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Haussaire D, Couchoud C, Elharrar X, Rostoker G. Epidemiology of tobacco use in dialysis patients in France and survey of nephrologists' involvement in counseling on tobacco discontinuation. J Nephrol 2024; 37:451-459. [PMID: 38253969 DOI: 10.1007/s40620-023-01842-2] [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: 08/16/2023] [Accepted: 11/18/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Tobacco smoking is an independent risk factor for chronic kidney disease (CKD) and increases morbidity and mortality in CKD patients. The primary objective of the study was to investigate the epidemiology of smoking in patients undergoing maintenance dialysis in France. A second objective was to assess the involvement of nephrologists in supporting patients for smoking cessation. METHODS Data on the smoking history of prevalent patients on maintenance dialysis in France between 2010 and 2020 were obtained from the REIN database (Renal Epidemiology and Information Network), updated by all French nephrology and dialysis centers. As for the support to smoking discontinuation, a questionnaire on smoking cessation assistance was sent to all members of the French Society of Nephrology, Dialysis and Transplantation (SFNDT). RESULTS The proportion of current smokers among patients on maintenance dialysis was 10.4% in 2010, 11.2% in 2015 and 11.6% in 2020. A total of 228 nephrologists among the 790 members of the SFNDT participated in the survey (28.9%). Most respondents were women (57.3%), worked at a public hospital (61.1%), were under 40 years of age (51.3%) and had no history of smoking (60.8%). The majority reported asking patients about their smoking status and offering brief advice. Among respondents, 72.8% offered help with smoking cessation, 46.3% referred their smoking patients to a tobacco specialist, 51.8% reported prescribing drugs to quit tobacco, and 81.6% requested further training in how to support patients for smoking cessation. CONCLUSION Smoking cessation training for nephrologists and dedicated programs for patients in nephrology units could improve our practices and decrease the high prevalence of smoking in patients with ESKD.
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Affiliation(s)
- Delphine Haussaire
- Centre Hospitalier Intercommunal de Mont de Marsan, Avenue Pierre de Coubertin, BP 417, 40024, Mont-de-Marsan, France.
| | - Cécile Couchoud
- Registre Réseau Épidémiologique Et Information en Néphrologie (REIN), Agence de La Biomédecine, 1 Avenue du Stade de France, 93212, Saint-Denis-La Plaine, France
| | - Xavier Elharrar
- Centre Hospitalier de Dax, Côte d'argent, Boulevard Yves du Manoir, 40100, Dax, France
| | - Guy Rostoker
- Hôpital Privé Claude Galien, Ramsay Santé, 20 Route de Boussy-Saint-Antoine, 91480, Quincy-Sous-Sénart, France
- Collège de médecine des Hôpitaux de Paris, 10 Rue Des Fossés Saint-Marcel, 75005, Paris, France
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2
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Yohanna S, Naylor KL, Luo B, Dixon SN, Bota SE, Kim SJ, Blake PG, Elliott L, Cooper R, Knoll GA, Treleaven D, Wang C, Garg AX. Variation in Kidney Transplant Referral Across Chronic Kidney Disease Programs in Ontario, Canada. Can J Kidney Health Dis 2023; 10:20543581231169608. [PMID: 37359986 PMCID: PMC10286544 DOI: 10.1177/20543581231169608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/11/2023] [Indexed: 06/28/2023] Open
Abstract
Background Eligible patients with kidney failure should have equal access to kidney transplantation. Transplant referral is the first crucial step toward receiving a kidney transplant; however, studies suggest substantial variation in the rate of kidney transplant referral across regions. The province of Ontario, Canada, has a public, single-payer health care system with 27 regional chronic kidney disease (CKD) programs. The probability of being referred for kidney transplant may not be equal across CKD programs. Objective To determine whether there is variability in kidney transplant referral rates across Ontario's CKD programs. Design Population-based cohort study using linked administrative health care databases from January 1, 2013, to November 1, 2016. Setting Twenty-seven regional CKD programs in the province of Ontario, Canada. Patients Patients approaching the need for dialysis (advanced CKD) and patients receiving maintenance dialysis (maximum follow-up: November 1, 2017). Measurements Kidney transplant referral. Methods We calculated