence interval [CI]: 0.64-0.67) and preemptive KT (aHR = 0.60, 95% CI: 0.59-0.62) than those in low-deprivation neighborhoods. These associations differedby race and ethnicity (Black: aHRLDKT = 0.58, 95% CI: 0.55-0.62; aHRpreemptive KT = 0.68, 95% CI: 0.63-0.73; Pinteractions: LDKT < 0.001; Preemptive KT = 0.002). All deprivation components were associated with the likelihood of both LDKT and preemptive KT (except median home value): for example, higher median household income (LDKT: aHR = 1.08, 95% CI: 1.07-1.09; Preemptive KT: aHR = 1.10, 95% CI: 1.08-1.11) and educational attainments (≥high school [LDKT: aHR = 1.17, 95% CI: 1.15-1.18; Preemptive KT: aHR = 1.23, 95% CI: 1.21-1.25]). CONCLUSION Residence in socioeconomically deprived neighborhoods is associated with a lower likelihood of LDKT and preemptive KT, differentially impacting minority candidates. Identifying and understanding which neighborhood-level socioeconomic status contributes to these racial disparities can be instrumental in tailoring interventions to achieve health equity in LDKT and preemptive KT.
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Affiliation(s)
- Yiting Li
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Gayathri Menon
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Byoungjun Kim
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Maya N Clark-Cutaia
- Rory Meyers College of Nursing, New York University, New York, New York, USA
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Jane J Long
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Garyn T Metoyer
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Dinushika Mohottige
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alexandra T Strauss
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nidhi Ghildayal
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Evelien E Quint
- Division of Transplant Surgery, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Wenbo Wu
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Dorry L Segev
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Mara A McAdams-DeMarco
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
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Valderrama-Rios MC, Sánchez R, Sanabria M. Psychometric properties of the Kidney Disease Quality of Life short form 36 (KDQOL-36) scale for the assessment of quality of life in Colombian patients with chronic kidney disease on dialysis. Int Urol Nephrol 2024; 56:2337-2350. [PMID: 38376660 PMCID: PMC11190008 DOI: 10.1007/s11255-024-03940-x] [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: 05/31/2023] [Accepted: 01/01/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE Considering the importance of incorporating quality of life (QoL) construct during the health care of patients with stage 5 chronic kidney disease (CKD) on dialysis, it is necessary to have evidence on the clinimetric properties of the instruments used for its measurement. This study aimed to establish the clinimetric properties of the Kidney Disease Quality of Life Short Form 36 (KDQOL-36) scale in patients with stage 5 CKD on dialysis in Colombia. METHODS A scale validation study was conducted using the classical test theory methodology. The statistical analysis included exploratory factor analysis (EFA) and confirmatory (CFA) techniques performed on two independent subsamples; concurrent criterion validity assessments; internal consistency using four different coefficients; test-retest reliability; and sensitivity to change using mixed model for repeated measures. RESULTS The KDQOL-36 scale was applied to 506 patients with a diagnosis of stage 5 CKD on dialysis, attended in five renal units in Colombia. The EFA endorsed the three-factor structure of the scale, and the CFA showed an adequate fit of both the original and empirical models. Spearman's correlation coefficient values ≥0.50 were found between the domains of the CKD-specific core of the KDQOL-36 scale and the KDQ. Cronbach's alpha, McDonald's omega, Greatest lower bound (GLB), and Guttman's lambda coefficients were ≥0.89, indicating a high degree of consistency. A high level of concordance correlation was found between the two moments of application of the instrument, with values for Lin's concordance correlation coefficient ≥0.7. The application of the instrument after experiencing an event that could modify the quality of life showed statistically significant differences in the scores obtained. CONCLUSION The KDQOL-36 scale is an adequate instrument for measuring QoL in Colombian patients with stage 5 CKD on dialysis.
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Affiliation(s)
| | - Ricardo Sánchez
- Clinical Research Institute, School of Medicine, Universidad Nacional de Colombia, Bogotá, DC, Colombia
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Quint EE, Pol RA, Segev DL, McAdams-DeMarco MA. Age Is Just a Number for Older Kidney Transplant Patients. Transplantation 2024:00007890-990000000-00760. [PMID: 38771060 DOI: 10.1097/tp.0000000000005073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
The rise in the mean age of the global population has led to an increase in older kidney transplant (KT) patients. This demographic shift, coupled with the ongoing organ shortage, requires a nuanced understanding of which older adults are most suitable for KT. Recognizing the increased heterogeneity among older adults and the limitations of solely relying on chronological age, there is a need to explore alternative aging metrics beyond chronological age. In this review, we discuss the impact of older age on access to KT and postoperative outcomes. Emphasizing the need for a comprehensive evaluation that extends beyond chronological age, we explore alternative aging metrics such as frailty, sarcopenia, and cognitive function, underscoring their potential role in enhancing the KT evaluation process. Most importantly, we aim to contribute to the ongoing discourse, fostering an optimized approach to KT for the rapidly growing population of older adults.
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Affiliation(s)
- Evelien E Quint
- Division of Transplant Surgery, Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Robert A Pol
- Division of Transplant Surgery, Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Dorry L Segev
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mara A McAdams-DeMarco
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Sluiter A, van Zwieten A, Shen JI, Manera K. Measuring Social Functioning in Chronic Kidney Disease. Semin Nephrol 2024; 44:151547. [PMID: 39214733 DOI: 10.1016/j.semnephrol.2024.151547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Social functioning is a key aspect of daily life and is important to patients living with chronic kidney disease (CKD) and their caregivers. Many patients with CKD experience debilitating symptoms and treatment burden that can diminish their social functioning and thereby overall social health, which is the aspect of a person's well-being relating to their interactions and connections with others. In patients with CKD, symptoms (e.g., fatigue and pain), burden of ongoing treatments (including kidney replacement therapies), and medication side effects can impair social functioning. Having to manage responsibilities of self-management, which can include time-consuming and invasive treatments such as dialysis, can severely limit social functioning in patients with CKD. This can lead to poor social connections at many levels, including with family, friends, peers, and colleagues, and can hinder the development of new relationships. Patients with CKD with poorer social functioning have been reported to have worse quality of life and impaired mental health. Many patients with CKD rely on an informal caregiver-usually a family member or friend-to assist with management of their disease. This can place strain on the caregiver, further limiting opportunities for social connections for both the patient and caregiver. Although social functioning is critical for the overall well-being of patients with CKD, it remains underaddressed clinically, and patient-reported outcome measures (PROMs) to assess social functioning are limited. The objective of this article is to define social functioning, discuss the impacts of social functioning in patients with CKD and their caregivers, outline PROMs that have included assessment of social functioning, and discuss considerations in developing an appropriate PROM to measure social functioning in patients with CKD. This may help to inform the evaluation of interventions and care regarding social functioning within the CKD population.
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Affiliation(s)
- Amanda Sluiter
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, Children's Hospital at Westmead, Sydney, Australia.
| | - Anita van Zwieten
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, Children's Hospital at Westmead, Sydney, Australia
| | - Jenny I Shen
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA
| | - Karine Manera
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, Children's Hospital at Westmead, Sydney, Australia
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Chanan EL, Wagener G, Whitlock EL, Berger JC, McAdams-DeMarco MA, Yeh JS, Nunnally ME. Perioperative Considerations in Older Kidney and Liver Transplant Recipients: A Review. Transplantation 2024:00007890-990000000-00716. [PMID: 38557579 PMCID: PMC11442682 DOI: 10.1097/tp.0000000000005000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
With the growth of the older adult population, the number of older adults waitlisted for and undergoing kidney and liver transplantation has increased. Transplantation is an important and definitive treatment for this population. We present a contemporary review of the unique preoperative, intraoperative, and postoperative issues that patients older than 65 y face when they undergo kidney or liver transplantation. We focus on geriatric syndromes that are common in older patients listed for kidney or liver transplantation including frailty, sarcopenia, and cognitive dysfunction; discuss important considerations for older transplant recipients, which may impact preoperative risk stratification; and describe unique challenges in intraoperative and postoperative management for older patients. Intraoperative challenges in the older adult include using evidence-based best anesthetic practices, maintaining adequate perfusion pressure, and using minimally invasive surgical techniques. Postoperative concerns include controlling acute postoperative pain; preventing cardiovascular complications and delirium; optimizing immunosuppression; preventing perioperative kidney injury; and avoiding nephrotoxicity and rehabilitation. Future studies are needed throughout the perioperative period to identify interventions that will improve patients' preoperative physiologic status, prevent postoperative medical complications, and improve medical and patient-centered outcomes in this vulnerable patient population.
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Affiliation(s)
- Emily L Chanan
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Gebhard Wagener
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY
| | - Elizabeth L Whitlock
- Department of Anesthesia & Perioperative Care, University of California, San Francisco, San Francisco, CA
| | - Jonathan C Berger
- Department of Surgery, NYU Grossman School of Medicine, New York, NY
| | - Mara A McAdams-DeMarco
- Department of Surgery, NYU Grossman School of Medicine, New York, NY
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Joseph S Yeh
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Mark E Nunnally
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY
- Department of Surgery, NYU Grossman School of Medicine, New York, NY
- Department of Neurology, NYU Grossman School of Medicine, New York, NY
- Department of Medicine, NYU Grossman School of Medicine, New York, NY
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Thongwitokomarn H, Noppakun K, Chaiwarith R, Chattipakorn SC, Chattipakorn N. Extracellular vesicles as potential diagnostic markers for kidney allograft rejection. Clin Transplant 2024; 38:e15314. [PMID: 38628057 DOI: 10.1111/ctr.15314] [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: 10/10/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/19/2024]
Abstract
Kidney transplantation is a highly effective treatment for end-stage kidney disease. However, allograft rejection remains a significant clinical challenge in kidney transplant patients. Although kidney allograft biopsy is the gold-standard diagnostic method, it is an invasive procedure. Since the current monitoring methods, including screening of serum creatinine and urinary protein, are not of sufficient sensitivity, there is a need for effective post-transplant monitoring to detect allograft rejection at an early stage. Extracellular vesicles are vesicles with a lipid bilayer that originate from different cell types in pathological and physiological conditions. The content of extracellular vesicles reflects the status of cells at the time of their production. This review comprehensively summarizes clinical, in vivo, and in vitro reports that highlight the potential of extracellular vesicles as diagnostic biomarkers for kidney allograft rejection. Clarification would facilitate differentiation between rejection and non-rejection and identification of the mechanisms involved in the allograft rejection. Despite increasing evidence, further research is necessary to establish the clinical utility of extracellular vesicles in the diagnosis and monitoring of allograft rejection in kidney transplant recipients. Using extracellular vesicles as non-invasive biomarkers for diagnosis of kidney allograft rejection could have tremendous benefits in improving patient outcomes and reduce the need for invasive procedures.
