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Abstract
It is well recognised that kidney transplant recipients have an increased risk of cancers compared with the age and gender matched general population. Malignancy is one of the commonest causes of death among this cohort after cardiovascular disease. This increased risk is largely attributable to the effect of immunosuppression, which impairs T cell function, immunosurveillance and the immunological control of oncogenic viral infections. Cancer related mortality rates are also higher in solid organ transplant recipients compared with the general population. While early diagnosis may improve outcomes in these patients, cancer screening is debatable given the lack of randomised controlled trials in this cohort, and treatment is often challenging. This article reviews the epidemiology and risk factors for the development of malignancy in the post-transplant setting, as well as screening guidelines for specific malignancies of which patients are at particular risk.
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Floege J, Regele H, Gesualdo L. The ERA-EDTA database on recurrent glomerulonephritis following renal transplantation. Nephrol Dial Transplant 2013; 29:15-21. [DOI: 10.1093/ndt/gft299] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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McCann M, Clarke M, Mellotte G, Plant L, Fitzpatrick F. Vascular access and infection prevention and control: a national survey of routine practices in Irish haemodialysis units. Clin Kidney J 2013; 6:176-82. [PMID: 26019846 PMCID: PMC4432454 DOI: 10.1093/ckj/sft020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 02/14/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND National and international guidelines recommend the use of effective vascular access (VA) and infection prevention and control practices within the haemodialysis environment. Establishing an arterio-venous fistula (AVF) and preventing central venous catheter (CVC)-related infections are ongoing challenges for all dialysis settings. We surveyed VA and routine infection prevention and control practices in dialysis units, to provide national data on these practices in Ireland. METHODS A descriptive survey was emailed to nurse managers at all adult (n = 19) and children (n = 1) outpatient haemodialysis units in the Republic of Ireland. Data collected included AVF formation, CVC insertion and maintenance practices, VA use and surveillance of infection and screening protocols. Nineteen of the 20 units responded to the survey. RESULTS The AVF prevalence was 49% for 1370 patients in 17 units who provided these data [mean prevalence per unit: 45.7% (SD 16.2)]; the CVC mean prevalence per unit was 52.5% (SD 16.0). Fourteen dialysis units experienced inadequate access to vascular surgical procedures either due to a lack of dedicated theatre time or hospital beds. Six units administered intravenous prophylactic antimicrobials prior to CVC insertion with only two units using a CVC insertion checklist at the time of catheter insertion. CONCLUSION In general, dialysis units in Ireland show a strong adherence to national guidelines. Compared with the 12 countries participating in the Dialysis Outcomes Practice Patterns Study (DOPPS 4), in 2010, AVF prevalence in Irish dialysis units is the second lowest. Recommendations include establishing an AVF national prevalence target rate, discontinuing the administration of intravenous prophylactic antimicrobials prior to CVC insertion and promoting the use of CVC insertion checklists.
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Affiliation(s)
- Margaret McCann
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Michael Clarke
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- The All Ireland Hub for Trial Methodology Research, Queens University Belfast, Belfast, UK
| | - George Mellotte
- Department of Nephrology, Tallaght Hospital, Dublin, Ireland
| | - Liam Plant
- HSE National Renal Office andCork University Hospital, Cork, Ireland
| | - Fidelma Fitzpatrick
- Royal College of Physicians in Ireland, Beaumont Hospital & the Health Protection Surveillance Centre, Dublin, Ireland
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Rutkowski B, Rychlik I. Daily hemodialysis and caregivers burden. Nephrol Dial Transplant 2011; 26:2074-6. [PMID: 21708982 DOI: 10.1093/ndt/gfr298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Bolesław Rutkowski
- Department of Nephrology, Transplantology, and Internal Disease, University Medical of Gdansk, Gdansk, Poland.