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Affiliation(s)
- Harit Thongwitokomarn
- Faculty of Medicine, Department of Internal Medicine, Division of Infectious Disease, Chiang Mai University, Chiang Mai, Thailand
| | - Kajohnsak Noppakun
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Chiang Mai University, Chiang Mai, Thailand
| | - Romanee Chaiwarith
- Faculty of Medicine, Department of Internal Medicine, Division of Infectious Disease, Chiang Mai University, Chiang Mai, Thailand
| | - Siriporn C Chattipakorn
- Faculty of Medicine, Cardiac Electrophysiology Research and Training Center, Chiang Mai University, Chiang Mai, Thailand
- Faculty of Medicine, Department of Physiology, Cardiac Electrophysiology Unit, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Nipon Chattipakorn
- Faculty of Medicine, Cardiac Electrophysiology Research and Training Center, Chiang Mai University, Chiang Mai, Thailand
- Faculty of Medicine, Department of Physiology, Cardiac Electrophysiology Unit, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
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12
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Li Y, Menon G, Kim B, Bae S, Quint EE, Clark-Cutaia MN, Wu W, Thompson VL, Crews DC, Purnell TS, Thorpe RJ, Szanton SL, Segev DL, McAdams DeMarco MA. Neighborhood Segregation and Access to Live Donor Kidney Transplantation. JAMA Intern Med 2024; 184:402-413. [PMID: 38372985 PMCID: PMC10877505 DOI: 10.1001/jamainternmed.2023.8184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/10/2023] [Indexed: 02/20/2024]
Abstract
Importance Identifying the mechanisms of structural racism, such as racial and ethnic segregation, is a crucial first step in addressing the persistent disparities in access to live donor kidney transplantation (LDKT). Objective To assess whether segregation at the candidate's residential neighborhood and transplant center neighborhood is associated with access to LDKT. Design, Setting, and Participants In this cohort study spanning January 1995 to December 2021, participants included non-Hispanic Black or White adult candidates for first-time LDKT reported in the US national transplant registry. The median (IQR) follow-up time for each participant was 1.9 (0.6-3.0) years. Main Outcome and Measures Segregation, measured using the Theil H method to calculate segregation tertiles in zip code tabulation areas based on the American Community Survey 5-year estimates, reflects the heterogeneity in neighborhood racial and ethnic composition. To quantify the likelihood of LDKT by neighborhood segregation, cause-specific hazard models were adjusted for individual-level and neighborhood-level factors and included an interaction between segregation tertiles and race. Results Among 162 587 candidates for kidney transplant, the mean (SD) age was 51.6 (13.2) years, 65 141 (40.1%) were female, 80 023 (49.2%) were Black, and 82 564 (50.8%) were White. Among Black candidates, living in a high-segregation neighborhood was associated with 10% (adjusted hazard ratio [AHR], 0.90 [95% CI, 0.84-0.97]) lower access to LDKT relative to residence in low-segregation neighborhoods; no such association was observed among White candidates (P for interaction = .01). Both Black candidates (AHR, 0.94 [95% CI, 0.89-1.00]) and White candidates (AHR, 0.92 [95% CI, 0.88-0.97]) listed at transplant centers in high-segregation neighborhoods had lower access to LDKT relative to their counterparts listed at centers in low-segregation neighborhoods (P for interaction = .64). Within high-segregation transplant center neighborhoods, candidates listed at predominantly minority neighborhoods had 17% lower access to LDKT relative to candidates listed at predominantly White neighborhoods (AHR, 0.83 [95% CI, 0.75-0.92]). Black candidates residing in or listed at transplant centers in predominantly minority neighborhoods had significantly lower likelihood of LDKT relative to White candidates residing in or listed at transplant centers located in predominantly White neighborhoods (65% and 64%, respectively). Conclusions Segregated residential and transplant center neighborhoods likely serve as a mechanism of structural racism, contributing to persistent racial disparities in access to LDKT. To promote equitable access, studies should assess targeted interventions (eg, community outreach clinics) to improve support for potential candidates and donors and ultimately mitigate the effects of segregation.
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Affiliation(s)
- Yiting Li
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Gayathri Menon
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Byoungjun Kim
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Sunjae Bae
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Evelien E Quint
- Division of Transplant Surgery, Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Maya N Clark-Cutaia
- New York University Rory Meyers College of Nursing, New York, New York
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Wenbo Wu
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Valerie L Thompson
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Deidra C Crews
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tanjala S Purnell
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
| | - Roland J Thorpe
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
| | - Sarah L Szanton
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Dorry L Segev
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Mara A McAdams DeMarco
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
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13
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Caylan AE, Uçar M, Gürman R, Kutlu Ö. Diagnosis and Management of Ureteropelvic Obstruction in Kidney Transplant Recipients and Outcomes of Foley Y-V Pyeloplasty. EXP CLIN TRANSPLANT 2024; 22:277-283. [PMID: 38742318 DOI: 10.6002/ect.2023.0269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
OBJECTIVES To evaluate the etiology and diagnostic tools for ureteropelvic obstruction in kidney transplant recipients, we investigated the short-term and long-term outcomes of Foley Y-V pyeloplasty. MATERIALS AND METHODS We retrospectively reviewed 10 patients who underwent kidney transplant followed by additional interventions to treat obstructive ureteral pathologies between 2016 and 2020. We enrolled 4 patients who had received intervention to treat ureteropelvic obstruction. For these 4 patients, serum creatinine and estimated glomerular filtration rate levels were recorded at baseline, during the symptomatic period, and long-term. In this single center study, we investigated diagnostic tools and management strategies for ureteropelvic obstruction and assessed performance of Foley Y-V nondismembered pyeloplasty in kidney transplant recipients. RESULTS Among 4 patients, graft function (assessed by serum creatinine and estimated glomerular filtration rate) worsened significantly (P = .03) in the symptomatic period of ureteropelvic obstruction in all patients; however, graft function levels improved rapidly to levels similar to baseline (P = .07) after Y-V pyeloplasty. In addition, no statistically significant difference was detected between baseline and longterm graft functions afterY-V pyeloplasty in follow-up (P = .28). CONCLUSIONS Diagnosis and management of ureteropelvic obstruction in kidney transplant recipients are challenging due to rarity and lack of an ideal management algorithm.There is no specific diagnostic tool to discriminate this pathology from other ureteral pathologies; therefore, a regimen of conventional imaging modalities and diuretic renogram combined with endoscopic evaluation is more reliable. Moreover, nondismembered Foley Y-V pyeloplasty is effective and safe for graft function in the short-term and long-term.
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Affiliation(s)
- Ahmet Ender Caylan
- From the Department of Urology, Akdeniz University School of Medicine, Antalya, Turkey
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14
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Yu C, Zhang J, Pei J, Luo J, Hong Y, Tian X, Liu Z, Zhu C, Long C, Shen L, He X, Wen S, Liu X, Wu S, Hua Y, Wei G. IL-13 alleviates acute kidney injury and promotes regeneration via activating the JAK-STAT signaling pathway in a rat kidney transplantation model. Life Sci 2024; 341:122476. [PMID: 38296190 DOI: 10.1016/j.lfs.2024.122476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/18/2024] [Accepted: 01/26/2024] [Indexed: 02/09/2024]
Abstract
AIMS To identify whether and how a younger systemic internal milieu alleviates acute kidney injury (AKI) in grafts after kidney transplantation. MATERIALS AND METHODS We conducted an allogenic heterotopic rat kidney transplantation model with young and adult recipients receiving similar donor kidneys. We evaluated the renal function, histological damage, apoptosis, dedifferentiation, proliferation, hub regulating cytokines, and signaling pathways involved in young and adult recipients based on transcriptomics, proteomics, and experimental validation. We also validated the protective effect and mechanism of interleukin-13 (IL-13) on tubular epithelial cell injury induced by transplantation in vivo and by cisplatin in vitro. KEY FINDINGS Compared with adult recipients, the young recipients had lower levels of renal histological damage and apoptosis, while had higher levels of dedifferentiation and proliferation. Serum IL-13 levels were higher in young recipients both before and after surgery. Pretreating with IL-13 decreased apoptosis and promoted regeneration in injured rat tubular epithelial cells induced by cisplatin, while this effect can be counteracted by a JAK2 and STAT3 specific inhibitor, AG490. Recipients pretreated with IL-13 also had lower levels of histological damage and improved renal function. SIGNIFICANCE Higher levels of IL-13 in young recipients ameliorates tubular epithelial cell apoptosis and promotes regeneration via activating the JAK-STAT signaling pathway both in vivo and in vitro. Our results suggest that IL-13 is a promising therapeutic strategy for alleviating AKI. The therapeutic potential of IL-13 in injury repair and immune regulation deserves further evaluation and clinical consideration.
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Affiliation(s)
- Chengjun Yu
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, Chongqing, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China; Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Jie Zhang
- National Clinical Research Center for Child Health and Disorders, Chongqing, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Jun Pei
- National Clinical Research Center for Child Health and Disorders, Chongqing, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Jin Luo
- National Clinical Research Center for Child Health and Disorders, Chongqing, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China; Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Yifan Hong
- National Clinical Research Center for Child Health and Disorders, Chongqing, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China; Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China.
| | - Xiaomao Tian
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, Chongqing, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China; Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Zhiyuan Liu
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Chumeng Zhu
- National Clinical Research Center for Child Health and Disorders, Chongqing, China; Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Chunlan Long
- National Clinical Research Center for Child Health and Disorders, Chongqing, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China; Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China.
| | - Lianju Shen
- National Clinical Research Center for Child Health and Disorders, Chongqing, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China; Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China.
| | - Xingyue He
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, Chongqing, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China; Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Sheng Wen
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, Chongqing, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China; Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Xing Liu
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, Chongqing, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China; Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Shengde Wu
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, Chongqing, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China; Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China.
| | - Yi Hua
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, Chongqing, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China; Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China.
| | - Guanghui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, Chongqing, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China; Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China.
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15
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Shomron B. The solicitation of altruistic kidney donations on Facebook. Soc Sci Med 2024; 344:116615. [PMID: 38295531 DOI: 10.1016/j.socscimed.2024.116615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 02/02/2024]
Abstract
Chronic kidney failure poses a risk to human life and quality of life. Patients often receive renal replacement therapy or a kidney transplant, with the latter considered superior, though often inaccessible due to long waiting lists. While most kidney donations originate from the deceased, Israel has transformed as the first country where most kidney donations originate from altruistic living donors. This creates a social environment in which patients are tasked with kidney solicitation which often occurs on digital social networks. This study examines the phenomenon of digital kidney solicitation by employing a thematic analysis of 76 attempts of solicitation on Facebook. The analysis revealed the act of digital solicitation comprises of reflecting the inner conflicts of solicitation and justifying the kidney donation both in general and for the particular solicitor. This study sheds light on the phenomenon of people with kidney failure attempting to save their own lives through digital social networks. A phenomenon that could influence the social-health debate concerning the fair distribution of health resources in society.
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Affiliation(s)
- Baruch Shomron
- Department of Communication, Johannes Gutenberg University Mainz, Mainz, Jakob-Welder-Weg 12 55128, Germany.
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16
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Moreels T, Van de Velde D, Goethals J, Vanden Wyngaert K, De Baets S, Nagler E, Leune T, De Vriendt P, Van Biesen W. Self-Management Interventions for Facilitating Life Participation for Persons with Kidney Failure: A Systematic Review. Clin J Am Soc Nephrol 2024; 19:189-201. [PMID: 37943537 PMCID: PMC10861108 DOI: 10.2215/cjn.0000000000000347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/28/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND For persons with kidney failure, life participation is a critically important outcome, strongly linked to quality of life and mortality. To support patients' self-management abilities, three domains are typically emphasized: medical management, emotional management, and management of everyday life ( i.e. , role management). Although role management is strongly linked to life participation, there is currently limited research on interventions designed to support it. We explored existing self-management interventions that aim to support everyday life functioning, rather than only medical management. METHODS In this systematic review and qualitative meta-synthesis, we searched MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and CENTRAL up to April 2022 for interventional studies involving self-management interventions designed, at least partly, to support management of everyday life. The guidelines by Sandelowski and Barosso were used to analyze and synthesize the results. A taxonomy of everyday self-management strategies was used to further explore intervention content. Study quality was assessed using the Cochrane Collaboration risk-of-bias tools. Evidence of effectiveness was summarized, and a meta-analysis of eligible outcomes was conducted. RESULTS Of 22,667 records, 53 studies were included in the meta-synthesis. Most self-management interventions focused on medical management. Included interventions involved strategies to support eight domains: Activities of daily living, Work and school life, Meaningful occupations, Leisure activities, Mobility and travel, Interpersonal relationships, Role functioning, and Social participation. Major interventions focused on providing education, skill training, counseling, and cognitive behavioral therapy. Evidence of effectiveness was reported across a wide range of patient-reported outcomes, including (health-related) quality of life, depression, and self-efficacy. Studies were geographically concentrated and were of moderate to low quality. CONCLUSIONS Despite its well-recognized importance, research on interventions to improve life participation mostly consisted of pilot and feasibility studies and studies of low quality. Interventions were reported heterogeneously, limiting comparability, and were restricted to specific regions and cultures, limiting generalizability.
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Affiliation(s)
- Timothy Moreels
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Dominique Van de Velde
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Justine Goethals
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Karsten Vanden Wyngaert
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Center for Nursing Excellence, Ghent University Hospital, Ghent, Belgium
| | - Stijn De Baets
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Frailty in Ageing (FRIA) Research Group, Department of Gerontology and Mental Health and Wellbeing (MENT) Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit, Brussels, Belgium
| | - Evi Nagler
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Tamara Leune
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Patricia De Vriendt
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Frailty in Ageing (FRIA) Research Group, Department of Gerontology and Mental Health and Wellbeing (MENT) Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit, Brussels, Belgium
- Department of Occupational Therapy, Artevelde University of Applied Sciences, Ghent, Belgium
| | - Wim Van Biesen
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
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17
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Trinh E, Manera K, Scholes-Robertson N, Shen JI. The Burden of Home Dialysis: An Overlooked Challenge. Clin J Am Soc Nephrol 2024; 19:01277230-990000000-00326. [PMID: 38190177 PMCID: PMC11390025 DOI: 10.2215/cjn.0000000000000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 12/19/2023] [Indexed: 01/09/2024]
Abstract
Home dialysis offers several clinical and quality-of-life benefits for patients with kidney failure. However, it is important to recognize that home dialysis may place an increased burden on patients and their care partners. Sources of burden may include concerns about the ability to adequately and safely perform dialysis at home, physical symptoms, impairment of life participation, psychosocial challenges, and care partner burnout. Overlooking or failing to address these issues may lead to adverse events that negatively affect health and quality of life and reduce longevity of home dialysis. This study will explore aspects of home dialysis associated with burden, emphasize the need for increased awareness of potential challenges, and elaborate on strategies to overcome sources of burden. Future research should actively involve patients and care partners to better understand their motivation, experiences, and needs to better inform support strategies.
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Affiliation(s)
- Emilie Trinh
- Division of Nephrology, Department of Medicine, McGill University Health Center, Montreal, Canada
| | - Karine Manera
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Jenny I Shen
- Division of Nephrology and Hypertension, The Lundquist Research Institute at Harbor-UCLA Medical Center, Torrance, California
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18
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Weightman AC, Coghlan S, Clayton PA. Respecting living kidney donor autonomy: an argument for liberalising living kidney donor acceptance criteria. Monash Bioeth Rev 2023; 41:156-173. [PMID: 36484936 PMCID: PMC10654180 DOI: 10.1007/s40592-022-00166-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 06/17/2023]
Abstract
Doctors routinely refuse donation offers from prospective living kidney donors with certain comorbidities such as diabetes or obesity out of concern for donor wellbeing. This refusal occurs despite the ongoing shortage of kidney transplants and the superior performance of living donor kidney transplants compared to those from deceased donors. In this paper, we argue that this paternalistic refusal by doctors is unjustified and that, within limits, there should be greater acceptance of such donations. We begin by describing possible weak and strong paternalistic justifications of current conservative donor acceptance guidelines and practices. We then justify our position by outlining the frequently under-recognised benefits and the routinely overestimated harms of such donation, before discussing the need to respect the autonomy of willing donors with certain comorbidities. Finally, we respond to a number of possible objections to our proposal for more liberal kidney donor acceptance criteria. We use the situation in Australia as our case study, but our argument is applicable to comparable situations around the world.
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Affiliation(s)
- Alison C Weightman
- Adelaide Medical School, University of Adelaide, Adelaide, Australia.
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, 5000, Australia.
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, 5000, Australia.
| | - Simon Coghlan
- Centre for AI and Digital Ethics, School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Philip A Clayton
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, 5000, Australia
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, 5000, Australia
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19
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Padayachee S, Adam A, Fabian J. The impact of diabetes and hypertension on renal allograft survival- A single center study. Curr Urol 2023; 17:286-291. [PMID: 37994332 PMCID: PMC10662914 DOI: 10.1097/cu9.0000000000000068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/10/2021] [Indexed: 11/26/2022] Open
Abstract
Background To determine the impact of pre-transplant diabetes mellitus (DM) and post-transplant hypertension (HT) at 1 year on renal allograft survival in all adult first kidney-only (FKO) transplant recipients at a single transplant center in Johannesburg, South Africa. Materials and methods A retrospective review was conducted of all adult FKO transplant procedures at the Charlotte Maxeke Johannesburg Academic Hospital transplant unit between 1966 and 2013. Results During the stipulated timeframe, 1685 adult FKO transplant procedures were performed. Of these, 84.1% were from deceased donors (n = 1413/1685). The prevalence of pre-transplant DM transplant recipients with no missing or incomplete records was 6.5% (n = 107/1625). Of the total cohort of 1685 adult FKO transplant recipients, 63.6% of those with no missing data survived to 1 year (n = 1072/1685). The prevalence of HT at 1-year post-transplant was 53.6% (n = 503/1072). HT at 1-year post-transplant, even after adjusted survival analysis, proved a significant risk factor for renal allograft loss (hazard ratio, 1.63; 95% confidence interval, 1.37-1.94) (p < 0.0001). Similarly, after adjusted survival analysis, the risk of renal allograft loss within the pre-transplant DM group was significantly higher (p = 0.043; hazard ratio, 1.26; 95% confidence interval, 1.01-1.58). Conclusions This study identified pre-transplantation diabetes mellitus and post-transplantation HT as significant risk factors for graft loss within the population assessed in this region of the world. These factors could potentially be used as independent predictors of renal graft survival.
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Affiliation(s)
- Sumesh Padayachee
- Division of Urology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ahmed Adam
- Division of Urology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Departments of Urology, Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Helen Joseph Hospital (HJH), and Rahima; Moosa Mother & Child Hospital (RMMCh); Wits Donald Gordon Medical Center, Johannesburg, South Africa
| | - June Fabian
- Wits Donald Gordon Medical Center, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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20
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Chang JH, Kim YC, Song SH, Kim S, Jo MW, Kim S. Shared Decision Making for Choosing renAl Replacement Therapy in Chronic Kidney Disease Patients (SDM-ART trial): study protocol for randomized clinical trial. Kidney Res Clin Pract 2023; 42:751-761. [PMID: 37098669 DOI: 10.23876/j.krcp.22.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/04/2022] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) should be educated about their condition so that they can initiate dialysis at the optimal time and make an informed choice between dialysis modalities. Shared decision-making (SDM) empowers patients to select their own treatment and improves patient outcomes. This study aimed to evaluate whether SDM affects the choice of renal replacement therapy among CKD patients. METHODS This is a multicenter, open-label, randomized, pragmatic clinical trial. A total of 1,194 participants with CKD who are considering renal replacement therapy were enrolled. The participants will be randomized into three groups in a 1:1:1 ratio: the conventional group, extensive informed decision-making group, and SDM group. Participants will be educated twice at months 0 and 2. Videos and leaflets will be provided to all patients. Patients in the conventional group will receive 5 minutes of education at each visit. The extensive informed decision-making group will receive more informed and detailed education using intensive learning materials for 10 minutes each visit. Patients in the SDM group will be educated for 10 minutes each visit according to illness perception and item-based analysis. The primary endpoint is the ratio of hemodialysis to peritoneal dialysis and kidney transplantation among the groups. Secondary outcomes include unplanned dialysis, economic efficiency, patient satisfaction, patient evaluation of the process, and patient adherence. DISCUSSION The SDM-ART is an ongoing clinical study to investigate the effect of SDM on the choice of renal replacement therapy in patients with CKD.
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Affiliation(s)
- Jae Hyun Chang
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang Heon Song
- Department of Internal Medicine and BioMedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Soojin Kim
- Division of Communication and Media, Ewha Womans University, Seoul, Republic of Korea
| | - Min-Woo Jo
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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21
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Tannor EK, Hutton-Mensah K, Opare-Addo P, Agyei MK, Gyan KF, Inusah AJ, Nyann BI, Amo-Antwi K, Luyckx V, Okpechi I. Fifty years of hemodialysis in Ghana-current status, utilization and cost of dialysis services. BMC Health Serv Res 2023; 23:1170. [PMID: 37891605 PMCID: PMC10612280 DOI: 10.1186/s12913-023-10154-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Kidney failure is common in Ghana. Haemodialysis (HD) is the most common treatment modality for survival. Although, HD has been available in Ghana for 50 years, the majority of patients who develop kidney failure cannot access it. We describe the state of HD, dialysis prevalence, its utilization and cost of HD after fifty years of dialysis initiation in Ghana. METHODS A situational assessment of HDs centres in Ghana was conducted by surveying nephrologists, doctors, nurses and other health care professionals in HD centres from August to October 2022. We assessed the density of HD centres, number of HD machines, prevalence of nephrologists, number of patients receiving HD treatment and the cost of dialysis in private and government facilities in Ghana. RESULTS There are 51 HD centres located in 9 of the 16 regions of Ghana. Of these, only 40 centres are functioning, as 11 had shut down or are yet to operate. Of the functioning centres most (n = 26, 65%) are in the Greater Accra region serving 17.7% of the population and 7(17.5%) in the Ashanti region serving 17.5% of the population in Ghana. The rest of the seven regions have one centre each. The private sector has twice as many HD centers (n = 27, 67.5%) as the public sector (n = 13,32.5%). There are 299 HD machines yielding 9.7 HD machines per million population (pmp) with a median of 6 (IQR 4-10) machines per centre. Ghana has 0.44 nephrologists pmp. Currently, 1195 patients receive HD, giving a prevalence of 38.8 patients pmp with 609(50.9%) in the private sector. The mean cost of HD session is US $53.9 ± 8.8 in Ghana. CONCLUSION There are gross inequities in the regional distribution of HD centres in Ghana, with a low HD prevalence and nephrology workforce despite a high burden of CKD. The cost of haemodialysis remains prohibitive and mainly paid out-of-pocket limiting its utilization.
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Affiliation(s)
- Elliot Koranteng Tannor
- Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
- Renal Unit, Directorate of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Kojo Hutton-Mensah
- Renal Unit, Directorate of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Priscilla Opare-Addo
- Renal Unit, Directorate of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Martin Kofi Agyei
- Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kwadwo Faka Gyan
- Renal Unit, Directorate of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Abdul-Jalil Inusah
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana
| | | | - Kwabena Amo-Antwi
- Department of Obstetrics and Gynaecology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Valerie Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Department of Public and Global Health, Epidemiology, Biostatistics and Preventive Institute, University of Zurich, Zürich, Switzerland
| | - Ikechi Okpechi
- Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- Department of Medicine, Division of Nephrology and Immunology, University of Alberta, Edmonton, Canada
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22
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Nejad MK, Hasani A, Soofiyani SR, Nahandi MZ, Hasani A. Aptitude of Uropathogenic Escherichia coli in Renal Transplant Recipients: A Comprehensive Review on Characteristic Features, and Production of Extended Spectrum β-Lactamase. Curr Microbiol 2023; 80:382. [PMID: 37864769 DOI: 10.1007/s00284-023-03476-w] [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: 06/04/2022] [Accepted: 09/05/2023] [Indexed: 10/23/2023]
Abstract
Urinary tract infection is the most common infection in almost half of the renal transplant patients. The development of UTI in these patients may progress to bacteremia, acute T cell-mediated rejection, impaired allograft function, or allograft loss, along with the increased risk of hospitalization and death. Among various pathogens implicated, Uropathogenic E. coli (UPEC), especially sequence type 131 (ST131), is the most virulent and multidrug-resistant pathogen. High antimicrobial resistance to most β-lactam antibiotics, mediated by extended spectrum β-lactamases (ESBLs) produced by UPEC, is a challenge in the clinical management of UTIs in kidney transplant recipients. Indeed, multidrug resistance to β-lactam antibiotics is a direct consequence of ESBL production. Resistance to other antibiotics such as aminoglycosides, fluoroquinolones, and trimethoprim-sulphamethoxazole has also been reported in ESBLs-producing UPEC, which reduces the therapeutic options, rising healthcare-associated costs and subsequently leads to renal failure or even graft loss. In this review, we aimed to discuss the post-transplant risk factors of UTI, UPEC virulence factors (VF), and the related factors including quorum sensing, and stress resistance genes. Furthermore, we searched for the current treatment strategies and some of the alternate approaches proposed as therapeutic options that may affirm the treatment of ESBL-producing UPEC.
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Affiliation(s)
- Masoomeh Kashef Nejad
- Clinical Research Development Unit, Sina Educational, Research and Treatment Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alka Hasani
- Clinical Research Development Unit, Sina Educational, Research and Treatment Center, Tabriz University of Medical Sciences, Tabriz, Iran.
- Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Saiedeh Razi Soofiyani
- Clinical Research Development Unit, Sina Educational, Research and Treatment Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Molecular Medicine, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Zaare Nahandi
- Clinical Research Development Unit, Sina Educational, Research and Treatment Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akbar Hasani
- Department of Clinical Biochemistry and Laboratory Sciences, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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23
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Fidan C, Ağırbaş İ. The effect of renal replacement therapy on health-related quality of life in end-stage renal disease: a meta-analysis. Clin Exp Nephrol 2023; 27:829-846. [PMID: 37466815 DOI: 10.1007/s10157-023-02377-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/02/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND End-stage renal disease (ESRD) patients judge health-related quality of life (HRQoL) as an essential outcome. In meta-analysis studies, there is ongoing debate regarding the impact of renal replacement therapy (RRT) methods on HRQoL in ESRD patients. Hence, the main objective of this study was to examine the influence of RRT method utilization on HRQoL in individuals with ESRD. Additionally, the secondary objective was to explore the impact of RRT method use on HRQoL, considering various moderator variables. METHODS RRT methods called hemodialysis (HD), peritoneal dialysis (PD), home dialysis (HoD), and kidney transplantation (KT) are used to treat ESRD. HD was defined as in-center HD (ICHD) and home HD (HHD). HoD was defined as HHD and PD. The estimated Hedges' g were conducted by random effect meta-analysis. RESULTS A total of 111 publications, including 50.151 patients, were included. KT was better at improving patients' HRQoL than other methods. PD was better at improving patients' HRQoL than HD. HoD was better at improving patients' HRQoL than ICHD. Sensitivity analyses yielded similar results. Publication bias was not tested. The subgroup and meta-regression analyses showed that the moderating variables had a statistically significant effect on the HRQoL of patients with ESRD. CONCLUSION For the treatment of ESRD, either KT, PD, or HoD can be used in terms of HRQoL. We need to improve the factors affecting the HRQoL of ESRD patients undergoing HD and ICHD. Healthcare professionals should consider the factors that influence HRQoL and choose an RTT method for each ESRD patient.
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Affiliation(s)
- Cuma Fidan
- Department of Healthcare Management, Health Sciences Faculty, Mus Alparslan University, 49250, Mus, Turkey.
| | - İsmail Ağırbaş
- Department of Healthcare Management, Ankara University, Ankara, Turkey
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24
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Bocchi F, Beldi G, Kuhn C, Storni F, Müller N, Sidler D. Impact of suboptimal donor to suboptimal recipient kidney transplant on delayed graft function and outcome. FRONTIERS IN TRANSPLANTATION 2023; 2:1240155. [PMID: 38993921 PMCID: PMC11235345 DOI: 10.3389/frtra.2023.1240155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/17/2023] [Indexed: 07/13/2024]
Abstract
Introduction The demographics of donor and recipient candidates for kidney transplantation (KT) have substantially changed. Recipients tend to be older and polymorbid and KT to suboptimal recipients is associated with delayed graft function (DGF), prolonged hospitalization, inferior long-term allograft function, and poorer patient survival. In parallel, donors are also older, suffer from several comorbidities, and donations coming from circulatory death (DCD) predominate, which in turn leads to early and late complications. However, it is unclear how donor and recipient risk factors interact. Methods In this retrospective cohort study, we assess the impact of a KT from suboptimal donors to suboptimal recipients. We focused on: 1) DGF; 2) hospital stay and number of dialysis days after KT and 3) allograft function at 12 months. Results and discussion Among the 369 KT included, the overall DGF rate was 25% (n = 92) and median time from reperfusion to DGF resolution was 7.8 days (IQR: 3.0-13.8 days). Overall, patients received four dialysis sessions (IQR: 2-8). The combination of pre-KT anuria (<200 ml/24 h, 32%) and DCD procurement (14%) was significantly associated with DGF, length of hospital stay, and severe perioperative complications, predominantly in recipients 50 years and older.
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Affiliation(s)
- Federica Bocchi
- Department of Nephrology and Hypertension, Inselspital, Bern, Switzerland
| | - Guido Beldi
- Departement of Visceral Surgery and Medicine, Inselspital, Bern, Switzerland
| | - Christian Kuhn
- Department of Nephrology and Hypertension, Inselspital, Bern, Switzerland
| | - Federico Storni
- Departement of Visceral Surgery and Medicine, Inselspital, Bern, Switzerland
| | - Natalie Müller
- Department of Nephrology and Hypertension, Inselspital, Bern, Switzerland
| | - Daniel Sidler
- Department of Nephrology and Hypertension, Inselspital, Bern, Switzerland
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25
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Biabani F, Rahmani A, MahmudiRad G, Hassankhani H, Azadi A. Reasons for kidney transplant refusal among patients receiving peritoneal dialysis: A qualitative study. Perit Dial Int 2023; 43:395-401. [PMID: 36601692 DOI: 10.1177/08968608221146865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Even though kidney transplantation has better outcomes compared to dialysis therapies, some patients undergoing peritoneal dialysis (PD) refuse to consider kidney transplantation. Identification of the underlying reason for patient refusal may improve patients' acceptance of kidney transplantation. AIM The aim of this study was to describe the reasons given by Iranian PD patients for refusing kidney transplantation. METHOD Eighteen patients undergoing PD participated. Data were collected using semi-structured interviews and were analysed using conventional qualitative content analysis. RESULTS The analysis leads to the emergence of two categories and six subcategories: negative outcomes of kidney transplantation (financial burden, psychosocial problems and physical complications) and doubtful factors for kidney transplantation (negative attitudes towards kidney transplantation, long waiting time for kidney transplantation and compatibility of PD with daily life). The financial burden and long waiting time for kidney transplantation were the most important factors in the reluctance of kidney transplantation by PD patients. IMPLICATION FOR PRACTICE Patients undergoing PD declined kidney transplantation for several reasons, such as financial burden, fear of post-transplantation side effects, long waiting time for kidney transplantation. Reducing the time of kidney transplantation and insurance coverage of transplant costs can change the attitude of PD patients towards transplant.
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Affiliation(s)
- Fateme Biabani
- Nursing and Midwifery Faculty, Birjand University of Medical Sciences, Iran
| | - Azad Rahmani
- Medical-Surgical Department, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Iran
| | | | - Hadi Hassankhani
- Medical-Surgical Department, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Iran
| | - Arman Azadi
- Nursing Department, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Iran
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26
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Martínez-Majolero V, Urosa B, Hernández-Sánchez S, Arroyo D. The Moderating Role of Health Variables on the Association between Physical Exercise and Quality of Life in Patients with End-Stage Renal Disease. Healthcare (Basel) 2023; 11:2148. [PMID: 37570388 PMCID: PMC10419082 DOI: 10.3390/healthcare11152148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Scientific evidence demonstrates the positive impact that physical exercise has on the quality of life (QOL) of patients with chronic kidney disease (CKD). However, no study has proposed a model investigating the effect physical exercise has on the QOL of end-stage renal disease (ESRD) patients, considering the most frequent associated diseases (diabetes/hypertension). The objectives were (1) to explore the relationship between physical exercise and the QOL of adults with ESRD, and (2) to examine the moderating and/or mediating role of relevant patient variables. This non-interventional study utilized an ex post facto retrospective data analysis design with a sample of 310 patients with ESRD through two validated questionnaires. The dependent variables were the QOL scale (KDQOL-SF), and the physical function dimension (EFFISICA). The independent variables were the regular practice of intense physical activity (DEPINTE) and the daily time (in hours) the patient is in a sedentary attitude (TiParado). The moderating variables were the clinical situation and associated diseases. The mediator variable used was the body mass index. Bivariate and multiple regression analyses were conducted. Findings suggest implementing intense physical activity in transplant recipients and programmes to avoid sedentary lifestyles in dialysis patients have a positive effect in the QOL of ESRD patients.
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Affiliation(s)
| | - Belén Urosa
- Faculty of Human and Social Sciences, Universidad Pontificia Comillas, 28049 Madrid, Spain;
| | | | - David Arroyo
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain;
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27
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Kim I, Maggiore U, Knight SR, Rana Magar R, Pengel LHM, Dor FJMF. Pre-emptive living donor kidney transplantation: A public health justification to change the default. Front Public Health 2023; 11:1124453. [PMID: 37006536 PMCID: PMC10063978 DOI: 10.3389/fpubh.2023.1124453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/28/2023] [Indexed: 03/19/2023] Open
Affiliation(s)
- Isaac Kim
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Umberto Maggiore
- Dipartimento di Medicina e Chirurgia, Università di Parma, Unità Operativa Nefrologia, Azienda Ospedaliera-Universitaria Parma, Parma, Italy
| | - Simon R. Knight
- Sir Peter Morris Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Reshma Rana Magar
- Sir Peter Morris Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Liset H. M. Pengel
- Sir Peter Morris Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Frank J. M. F. Dor
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- *Correspondence: Frank J. M. F. Dor
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28
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Firat M, Vardar-Yagli N, Saglam M, Yildirim T, Erdem Y. Quality of life and physical activity level in patients with chronic kidney disease during COVID-19 pandemic. PSYCHOL HEALTH MED 2023; 28:640-647. [PMID: 36128610 DOI: 10.1080/13548506.2022.2119481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The COVID-19 pandemic process may affect the physical and psychosocial health in patients with chronic kidney disease (CKD). The aim of this study was to compare the quality of life, physical activity, fear of COVID-19 and mental health in CKD patients and healthy individualsand compare the aforementioned parameters in end-stage renal disease (ESRD) and renal transplantation (RTx) patients during the pandemic. Eighty-two patients (33 ESRD, 49 RTx) and age-gender matched 108 healthy individuals were included. Quality of life (Short Form 36 Health Survey Questionnaire-SF-36), physical activity (short form of the International Physical Activity Questionnaire -IPAQ-SF), fear of COVID-19 (Fear of COVID-19 Scale-FCV-19S) and mental health (Hospital Anxiety and Depression Scale-HADS) were evaluated. Physical activity levels and all SF-36 scores except mental health in CKD patients were significantly lower than healthy individuals (p < 0.05). FCV-19S and HADS scores were similar between the groups (p > 0.05). ESRD patients' pain and general health perceptions scores of SF-36 were lower than RTx patients' (p < 0.05). Quality of life and physical activity levels were worse in CKD patients compared to healthy individuals during the pandemic. The participants had fear of COVID-19, poor mental health and low physical activity. For these reasons, psychosocial and physical activity interventions for the both groups may be beneficial for the affected outcomes during COVID-19 pandemic.
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Affiliation(s)
- Merve Firat
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Naciye Vardar-Yagli
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Melda Saglam
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Tolga Yildirim
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Hacettepe University, Ankara, Turkey
| | - Yunus Erdem
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Hacettepe University, Ankara, Turkey
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29
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Moein M, Iskhagi S, Shahbazov R, Ball A, Loerzel S, Shaban E, Hod Dvorai R, Hanlon M, Saidi RF. Deceased Donor Kidney Transplantation From Donors With Acute Kidney Injury: Realities and Costs. EXP CLIN TRANSPLANT 2023; 21:104-109. [PMID: 36919718 DOI: 10.6002/ect.2022.0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVES Transplant of kidneys from donors with acute kidney injury has shown favorable outcomes. We investigated the outcomes of kidney transplant recipients with deceased donors who developed acute kidney injury before organ procurement. MATERIALS AND METHODS We retrospectively reviewed the medical records of recipients from January 2016 to December 2021 in a single center. Outcomes in recipients of kidney grafts from donors with and without acute kidney injury were compared. RESULTS The mean follow-up time was 40 months. Our study included 129 (34%) kidneys transplanted from donors with acute kidney injury and 251 (66%) kidneys from donors without acute kidney injury. Delayed graft function rate in recipients was 33% in the acute kidney injury group and 25.5% in the group without acute kidney injury (P = .099). Readmission rate at 30 days was significantly higher among recipients of kidneys with acute kidney injury compared with recipients of kidneys without acute kidney injury (45% vs 33.5%; P = .02). The mean overall costs of transplant in the acute kidney injury group were comparable to the group without acute kidney injury ($253 865 vs $253 611; P = .97). The acute rejection rate was comparable between the 2 groups (4% in both groups; P = .96). Delayed graft function rate was increased with increased stage of acute kidney injury (18% stage 1, 45% stage 2, 36% stage 3; P = .03). However, the overall length of hospital stay and costs were comparable among recipients of different stages of acute kidney injury. CONCLUSIONS Our study showed that kidney transplants from donors with acute kidney injury have early and late outcomes comparable to kidney transplants from donors without acute kidney injury. Allografts from donors with acute kidney injury can be used safely and can expand the donor pool in kidney transplant without increasing perioperative resource utilization.