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Eitner F, Fischereder M. Reply. Nephrol Dial Transplant 2011. [DOI: 10.1093/ndt/gfr162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Heemann U, Abramowicz D, Spasovski G, Vanholder R. Endorsement of the Kidney Disease Improving Global Outcomes (KDIGO) guidelines on kidney transplantation: a European Renal Best Practice (ERBP) position statement. Nephrol Dial Transplant 2011; 26:2099-106. [PMID: 21555392 DOI: 10.1093/ndt/gfr169] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
KDIGO (Kidney Disease: Improving Global Outcomes) is an international independent body aiming to 'improve the care and outcomes of kidney disease patients worldwide, through the development and implementation of clinical practice guidelines'. Recently, the KDIGO work group has produced comprehensive clinical practice guidelines for the care of kidney transplant recipients (KTRs). The guideline makes recommendations for immunosuppression, graft monitoring, as well as prevention and treatment of infection, cardiovascular disease, malignancy and other complications that are common in KTRs, including haematological and bone disorders. Because most guidelines were 'soft' rather than 'strong', and because global guidelines need to be adapted and implemented into the regional context where they are used, the European Renal Best Practice (ERBP) Advisory Board appointed a work group of transplant nephrologists and surgeons to review the newest KDIGO guideline and comment on its relevance and applicability for European KTRs. In this article, we concentrate only on those guidelines which we considered worth amending or adapting. All guidelines not mentioned are fully endorsed.
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Udayaraj UP, Haynes R, Winearls CG. Late presentation of patients with end-stage renal disease for renal replacement therapy--is it always avoidable? Nephrol Dial Transplant 2011; 26:3646-51. [DOI: 10.1093/ndt/gfr164] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Eitner F, Hauser IA, Rettkowski O, Rath T, Lopau K, Pliquett RU, Fiedler R, Guba M, Hilgers RD, Floege J, Fischereder M. Risk factors for Pneumocystis jiroveci pneumonia (PcP) in renal transplant recipients. Nephrol Dial Transplant 2010; 26:2013-7. [PMID: 21071545 DOI: 10.1093/ndt/gfq689] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pneumocystis jiroveci pneumonia (PcP) is a potentially life-threatening complication in renal transplant recipients with increased reports during the past few years. Individual risk factors for susceptibility to PcP are incompletely understood. METHODS We retrospectively analysed 60 cases of confirmed PcP, diagnosed in six German transplant centres between 2004 and 2008, as well as 60 matched controls. RESULTS Compared with controls, PcP cases revealed the following significant differences: PcP cases had a poorer renal function (eGFR 31 vs. 42 mL/min in controls), more biopsy-proven rejections (18 vs. 5 patients), more frequent treatment with mycophenolate mofetil (53 vs. 44 patients) and less frequent treatment with interleukin-2 receptor antagonist (20 vs. 32 patients). According to centre policy, in those years, none of the patients or controls had received PcP prophylaxis after transplantation. Of the 60 patients with PcP, 30% developed the disease after the currently recommended duration of prophylactic treatment, 27% died in the course of the disease and 45% required treatment in the ICU. CONCLUSIONS Our case-control study reveals a novel risk profile for PcP. Renal transplant recipients with more pronounced renal insufficiency following rejection episodes and treated with intensified immunosuppression are at particular risk for PcP.
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Affiliation(s)
- Frank Eitner
- Division of Nephrology and Immunology, Rheinisch-Westfälische Technische Hochschule Aachen, Germany.
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Dion-Labrie M, Fortin MC, Hébert MJ, Doucet H. Use of personalized medicine in the selection of patients for renal transplantation: views of Quebec transplant physicians and referring nephrologists. Per Med 2009; 6:485-499. [PMID: 29783306 DOI: 10.2217/pme.09.43] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM To explore the views of physicians on the use of personalized medicine tools to develop a new method for selecting potential recipients of a renal allograft. METHODS A total of 22 semidirected interviews, using clinical case studies. RESULTS According to the participants, this method has several possible applications within renal transplantation (individualizing immunosuppressive therapy, help with decision making, and possibly with the selection of patients). It could be more effective than the method presently used. The method must be validated scientifically, and must also involve clinical judgment. CONCLUSION The use of personalized medicine within transplantation must be in the best interests of the patient. An ethical reflection is necessary in order to focus on the possibility of patients being excluded, as well as on the resolution of the equity/efficacy dilemma. Empirical research has shown itself to be essential for ascertaining the views of the clinicians who will be working with the tools provided by personalized medicine.