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Affiliation(s)
- Mahmoudreza Moein
- From the Department of Surgery, Division of Transplantation, SUNY Upstate Medical University, Syracuse, New York, USA
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30
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Ladin K, Tighiouart H, Bronzi O, Koch-Weser S, Wong JB, Levine S, Agarwal A, Ren L, Degnan J, Sewall LN, Kuramitsu B, Fox P, Gordon EJ, Isakova T, Rifkin D, Rossi A, Weiner DE. Effectiveness of an Intervention to Improve Decision Making for Older Patients With Advanced Chronic Kidney Disease : A Randomized Controlled Trial. Ann Intern Med 2023; 176:29-38. [PMID: 36534976 DOI: 10.7326/m22-1543] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Older patients with advanced chronic kidney disease (CKD) face difficult decisions about managing kidney failure, frequently experiencing decisional conflict, regret, and treatment misaligned with preferences. OBJECTIVE To assess whether a decision aid about kidney replacement therapy improved decisional quality compared with usual care. DESIGN Multicenter, randomized, controlled trial. (ClinicalTrials.gov: NCT03522740). SETTING 8 outpatient nephrology clinics associated with 4 U.S. centers. PARTICIPANTS English-fluent patients, 70 years and older with nondialysis CKD stages 4 to 5 recruited from 2018 to 2020. INTERVENTION DART (Decision-Aid for Renal Therapy) is an interactive, web-based decision aid for older adults with CKD. Both groups received written education about treatments. MEASUREMENTS Change in the decisional conflict scale (DCS) score from baseline to 3, 6, 12, and 18 months. Secondary outcomes included change in prognostic and treatment knowledge and change in uncertainty. RESULTS Among 400 participants, 363 were randomly assigned: 180 to usual care, 183 to DART. Decisional quality improved with DART with mean DCS declining compared with control (mean difference, -8.5 [95% CI, -12.0 to -5.0]; P < 0.001), with similar findings at 6 months, attenuating thereafter. At 3 months, knowledge improved with DART versus usual care (mean difference, 7.2 [CI, 3.7 to 10.7]; P < 0.001); similar findings at 6 months were modestly attenuated at 18 months (mean difference, 5.9 [CI, 1.4 to 10.3]; P = 0.010). Treatment preferences changed from 58% "unsure" at baseline to 28%, 20%, 23%, and 14% at 3, 6, 12, and 18 months, respectively, with DART, versus 51% to 38%, 35%, 32%, and 18% with usual care. LIMITATION Latinx patients were underrepresented. CONCLUSION DART improved decision quality and clarified treatment preferences among older adults with advanced CKD for 6 months after the DART intervention. PRIMARY FUNDING SOURCE Patient-Centered Outcomes Research Institute (PCORI).
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Affiliation(s)
- Keren Ladin
- Research on Ethics, Aging, and Community Health (REACH Lab), Medford, and Departments of Community Health and Occupational Therapy, Tufts University, Medford, Massachusetts (K.L.)
| | - Hocine Tighiouart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, and Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts (H.T.)
| | - Olivia Bronzi
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Boston, Massachusetts (O.B., D.E.W.)
| | - Susan Koch-Weser
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, Massachusetts (S.K.)
| | - John B Wong
- Division of Clinical Decision Making, Tufts Medical Center, Boston, Massachusetts (J.B.W.)
| | - Sarah Levine
- Cooper Medical School of Rowan University, Camden, New Jersey (S.L., A.A.)
| | - Arushi Agarwal
- Cooper Medical School of Rowan University, Camden, New Jersey (S.L., A.A.)
| | - Lucy Ren
- The University of North Texas Health Science Center at Fort Worth/Texas College of Osteopathic Medicine, Fort Worth, Texas (L.R.)
| | - Jack Degnan
- Division of Nephrology-Hypertension, UC San Diego, La Jolla, and Nephrology Section, VA San Diego Healthcare System, San Diego, California (J.D., D.R.)
| | - Lexi N Sewall
- Maine Nephrology Associates, Maine Medical Center, Portland, Maine (L.N.S.)
| | - Brianna Kuramitsu
- Division of Transplantation, Department of Surgery, Center for Health Services & Outcomes Research, and Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, Chicago, Illinois (B.K., E.J.G.)
| | - Patrick Fox
- Division of Nephrology and Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (P.F.)
| | - Elisa J Gordon
- Division of Transplantation, Department of Surgery, Center for Health Services & Outcomes Research, and Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, Chicago, Illinois (B.K., E.J.G.)
| | - Tamara Isakova
- Division of Nephrology and Hypertension, Department of Medicine, and Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (T.I.)
| | - Dena Rifkin
- Division of Nephrology-Hypertension, UC San Diego, La Jolla, and Nephrology Section, VA San Diego Healthcare System, San Diego, California (J.D., D.R.)
| | - Ana Rossi
- Piedmont Transplant Institute, Atlanta, Georgia (A.R.)
| | - Daniel E Weiner
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Boston, Massachusetts (O.B., D.E.W.)
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Parthenolide alleviates peritoneal fibrosis by inhibiting inflammation via the NF-κB/ TGF-β/Smad signaling axis. J Transl Med 2022; 102:1346-1354. [PMID: 36307537 DOI: 10.1038/s41374-022-00834-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/03/2022] [Indexed: 11/06/2022] Open
Abstract
Peritoneal fibrosis is a common complication of peritoneal dialysis (PD) with a complicated pathogenesis and limited treatments. Parthenolide (PTL), a recognized nuclear factor-κB (NF-κB) inhibitor extracted from Tanacetum balsamita, has been widely used to treat various inflammatory diseases and has been proven to improve peritoneal fibrosis in PD mice by selectively inhibiting the phosphorylation of Smad2/3. Transforming growth factor-β1 (TGF-β1), via Smad-dependent signaling, has a pivotal role in promoting pathogenic of fibrosis. To investigate whether PTL can inhibit peritoneal fibrosis, we affected the interaction between NF-κB and the TGF-β/Smad2/3 pathway. Long dwell peritoneal dialysis fluid (PDF) and peritoneum tissues were collected from continuous ambulatory peritoneal dialysis (CAPD) patients. PTL was administered intragastrically into a PD mouse model by daily infusion of 4.25% dextrose-containing PDF. Treated HMrSV5 cells or rat peritoneal mesothelial cells (RPMCs) were treated with high glucose(138 mM) at the same concentration as 2.5% dextrose-containing PDF and PTL. PD-related peritoneal fibrosis samples indicated an increase in inflammation, and PTL decreased the levels of inflammatory cytokines (L-6, TNF-α, and MCP-1). PTL inhibited high glucose-induced mesothelial-to-mesenchymal transition (MMT), as indicated by a reduced expression of fibrosis markers (fibronectin, collagen I, and α-SMA) and increased expression of the epithelial marker E-cadherin. PTL also significantly decreased TGF-β1 expression and the phosphorylation of IκBα and NF-κBp65. The changes in the levels of TGF-β1 expression and p-p65 or p65 showed similar trends according to western blot, immunohistochemistry, and immunofluorescence assays in vitro and in vivo. Chromatin immunoprecipitation (ChIP) and luciferase reporter assays were used to confirm that PTL regulates the transcription of TGF-β1 induced by high glucose through NF-κBp65. In summary, PTL induces a therapeutic effect in peritoneal fibrosis by inhibiting inflammation via the NF-κB/ TGF-β/Smad signaling axis.
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Huang B, Huang M, Zhang C, Yu Z, Hou Y, Miao Y, Chen Z. Individual dynamic prediction and prognostic analysis for long-term allograft survival after kidney transplantation. BMC Nephrol 2022; 23:359. [DOI: 10.1186/s12882-022-02996-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
Predicting allograft survival is vital for efficient transplant success. With dynamic changes in patient conditions, clinical indicators may change longitudinally, and doctors’ judgments may be highly variable. It is necessary to establish a dynamic model to precisely predict the individual risk/survival of new allografts.
Methods
The follow-up data of 407 patients were obtained from a renal allograft failure study. We introduced a landmarking-based dynamic Cox model that incorporated baseline values (age at transplantation, sex, weight) and longitudinal changes (glomerular filtration rate, proteinuria, hematocrit). Model performance was evaluated using Harrell’s C-index and the Brier score.
Results
Six predictors were included in our analysis. The Kaplan–Meier estimates of survival at baseline showed an overall 5-year survival rate of 87.2%. The dynamic Cox model showed the individual survival prediction with more accuracy at different time points (for the 5-year survival prediction, the C-index = 0.789 and Brier score = 0.065 for the average of all time points) than the static Cox model at baseline (C-index = 0.558, Brier score = 0.095). Longitudinal covariate prognostic analysis (with time-varying effects) was performed.
Conclusions
The dynamic Cox model can utilize clinical follow-up data, including longitudinal patient information. Dynamic prediction and prognostic analysis can be used to provide evidence and a reference to better guide clinical decision-making for applying early treatment to patients at high risk.
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Swift SL, Leyva Y, Wang S, Chang CCH, Dew MA, Shapiro R, Unruh M, Kendall K, Croswell E, Peipert JD, Myaskovsky L. Are cultural or psychosocial factors associated with patient-reported outcomes at the conclusion of kidney transplant evaluation? Clin Transplant 2022; 36:e14796. [PMID: 35988025 PMCID: PMC9772103 DOI: 10.1111/ctr.14796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Kidney transplant evaluation (KTE) is a period marked by many stressors for patients, which may lead to poorer patient-reported outcomes (PROs). Research on the association of cultural and psychosocial factors with PROs during KTE is lacking, even though cultural and psychosocial variables may mitigate the relationship between acceptance status and PROs. METHODS Using a prospective cohort study of 955 adults referred for KTE, we examined whether cultural factors and psychosocial characteristics, assessed at the initiation of KTE, are associated with PROs at KTE completion, controlling for demographics and medical factors. Also, we analyzed whether these factors moderate the relationship between transplant acceptance status and PROs. RESULTS In multivariable regression models, a stronger sense of mastery was associated with higher physical and mental QOL. A stronger sense of self-esteem was associated with higher kidney-specific QOL. Depression was associated with a lower mental QOL, but only in those who were accepted for transplant. Having low levels of external locus of control was associated with better mental QOL in those who were not accepted for transplant. Higher anxiety was associated with poorer kidney-specific QOL among those who were not accepted for KT, but trust in physician was only associated with greater satisfaction in transplant clinic service for those who were accepted for KT. CONCLUSIONS Targeting interventions to increase patient mastery and external locus of control, and reduce depression and anxiety in patients undergoing kidney transplant evaluation may be useful approaches to improve their experience during this stressful period.
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Affiliation(s)
- Samuel L. Swift
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Sciences Center
- SS now at New Mexico Department of Health, Epidemiology
| | - Yuri Leyva
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Sciences Center
| | - Shu Wang
- Department of Biostatistics, University of Florida
| | - Chung-Chou H. Chang
- Department of Biostatistics, University of Pittsburgh, Graduate School of Public Health
- Department of Medicine, University of Pittsburgh, School of Medicine
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh, School of Medicine
| | - Ron Shapiro
- Mount Sinai Recanati/Miller Transplantation Institute, Icahn School of Medicine
| | - Mark Unruh
- Department of Internal Medicine, University of New Mexico, School of Medicine
| | | | - Emilee Croswell
- Department of Psychiatry, University of Pittsburgh, School of Medicine
| | - John Devin Peipert
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
- Northwestern University Transplant Outcomes Research Collaboration (NUTORC), Feinberg School of Medicine, Northwestern University
| | - Larissa Myaskovsky
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Sciences Center
- Department of Internal Medicine, University of New Mexico, School of Medicine
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Cho OH, Hong I, Kim H. Effect of Uncertainty in Illness and Fatigue on Health-Related Quality of Life of Patients on Dialysis: A Cross-Sectional Correlation Study. Healthcare (Basel) 2022; 10:healthcare10102043. [PMID: 36292490 PMCID: PMC9601980 DOI: 10.3390/healthcare10102043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to determine the effect of uncertainty in illness and fatigue on the health-related quality of life of patients on dialysis. A community-based cross-sectional study was conducted among patients on hemodialysis (n = 80) and peritoneal dialysis (n = 81) in Korea. Data were collated using self-reported structured questionnaires. Multiple regression analysis was used to identify those factors affecting the physical and mental health-related quality of life of patients. Patients on peritoneal dialysis reported higher levels of fatigue (p < 0.001). Factors affecting the physical health-related quality of life of patients on dialysis were fatigue (p < 0.001), employment (p = 0.001), and exercise (p = 0.016), thus explaining the observed variance of 37%. Factors affecting mental health-related quality of life were fatigue (p < 0.001), uncertainty (p = 0.004), educational level (p = 0.005), and smoking (p = 0.035). To improve the health-related quality of life of patients on dialysis, clinicians should assess their fatigue levels and plan multidisciplinary interventions to manage it. In addition, education level and employment status should be considered, and tailored interventions should be provided to acquire positive coping strategies and health promotion behaviors to counter disease uncertainty.
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Affiliation(s)
- Ok-Hee Cho
- Department of Nursing, College of Nursing and Health, Kongju National University, Gongju 32588, Korea
| | - Insook Hong
- Department of Nursing, Gyeongbuk College of Health, Gimcheon 39525, Korea
| | - Hyekyung Kim
- Department of Nursing, Catholic Kwandong University, Gangneung 25601, Korea
- Correspondence: ; Tel.: +82-33-649-7615; Fax: +82-33-649-7620
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Cai G, Ying J, Pan M, Lang X, Yu W, Zhang Q. Development of a risk prediction nomogram for sarcopenia in hemodialysis patients. BMC Nephrol 2022; 23:319. [PMID: 36138351 PMCID: PMC9502581 DOI: 10.1186/s12882-022-02942-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 09/14/2022] [Indexed: 12/02/2022] Open
Abstract
Background Sarcopenia is associated with various adverse outcomes in hemodialysis patients. However, current tools for assessing and diagnosing sarcopenia have limited applicability. In this study, we aimed to develop a simple and reliable nomogram to predict the risk of sarcopenia in hemodialysis patients that could assist physicians identify high-risk patients early. Methods A total of 615 patients undergoing hemodialysis at the First Affiliated Hospital College of Medicine Zhejiang University between March to June 2021 were included. They were randomly divided into either the development cohort (n = 369) or the validation cohort (n = 246). Multivariable logistic regression analysis was used to screen statistically significant variables for constructing the risk prediction nomogram for Sarcopenia. The line plots were drawn to evaluate the effectiveness of the nomogram in three aspects, namely differentiation, calibration, and clinical net benefit, and were further validated by the Bootstrap method. Results The study finally included five clinical factors to construct the nomogram, including age, C-reactive protein, serum phosphorus, body mass index, and mid-upper arm muscle circumference, and constructed a nomogram. The area under the ROC curve of the line chart model was 0.869, with a sensitivity and specificity of 77% sensitivity and 83%, the Youden index was 0.60, and the internal verification C-statistic was 0.783. Conclusions This study developed and validated a nomogram model to predict the risk of sarcopenia in hemodialysis patients, which can be used for early identification and timely intervention in high-risk groups.
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Affiliation(s)
- Genlian Cai
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, #1367 Wenyixi Road, Hangzhou, 311121, China
| | - Jinping Ying
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, #1367 Wenyixi Road, Hangzhou, 311121, China.
| | - Mengyan Pan
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, #1367 Wenyixi Road, Hangzhou, 311121, China
| | - Xiabing Lang
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, #1367 Wenyixi Road, Hangzhou, 311121, China
| | - Weiping Yu
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, #1367 Wenyixi Road, Hangzhou, 311121, China
| | - Qinqin Zhang
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, #1367 Wenyixi Road, Hangzhou, 311121, China
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Abstract
Peritoneal dialysis (PD) is an important home-based treatment for kidney failure and accounts for 11% of all dialysis and 9% of all kidney replacement therapy globally. Although PD is available in 81% of countries, this provision ranges from 96% in high-income countries to 32% in low-income countries. Compared with haemodialysis, PD has numerous potential advantages, including a simpler technique, greater feasibility of use in remote communities, generally lower cost, lesser need for trained staff, fewer management challenges during natural disasters, possibly better survival in the first few years, greater ability to travel, fewer dietary restrictions, better preservation of residual kidney function, greater treatment satisfaction, better quality of life, better outcomes following subsequent kidney transplantation, delayed need for vascular access (especially in small children), reduced need for erythropoiesis-stimulating agents, and lower risk of blood-borne virus infections and of SARS-CoV-2 infection. PD outcomes have been improving over time but with great variability, driven by individual and system-level inequities and by centre effects; this variation is exacerbated by a lack of standardized outcome definitions. Potential strategies for outcome improvement include enhanced standardization, monitoring and reporting of PD outcomes, and the implementation of continuous quality improvement programmes and of PD-specific interventions, such as incremental PD, the use of biocompatible PD solutions and remote PD monitoring. The use of peritoneal dialysis (PD) can be advantageous compared with haemodialysis treatment, although several barriers limit its broad implementation. This review examines the epidemiology of peritoneal dialysis (PD) outcomes, including clinical, patient-reported and surrogate PD outcomes. Peritoneal dialysis (PD) has distinct advantages compared with haemodialysis, including the convenience of home treatment, improved quality of life, technical simplicity, lesser need for trained staff, greater cost-effectiveness in most countries, improved equity of access to dialysis in resource-limited settings, and improved survival, particularly in the first few years of initiating therapy. Important barriers can hamper PD utilization in low-income settings, including the high costs of PD fluids (owing to the inability to manufacture them locally and the exorbitant costs of their import), limited workforce availability and a practice culture that limits optimal PD use, often leading to suboptimal outcomes. PD outcomes are highly variable around the world owing in part to the use of variable outcome definitions, a heterogeneous practice culture, the lack of standardized monitoring and reporting of quality indicators, and kidney failure care gaps (including health care workforce shortages, inadequate health care financing, suboptimal governance and a lack of good health care information systems). Key outcomes include not only clinical outcomes (typically defined as medical outcomes based on clinician assessment or diagnosis) — for example, PD-related infections, technique survival, mechanical complications, hospitalizations and PD-related mortality — but also patient-reported outcomes. These outcomes are directly reported by patients and focus on how they function or feel, typically in relation to quality of life or symptoms; patient-reported outcomes are used less frequently than clinical outcomes in day-to-day routine care.
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Mohottige D, Davenport C, Lee HJ, Ephraim P, DePasquale N, Cabacungan A, Barrett T, McElroy L, Pendergrast J, Diamantidis CJ, Ebony Boulware L. Receipt and Sharing of Information to Improve Knowledge About Living Donor Kidney Transplant among Transplant Candidates with Advanced Chronic Kidney Disease. Prog Transplant 2022; 32:241-247. [PMID: 35698759 PMCID: PMC11200181 DOI: 10.1177/15269248221107047] [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] [Indexed: 11/15/2022]
Abstract
Introduction: Knowledge about living donor kidney transplant (LDKT) is associated with greater access. Yet, little is known about factors associated with high living donor transplant knowledge. Research Questions: Is receipt of LDKT information from health professionals or sharing information with family and friends associated with higher knowledge? Design: We conducted a cross-sectional analysis of data from preemptive LDKT candidates, which assessed knowledge, receipt of information about living donation from health professionals, and history of having shared living donor information with family members or friends. In multivariable logistic regression models adjusting for participants' age, race, and total household income, we quantified the association of high knowledge with receipt of living donation information from health professionals and sharing of this information with family/friends. Results: Among 130 participants, the median (IQR) age was 59.5 (52.0-65.0) years, 60% were female, 47.7% were Black, and 49.2% had a high school education or less. Over half (55.4%) had high LDKT knowledge. Nearly one third reported having received living donor information (33.1%) or sharing the information with family/friends (28.5%). After adjustment, those who received (vs. did not receive information) and shared information with family/friends had 3-fold higher odds of high LDKT knowledge (3.05 [1.24, 8.08]). Individuals who received LDKT information (vs. did not) from health professionals had 4-fold higher odds of high LDKT knowledge (adjusted OR [95% CI]: 4.01 [1.49, 12.18]. Conclusions: Receipt of living donation information from health professionals and sharing this information with family/friends were associated with high LDKT knowledge.
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Affiliation(s)
- Dinushika Mohottige
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Clemontina Davenport
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Hui-Jie Lee
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Patti Ephraim
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA
| | - Nicole DePasquale
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Ashley Cabacungan
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Tyler Barrett
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Lisa McElroy
- Division of Abdominal Transplant, Duke Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Jane Pendergrast
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Clarissa J. Diamantidis
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - L. Ebony Boulware
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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DePasquale N, Green JA, Ephraim PL, Morton S, Peskoe SB, Davenport CA, Mohottige D, McElroy L, Strigo TS, Hill-Briggs F, Browne T, Wilson J, Lewis-Boyer L, Cabacungan AN, Boulware LE. Decisional Conflict About Kidney Failure Treatment Modalities Among Adults With Advanced CKD. Kidney Med 2022; 4:100521. [PMID: 36090772 PMCID: PMC9449857 DOI: 10.1016/j.xkme.2022.100521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Rationale & Objective Choosing from multiple kidney failure treatment modalities can create decisional conflict, but little is known about this experience before decision implementation. We explored decisional conflict about treatment for kidney failure and its associated patient characteristics in the context of advanced chronic kidney disease (CKD). Study Design Cross-sectional study. Setting & Participants Adults (N = 427) who had advanced CKD, received nephrology care in Pennsylvania-based clinics, and had no history of dialysis or transplantation. Predictors Participants' sociodemographic, physical health, nephrology care/knowledge, and psychosocial characteristics. Outcomes Participants' results on the Sure of myself; Understand information; Risk-benefit ratio; Encouragement (SURE) screening test for decisional conflict (no decisional conflict vs decisional conflict). Analytical Approach We used multivariable logistic regression to quantify associations between aforementioned participant characteristics and decisional conflict. We repeated analyses among a subgroup of participants at highest risk of kidney failure within 2 years. Results Most (76%) participants reported treatment-related decisional conflict. Participant characteristics associated with lower odds of decisional conflict included complete satisfaction with patient-kidney team treatment discussions (OR, 0.16; 95% CI, 0.03-0.88; P = 0.04), attendance of treatment education classes (OR, 0.38; 95% CI, 0.16-0.90; P = 0.03), and greater treatment-related decision self-efficacy (OR, 0.97; 95% CI, 0.94-0.99; P < 0.01). Sensitivity analyses showed a similarly high prevalence of decisional conflict (73%) and again demonstrated associations of class attendance (OR, 0.26; 95% CI, 0.07-0.96; P = 0.04) and decision self-efficacy (OR, 0.95; 95% CI, 0.91-0.99; P = 0.03) with decisional conflict. Limitations Single-health system study. Conclusions Decisional conflict was highly prevalent regardless of CKD progression risk. Findings suggest efforts to reduce decisional conflict should focus on minimizing the mismatch between clinical practice guidelines and patient-reported engagement in treatment preparation, facilitating patient-kidney team treatment discussions, and developing treatment education programs and decision support interventions that incorporate decision self-efficacy-enhancing strategies.
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Affiliation(s)
- Nicole DePasquale
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC
| | - Jamie A. Green
- Department of Nephrology, Geisinger Commonwealth School of Medicine, Danville, PA
- Kidney Health Research Institute, Geisinger, Danville, PA
| | - Patti L. Ephraim
- Feinstein Institutes for Medical Research, Northwell Health, New York, NY
| | - Sarah Morton
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Sarah B. Peskoe
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Clemontina A. Davenport
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | | | - Lisa McElroy
- Department of Surgery, Duke University School of Medicine, Durham, NC
| | - Tara S. Strigo
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC
| | | | - Teri Browne
- College of Social Work, University of South Carolina, Columbia, SC
| | - Jonathan Wilson
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - LaPricia Lewis-Boyer
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ashley N. Cabacungan
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC
| | - L. Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC
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du Toit T, Chibuye K, Thomson D, Manning K. The use of brachiobasilic arteriovenous fistulae for haemodialysis: a single-centre descriptive study. Cardiovasc J Afr 2022; 33:248-253. [PMID: 35788625 PMCID: PMC9887435 DOI: 10.5830/cvja-2022-006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 02/01/2022] [Indexed: 10/08/2023] Open
Abstract
AIM The main aim of the study was to report on our local experience with the use of brachiobasilic arteriovenous fistulae (BBAVF) and to encourage wider local acceptance of the procedure in accordance with international guidelines. The primary aim was to report on access patency. The secondary aims were to report on functional outcomes and complications. METHODS This was a retrospective, descriptive study of 41 consecutive haemodialysis patients who underwent BBAVF creation. RESULTS The primary patency rates at 30 days, and one and three years were 95.1, 48.8 and 19.5%, respectively. Assisted primary patency rates at 30 days, and one and three years were 100, 67.7 and 24.3%, respectively. Secondary patency rates at 30 days, and one and three years were 100, 70.3 and 27%, respectively. CONCLUSION BBAVF creation can successfully be performed in a resource-constrained environment by surgeons with limited prior experience with the technique. However, careful monitoring, well-established referral pathways for dysfunctional fistulae and access to surgical and endovascular revision seem to be key factors in ensuring long-term patency.