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Affiliation(s)
- Marianne Dion-Labrie
- Groupe de recherche en bioéthique, Université de Montréal, P.O. Box 6128, Downtown Station, Montreal, Quebec, H3C 3J7, Canada.
| | - Marie-Chantal Fortin
- Centre Hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame, Québec, Canada
| | - Marie-Josée Hébert
- Shire Chair in Nephrology and Renal Transplantation and Regeneration Research Centre, Hôpital Notre-Dame, Québec, Canada
| | - Hubert Doucet
- Bioethics Department, Université de Montréal, Québec, Canada
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Vanholder R, Abramowicz D, Cannata-Andia JB, Cocchi V, Cochat P, Covic A, Eckardt KU, Fouque D, Heimburger O, Jenkins S, MacLeod A, Lindley E, Locatelli F, London G, Marti i Monros A, Spasovski G, Tattersall J, Van Biesen W, Wanner C, Wiecek A, Zoccali C. The future of European Nephrology 'Guidelines'-a declaration of intent by European Renal Best Practice (ERBP). NDT Plus 2009; 2:213-21. [PMID: 25983994 PMCID: PMC4421188 DOI: 10.1093/ndtplus/sfp035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 03/03/2009] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Daniel Abramowicz
- Département Médico-Chirurgical de Néphrologie, Dialyse et Transplantation, Hôpital Erasme, Brussels, Belgium
| | - Jorge B. Cannata-Andia
- Servicio de Metabolismo Oseo y Mineral, Instituto Reina Sofia de Investigación, REDinREN–ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Valentina Cocchi
- European Renal Association/European Dialysis and Transplantation Association
| | - Pierre Cochat
- Service de Pédiatrie, Centre De Référence Des Maladies Rénales Rares, Hospices Civils de Lyon et Université de Lyon, Lyon, France
| | - Adrian Covic
- Nephrology Dialysis and Transplantation, C. I. Parhon University Hospital, University of Medicine Gr. T. Popa, Iasi, Romania
| | - Kai-Uwe Eckardt
- Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Nuremberg, Germany
| | - Denis Fouque
- Département de Néphrologie, Hôpital Edouard-Herriot, Lyon, France
| | | | | | - Alison MacLeod
- Department of Medicine and Therapeutics, University of Aberdeen, Scotland
| | - Elisabeth Lindley
- Department of Renal Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Francesco Locatelli
- Department of Nephrology, Dialysis and Renal Transplantation, ‘A. Manzoni’ Hospital, Lecco, Italy
| | | | | | - Goce Spasovski
- Department of Nephrology, University Clinical Center, Skopje, Macedonia
| | - James Tattersall
- Department of Renal Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | - Andrej Wiecek
- Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia, Katowice, Francesca, Poland
| | - Carmine Zoccali
- Unità Operativa di Nefrologia, Dialisi e Trapianto, Ospedali Riuniti e CNR-IBIM, Reggio Cal 89125, Italy
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Vormfelde SV, Burckhardt G, Zirk A, Wojnowski L, Brockmöller J. Pharmacogenomics of diuretic drugs: data on rare monogenic disorders and on polymorphisms and requirements for further research. Pharmacogenomics 2003; 4:701-34. [PMID: 14596636 DOI: 10.1517/phgs.4.6.701.22817] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
This review summarizes the current status of our knowledge about the role of pharmacogenetic variation in response to diuretics and suggests future research topics for the field. Genes with a role in the pharmacokinetics of most diuretics are renal drug transporters, especially OAT1, OAT3 and OCT2 (genes SLC22A6, SLC22A8 and SLC22A2) whereas variants in carbonic anhydrase (CA), cytochrome P450 enzymes and sulfotransferases are relevant only for specific substances. Genes on the pharmacodynamic side include the primary targets of thiazide, loop, K+-sparing and aldosterone antagonistic diuretics: NCC, NKCC2, ENaC and the mineralocorticoid receptor (genes SLC12A3, SLC12A1, SCNN1A, B, G and NR3C2). Rare variants of these proteins cause Gitelman’s syndrome, Bartter’s syndrome, Liddle’s syndrome or pregnancy-induced hypertension. Polymorphisms in these and in associated proteins such as GNB3, α-adducin and angiotensin-converting enzyme (ACE) seem to be clinically relevant. In conclusion, first knowledge has evolved that efficacy of diuretic drugs may be determined by genetic polymorphisms in genes determining pharmacokinetics and pharmacodynamics of this drug class. In the future, the selection of a diuretic drug or the dosing schedules may be individually chosen based on pharmacogenetic parameters, however, many questions remain to be answered before this fantasy becomes reality.
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Affiliation(s)
- Stefan Viktor Vormfelde
- Department of Clinical Pharmacology & Department of Vegetative Physiology, Georg August University Göttingen, Robert-Koch-Str. 40, D-37075 Göttingen, Germany.
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Iseki K, Tozawa M. Reply. Nephrol Dial Transplant 2003. [DOI: 10.1093/ndt/gfg133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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