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Affiliation(s)
- Tinus du Toit
- Department of Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.
| | - Kenward Chibuye
- Department of Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - David Thomson
- Department of Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Kathryn Manning
- Department of Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
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40
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Alvarado F, Cervantes CE, Crews DC, Blanck J, Al Ammary F, Ng DK, Purnell TS. Examining post-donation outcomes in Hispanic/Latinx living kidney donors in the United States: A systematic review. Am J Transplant 2022; 22:1737-1753. [PMID: 35258164 PMCID: PMC9546009 DOI: 10.1111/ajt.17017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 02/18/2022] [Accepted: 02/19/2022] [Indexed: 01/25/2023]
Abstract
We conducted a systematic review to assess outcomes in Hispanic donors and explore how Hispanic ethnicity was characterized. We searched PubMed, EMBASE, and Scopus through October 2021. Two reviewers independently screened study titles, abstracts, and full texts; they also qualitatively synthesized results and independently assessed quality of included studies. Eighteen studies met our inclusion criteria. Study sample sizes ranged from 4007 to 143,750 donors and mean age ranged from 37 to 54 years. Maximum follow-up time of studies varied from a perioperative donor nephrectomy period to 30 years post-donation. Hispanic donors ranged between 6% and 21% of the donor populations across studies. Most studies reported Hispanic ethnicity under race or a combined race and ethnicity category. Compared to non-Hispanic White donors, Hispanic donors were not at increased risk for post-donation mortality, end-stage kidney disease, cardiovascular disease, non-pregnancy-related hospitalizations, or overall perioperative surgical complications. Compared to non-Hispanic White donors, most studies showed Hispanic donors were at higher risk for diabetes mellitus following nephrectomy; however, mixed findings were seen regarding the risk for post-donation chronic kidney disease and hypertension. Future studies should evaluate cultural, socioeconomic, and geographic differences within the heterogeneous Hispanic donor population, which may further explain variation in health outcomes.
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Affiliation(s)
- Flor Alvarado
- Section of Nephrology and HypertensionDepartment of MedicineTulane UniversityNew OrleansLouisinaUSA
| | - Carmen Elena Cervantes
- Division of NephrologyDepartment of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Deidra C. Crews
- Division of NephrologyDepartment of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
- Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Jamie Blanck
- Johns Hopkins Welch Medical LibraryJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Fawaz Al Ammary
- Division of NephrologyDepartment of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
- Division of TransplantationDepartment of SurgeryJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Derek K. Ng
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Tanjala S. Purnell
- Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins UniversityBaltimoreMarylandUSA
- Division of TransplantationDepartment of SurgeryJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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41
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McKeaveney C, Noble H, Courtney AE, Griffin S, Gill P, Johnston W, Maxwell AP, Teasdale F, Reid J. Dialysis, Distress, and Difficult Conversations: Living with a Kidney Transplant. Healthcare (Basel) 2022; 10:healthcare10071177. [PMID: 35885704 PMCID: PMC9321787 DOI: 10.3390/healthcare10071177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background: Providing holistic care to kidney patients is important; however, without full consideration of the perspectives of people living with a kidney transplant, the provision of truly ‘holistic healthcare’ cannot be possible. It is imperative to understand patient experiences by including kidney patients in key strategies and future renal service planning. Ignoring these important patient views means that there is a significant risk of inappropriate renal service provision and lack of adequate support, impacting overall health. The aim of this study was to develop an in-depth understanding of the lived experiences of kidney transplant recipients. Methods: A total of 23 participants were recruited between two regional nephrology units within the United Kingdom via clinical gatekeepers. In-depth interviews were undertaken. Interviews were digitally recorded, transcribed verbatim, and subjected to interpretative phenomenological analysis. Results: Two themes emerged: “managing ongoing fears of dialysis, distress, and COVID-19” and “dealing with difficult conversations”. Conclusions: Renal healthcare professionals need to understand more than the biological impact of receiving a kidney transplant. Understanding the holistic and multidomain experiences that these participants experience will help healthcare professionals to recognize the needs of this group and ensure more responsive psychosocial care.
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Affiliation(s)
- Clare McKeaveney
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (C.M.); (H.N.)
| | - Helen Noble
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (C.M.); (H.N.)
| | | | - Sian Griffin
- Department of Nephrology and Transplantation, Cardiff & Vale University Health Board, Cardiff CF14 4XW, UK;
| | - Paul Gill
- School of Healthcare Sciences, Cardiff University, Cardiff CF24 0AB, UK;
| | - William Johnston
- Northern Ireland Kidney Patients Association, Belfast BT9 7AB, UK;
| | | | | | - Joanne Reid
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (C.M.); (H.N.)
- Correspondence:
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Wong SP, Oestreich T, Chandler B, Curtis JR. Using Human-Centered Design Principles to Create a Decision Aid on Conservative Kidney Management for Advanced Kidney Disease. KIDNEY360 2022; 3:1242-1252. [PMID: 35919540 PMCID: PMC9337892 DOI: 10.34067/kid.0000392022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/04/2022] [Indexed: 01/11/2023]
Abstract
Background Most patients are unaware of approaches to treating advanced chronic kidney disease (CKD) other than dialysis. Methods We developed a dedicated decision aid on conservative kidney management using human-centered design principles in three phases: (1) discovery: engagement of informants to understand their needs and preferences; (2) design: multiple rapid cycles of ideation, prototyping, and testing of a decision aid with a small group of informants; and (3) implementation: testing the decision aid in real-world settings with attention to how the decision aid can be further refined. Informants included a national patient advisory committee on kidney diseases, 50 patients with stage 4 or 5 CKD and 35 of their family members, and 16 clinicians recruited from the greater Seattle area between June 2019 and September 2021. Results Findings from the discovery phase informed an initial prototype of the decision aid, which included five sections: a description of kidney disease and its signs and symptoms, an overview of conservative kidney management and the kinds of supports provided, self-reflection exercises to elicit patients' values and goals, the pros and cons of conservative kidney management, and the option of changing one's mind about conservative kidney management. The prototype underwent several rounds of iteration during its design phase, which resulted in the addition of an introductory section describing the intended audience and more detailed information in other sections. Findings from its implementation phase led to the addition of examples of common questions that patients and family members had about conservative kidney management and a final section on other related educational resources. Conclusions Human-centered design principles supported a systematic and collaborative approach between researchers, patients, family members, and clinicians for developing a decision aid on conservative kidney management.
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Affiliation(s)
- Susan P.Y. Wong
- VA Puget Sound Health Care System, Division of Nephrology, University of Washington, Seattle, Washington,University of Washington, School of Medicine, Division of Nephrology, Seattle, Washington
| | - Taryn Oestreich
- University of Washington, School of Medicine, Division of Nephrology, Seattle, Washington
| | - Bridgett Chandler
- University of Washington, School of Medicine, Division of Nephrology, Seattle, Washington
| | - J. Randall Curtis
- University of Washington, Division of Pulmonary, Critical Care and Sleep Medicine, Seattle, Washington
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43
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Cheetham MS, Wilkie M, Loud F, Manera KE, Ju A, Figueiredo A, Farragher J, Hurst H, Jassal SV, Mehrotra R, Morton RL, Schwartz D, Shen JI, Walker R, Cho Y, Johnson DW, Craig JC, Anumudu S, Baumgart A, Gonzalez AM, Scholes-Robertson N, Viecelli AK, Tong A. Establishing a core outcome measure for life participation in patients receiving peritoneal dialysis: A Standardised Outcomes in Nephrology-Peritoneal Dialysis consensus workshop report. ARCH ESP UROL 2022; 42:562-570. [PMID: 35538693 DOI: 10.1177/08968608221096560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Life participation is an outcome of critical importance to patients receiving peritoneal dialysis (PD). However, there is no widely accepted or validated tool for measuring life participation in patients receiving PD. METHODS Online consensus workshop to identify the essential characteristics of life participation as a core outcome, with the goal of establishing a patient-reported outcome measure for use in all trials in patients receiving PD. Thematic analysis of transcripts was performed. RESULTS Fifty-five participants, including 17 patients and caregivers, from 15 countries convened via online videoconference. Four themes were identified: reconfiguring expectations of daily living (accepting day-to-day fluctuation as the norm, shifting thresholds of acceptability, preserving gains in flexibility and freedom), ensuring broad applicability and interpretability (establishing cross-cultural relevance, incorporating valued activities, distinguishing unmodifiable barriers to life participation), capturing transitions between modalities and how they affect life participation (responsive to trajectory towards stable, reflecting changes with dialysis transitions) and maximising feasibility of implementation (reducing completion burden, administrable with ease and flexibility). CONCLUSIONS There is a need for a validated, generalisable outcome measure for life participation in patients receiving PD. Feasibility, including length of time to complete and flexible mode of delivery, are important to allow implementation in all trials that include patients receiving PD.
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Affiliation(s)
- Melissa S Cheetham
- Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Australia.,Sunshine Coast Health Institute, Birtinya, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Martin Wilkie
- Department of Nephrology, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | | | - Karine E Manera
- Sydney School of Public Health, The University of Sydney, New South Wales, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Australia
| | - Angela Ju
- Sydney School of Public Health, The University of Sydney, New South Wales, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Australia
| | - Ana Figueiredo
- School of Health Sciences and Life, Nursing School, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Janine Farragher
- Department of Occupational Science and Occupational Therapy, University of Toronto, Ontario, Canada
| | - Helen Hurst
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, University of Manchester, UK
| | - Sarbjit V Jassal
- Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Ontario, Canada
| | - Rajnish Mehrotra
- Division of Nephrology/Department of Medicine, University of Washington, Seattle, WA, USA
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, University of Sydney, New South Wales, Australia
| | - Daniel Schwartz
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jenny I Shen
- Division of Nephrology and Hypertension, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Rachael Walker
- School of Nursing, Eastern Institute of Technology, Hawke's Bay, New Zealand
| | - Yeoungjee Cho
- Faculty of Medicine, University of Queensland, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Australia
| | - David W Johnson
- Faculty of Medicine, University of Queensland, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Samaya Anumudu
- Selzman Institute of Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Amanda Baumgart
- Sydney School of Public Health, The University of Sydney, New South Wales, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Australia
| | - Andrea Matus Gonzalez
- Sydney School of Public Health, The University of Sydney, New South Wales, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Australia
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, The University of Sydney, New South Wales, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Australia
| | - Andrea K Viecelli
- Faculty of Medicine, University of Queensland, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, New South Wales, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Australia
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44
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Bush R, Upadhyay K, McPeters S. Identification of Anxiety and Depression Among Adolescent Kidney Transplant Recipients: A Cross-Sectional Observational Study. J Pediatr Health Care 2022; 36:270-276. [PMID: 34844818 DOI: 10.1016/j.pedhc.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Studies demonstrate an association between mental health disorders and organ transplantation, with adolescents five times more likely to experience anxiety and depression than their nontransplant peers. The purpose of this study is to describe the prevalence of anxiety and depression in adolescent kidney transplant recipients using standardized mental health screening tools. METHOD The standardized screening tools, generalized anxiety disorder-7 for anxiety and Patient Health Questionnaire-9 for depression, were administered over 6 months to kidney transplant recipients aged 12-21 years during the transplant clinic visit. RESULTS Mental health screening increased by 74.0%. Patients reported mild to moderate anxiety at 46.4% and depression at 35.7%. DISCUSSION Routine screening for mental health disorders in the transplant clinic allows for early identification of anxiety and depression, prompt referrals to a mental health professional, and improved health outcomes in adolescent kidney transplant recipients.
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45
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Memory KE, Wilkinson TJ, Smith AC, Lightfoot CJ. A qualitative exploration of the facilitators and barriers to self-management in kidney transplant recipients. J Nephrol 2022; 35:1863-1872. [PMID: 35467326 PMCID: PMC9035973 DOI: 10.1007/s40620-022-01325-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/27/2022] [Indexed: 11/26/2022]
Abstract
Background Understanding the behaviours that facilitate or impede one’s ability to self-manage is important to improve health-related outcomes in kidney transplant recipients (KTRs). Previous studies exploring the self-management experiences of KTRs have focused on specific tasks (e.g., medication adherence), age groups (e.g., adolescent or older recipients), or have been conducted outside of the UK where transferability of findings is unknown. Our study aimed to explore the perceptions and experiences of self-management in UK KTRs to identify facilitators and barriers associated with self-management tasks. Methods Semi-structured interviews were conducted with eleven KTRs. Topics explored included experiences of self-management tasks (diet, exercise, medications, stress management), perceived healthcare role, and future interventional approaches. Thematic analysis was used to identify and report themes. Results Eight themes were identified which were mapped onto the three self-management tasks described by Corbin and Strauss: medical, role and emotional management. Perceived facilitators to self-management were: gathering health-related knowledge, building relationships with healthcare professionals, creating routines within daily life, setting goals and identifying motivators, establishing support networks, and support from family and friends. Complexity of required treatment and adjusting to a new health status were perceived barriers to self-management. Conclusions Participants described the importance of collaborative consultations and continuity of care. Tailored interventions should identify individualised goals and motivators for participating in self-management. Education on effective strategies to manage symptoms and comorbidities could help alleviate KTRs’ perceived treatment burden. Family and peer support could emotionally support KTRs; however, managing the emotional burden of transplantation warrants more attention. Graphic abstract ![]()
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Affiliation(s)
- Katherine E Memory
- Leicester Medical School, University of Leicester, Leicester, UK
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Thomas J Wilkinson
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alice C Smith
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Courtney J Lightfoot
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK.
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46
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Goldman S, Bargman JM. Burden of kidney disease and the burden of proof. ARCH ESP UROL 2022; 42:233-235. [PMID: 35437087 DOI: 10.1177/08968608221093854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Shira Goldman
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Joanne M Bargman
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
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47
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Castro Filho JBSD, Pompeo JDC, Machado RB, Gonçalves LFS, Bauer AC, Manfro RC. Delayed Graft Function Under the Microscope: Surveillance Biopsies in Kidney Transplantation. Transpl Int 2022; 35:10344. [PMID: 35401043 PMCID: PMC8988887 DOI: 10.3389/ti.2022.10344] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/24/2022] [Indexed: 11/13/2022]
Abstract
Delayed graft function (DGF) is a common complication of kidney transplantation and frequently leads to the necessity of surveillance biopsies. The purpose of this study is to describe the histological findings in surveillance biopsies of deceased donor kidney transplant recipients and evaluate the risk factors for graft outcomes. This is a monocentric, retrospective study including kidney transplant recipients that underwent a graft biopsy during the DGF period between January 2006 and July 2019. 356 biopsies were performed in 335 deceased donor transplant recipients. Biopsies were analyzed according to the Banff classification. The main histological findings were: acute tubular necrosis in 150 biopsies (42.1%), acute rejection in 96 biopsies (26.9%), and borderline findings in 91 biopsies (25.5%). In the multivariate analysis, recipient age (p = 0.028) and DGF duration (p = 0.005) were associated with rejection, antibody-induction with anti-thymocyte globulin (ATG) was protective (p = 0.001). The occurrence of rejection was associated with lower death-censored graft survival (log-rank; p = 0.009). Surveillance biopsies of kidney grafts experiencing DGF remain an essential tool for the care of kidney transplant recipients. The recipient’s age and duration of DGF are independent risk factors for acute rejection, while antibody-induction therapy with ATG is associated with protection from its occurrence.
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Affiliation(s)
| | | | - Rafael Berlezi Machado
- UFRGS Medical School, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Luiz Felipe Santos Gonçalves
- Division of Nephrology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,UFRGS Medical School, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Andrea Carla Bauer
- Division of Nephrology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,UFRGS Medical School, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Roberto Ceratti Manfro
- Division of Nephrology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,UFRGS Medical School, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Division of Transplantation, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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48
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Young HML, Ruddock N, Harrison M, Goodliffe S, Lightfoot CJ, Mayes J, Nixon AC, Greenwood SA, Conroy S, Singh SJ, Burton JO, Smith AC, Eborall H. The Impact of Falls: A Qualitative Study of the Experiences of People Receiving Haemodialysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3873. [PMID: 35409557 PMCID: PMC8997574 DOI: 10.3390/ijerph19073873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 02/04/2023]
Abstract
The prevalence of falls is high in people receiving haemodialysis (HD). This study aimed to explore the experiences of people receiving HD who had fallen in the last six months. A qualitative study, informed by constructivist grounded theory, used semi-structured interviews in combination with falls diaries. Twenty-five adults (mean age of 69 ± 10 years, 13 female, 13 White British) receiving HD with a history of at least one fall in the last six months (median 3, IQR 2-4) participated. Data were organised within three themes: (a) participants' perceptions of the cause of their fall(s): poor balance, weakness, and dizziness, exacerbated by environmental causes, (b) the consequences of the fall: injuries were disproportionate to the severity of the fall leading to loss of confidence, function and disruptions to HD, (c) reporting and coping with falls: most did not receive any specific care regarding falls. Those who attended falls services reported access barriers. In response, personal coping strategies included avoidance, vigilance, and resignation. These findings indicate that a greater focus on proactively identifying falls, comprehensive assessment, and timely access to appropriate falls prevention programmes is required to improve care and outcomes.
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Affiliation(s)
- Hannah M. L. Young
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK;
- Department of Respiratory Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Nicki Ruddock
- John Walls Renal Unit, Leicester General Hospital, Leicester LE5 4PW, UK;
| | - Mary Harrison
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK;
| | - Samantha Goodliffe
- School of Health, Wellbeing and Social Care, The Open University, Milton Keynes MK7 6AA, UK;
| | - Courtney J. Lightfoot
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK; (C.J.L.); (S.C.); (A.C.S.)
| | - Juliet Mayes
- Department of Physiotherapy and Renal Medicine, King’s College Hospital, King’s College London, London SE5 9RS, UK; (J.M.); (S.A.G.)
| | - Andrew C. Nixon
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK;
| | - Sharlene A. Greenwood
- Department of Physiotherapy and Renal Medicine, King’s College Hospital, King’s College London, London SE5 9RS, UK; (J.M.); (S.A.G.)
| | - Simon Conroy
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK; (C.J.L.); (S.C.); (A.C.S.)
| | - Sally J. Singh
- Centre for Exercise & Rehabilitation Science, Leicester Biomedical Research Unit, Leicester LE3 9QP, UK;
- Department of Respiratory Medicine, University Hospitals of Leicester, Leicester LE3 9QP, UK
| | - James O. Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK;
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough LE11 3TU, UK
| | - Alice C. Smith
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK; (C.J.L.); (S.C.); (A.C.S.)
| | - Helen Eborall
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK;
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Kunin M, Beckerman P. The Peritoneal Membrane—A Potential Mediator of Fibrosis and Inflammation among Heart Failure Patients on Peritoneal Dialysis. MEMBRANES 2022; 12:membranes12030318. [PMID: 35323792 PMCID: PMC8954812 DOI: 10.3390/membranes12030318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/06/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022]
Abstract
Peritoneal dialysis is a feasible, cost-effective, home-based treatment of renal replacement therapy, based on the dialytic properties of the peritoneal membrane. As compared with hemodialysis, peritoneal dialysis is cheaper, survival rate is similar, residual kidney function is better preserved, fluid and solutes are removed more gradually and continuously leading to minimal impact on hemodynamics, and risks related to a vascular access are avoided. Those features of peritoneal dialysis are useful to treat refractory congestive heart failure patients with fluid overload. It was shown that in such patients, peritoneal dialysis improves functional status and quality of life, reduces hospitalization rate, and may decrease mortality rate. High levels of serum proinflammatory cytokines and fibrosis markers, among other factors, play an important part in congestive heart failure pathogenesis and progression. We demonstrated that those levels decreased following peritoneal dialysis treatment in refractory congestive heart failure patients. The exact mechanism of beneficial effect of peritoneal dialysis in refractory congestive heart failure is currently unknown. Maintenance of fluid balance, leading to resetting of neurohumoral activation towards a more physiological condition, reduced remodeling due to the decrease in mechanical pressure on the heart, decreased inflammatory cytokine levels and oxidative stress, and a potential impact on uremic toxins could play a role in this regard. In this paper, we describe the unique characteristics of the peritoneal membrane, principals of peritoneal dialysis and its role in heart failure patients.
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Affiliation(s)
- Margarita Kunin
- Correspondence: ; Tel.: +97-235-302-581; Fax: 97-235-302-582
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50
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Garavaglia ML, Giustarini D, Colombo G, Reggiani F, Finazzi S, Calatroni M, Landoni L, Portinaro NM, Milzani A, Badalamenti S, Rossi R, Dalle-Donne I. Blood Thiol Redox State in Chronic Kidney Disease. Int J Mol Sci 2022; 23:ijms23052853. [PMID: 35269995 PMCID: PMC8911004 DOI: 10.3390/ijms23052853] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/26/2022] [Accepted: 03/03/2022] [Indexed: 02/05/2023] Open
Abstract
Thiols (sulfhydryl groups) are effective antioxidants that can preserve the correct structure of proteins, and can protect cells and tissues from damage induced by oxidative stress. Abnormal levels of thiols have been measured in the blood of patients with moderate-to-severe chronic kidney disease (CKD) compared to healthy subjects, as well as in end-stage renal disease (ESRD) patients on haemodialysis or peritoneal dialysis. The levels of protein thiols (a measure of the endogenous antioxidant capacity inversely related to protein oxidation) and S-thiolated proteins (mixed disulphides of protein thiols and low molecular mass thiols), and the protein thiolation index (the molar ratio of the S-thiolated proteins to free protein thiols in plasma) have been investigated in the plasma or red blood cells of CKD and ESRD patients as possible biomarkers of oxidative stress. This type of minimally invasive analysis provides valuable information on the redox status of the less-easily accessible tissues and organs, and of the whole organism. This review provides an overview of reversible modifications in protein thiols in the setting of CKD and renal replacement therapy. The evidence suggests that protein thiols, S-thiolated proteins, and the protein thiolation index are promising biomarkers of reversible oxidative stress that could be included in the routine monitoring of CKD and ESRD patients.
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Affiliation(s)
- Maria Lisa Garavaglia
- Department of Biosciences (Department of Excellence 2018–2022), Università degli Studi di Milano, Via Celoria 26, 20133 Milan, Italy; (M.L.G.); (G.C.); (L.L.); (A.M.)
| | - Daniela Giustarini
- Department of Biotechnology, Chemistry and Pharmacy (Department of Excellence 2018–2022), University of Siena, Via A. Moro 2, 53100 Siena, Italy;
| | - Graziano Colombo
- Department of Biosciences (Department of Excellence 2018–2022), Università degli Studi di Milano, Via Celoria 26, 20133 Milan, Italy; (M.L.G.); (G.C.); (L.L.); (A.M.)
| | - Francesco Reggiani
- Nephrology and Dialysis Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy or (F.R.); (S.F.); or (M.C.); (S.B.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Silvia Finazzi
- Nephrology and Dialysis Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy or (F.R.); (S.F.); or (M.C.); (S.B.)
| | - Marta Calatroni
- Nephrology and Dialysis Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy or (F.R.); (S.F.); or (M.C.); (S.B.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Lucia Landoni
- Department of Biosciences (Department of Excellence 2018–2022), Università degli Studi di Milano, Via Celoria 26, 20133 Milan, Italy; (M.L.G.); (G.C.); (L.L.); (A.M.)
| | - Nicola Marcello Portinaro
- Department of Medical Biotechnologies and Translational Medicine, Università degli Studi di Milano, 20133 Milan, Italy;
| | - Aldo Milzani
- Department of Biosciences (Department of Excellence 2018–2022), Università degli Studi di Milano, Via Celoria 26, 20133 Milan, Italy; (M.L.G.); (G.C.); (L.L.); (A.M.)
| | - Salvatore Badalamenti
- Nephrology and Dialysis Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy or (F.R.); (S.F.); or (M.C.); (S.B.)
| | - Ranieri Rossi
- Department of Biotechnology, Chemistry and Pharmacy (Department of Excellence 2018–2022), University of Siena, Via A. Moro 2, 53100 Siena, Italy;
- Correspondence: (R.R.); (I.D.-D.)
| | - Isabella Dalle-Donne
- Department of Biosciences (Department of Excellence 2018–2022), Università degli Studi di Milano, Via Celoria 26, 20133 Milan, Italy; (M.L.G.); (G.C.); (L.L.); (A.M.)
- Correspondence: (R.R.); (I.D.-D.)
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