the 1-year unadjusted cumulative probability of kidney transplant referral for Ontario's 27 CKD programs using the complement of Kaplan-Meier estimator. We calculated standardized referral ratios (SRRs) for each CKD program, using expected referrals from a 2-staged Cox proportional hazards model, adjusting for patient characteristics in the first stage. Standardized referral ratios with a value less than 1 were below the provincial average (maximum possible follow-up of 4 years 10 months). In an additional analysis, we grouped CKD programs according to 5 geographic regions. Results Among 8641 patients with advanced CKD, the 1-year cumulative probability of kidney transplant referral ranged from 0.9% (95% confidence interval [CI]: 0.2%-3.7%) to 21.0% (95% CI: 17.5%-25.2%) across the 27 CKD programs. The adjusted SRR ranged from 0.2 (95% CI: 0.1-0.4) to 4.2 (95% CI: 2.1-7.5). Among 6852 patients receiving maintenance dialysis, the 1-year cumulative probability of transplant referral ranged from 6.4% (95% CI: 4.0%-10.2%) to 34.5% (95% CI: 29.5%-40.1%) across CKD programs. The adjusted SRR ranged from 0.2 (95% CI: 0.1-0.3) to 1.8 (95% CI: 1.6-2.1). When we grouped CKD programs according to geographic region, we found that patients residing in Northern regions had a substantially lower 1-year cumulative probability of transplant referral. Limitations Our cumulative probability estimates only captured referrals within the first year of advanced CKD or maintenance dialysis initiation. Conclusions There is marked variability in the probability of kidney transplant referral across CKD programs operating in a publicly funded health care system.
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Affiliation(s)
| | - Kyla L. Naylor
- ICES, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Bin Luo
- ICES, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Stephanie N. Dixon
- ICES, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Sarah E. Bota
- ICES, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - S. Joseph Kim
- Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Peter G. Blake
- Ontario Renal Network, Ontario Health, Toronto, ON, Canada
- Division of Nephrology, Western University, London, ON, Canada
| | - Lori Elliott
- Ontario Renal Network, Ontario Health, Toronto, ON, Canada
| | - Rebecca Cooper
- Ontario Renal Network and Trillium Gift of Life Network, Ontario Health, Toronto, ON, Canada
| | - Gregory A. Knoll
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Darin Treleaven
- Division of Nephrology, McMaster University, Hamilton, ON, Canada
| | - Carol Wang
- Division of Nephrology, Western University, London, ON, Canada
| | - Amit X. Garg
- ICES, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
- Division of Nephrology, Western University, London, ON, Canada
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3
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Schmid-Mohler G, Beckmann S, Zala P, Huber L, Held U, Fehr T, Wüthrich RP, Petry H, Mueller TF. First Testing of Literature-Based Models for Predicting Increase in Body Weight and Adipose Tissue Mass After Kidney Transplantation. Prog Transplant 2022; 32:300-308. [PMID: 36053125 PMCID: PMC9660270 DOI: 10.1177/15269248221122961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: Weight gain is a risk factor for poor clinical outcomes following kidney transplantation. Research Question: This study's aim was a first testing of 2 models to identify patients early after kidney transplantation who are at risk for weight gain and increase in adipose tissue mass in the first year after kidney transplantation. Design: The literature-based models were evaluated on longitudinal data of 88, respectively 79 kidney transplant recipients via ordinary and Firth regression, using gains ≥ 5% in weight and adipose tissue mass respectively as primary and secondary endpoints. Results: The models included physical activity, smoking cessation at time of kidney transplantation, self-reported health status, depressive symptomatology, gender, age, education, baseline body mass index and baseline trunk fat as predictors. Area under the curve was 0.797 (95%-CI 0.702 to 0.893) for the weight model and 0.767 (95%-CI 0.656 to 0.878) for the adipose tissue mass model-showing good, respectively fair discriminative ability. For weight gain ≥ 5%, main risk factors were smoking cessation at time of transplantation (OR 16.425, 95%-CI 1.737-155.288) and better self-reported baseline health state (OR 1.068 for each 1-unit increase, 95%-CI 1.012-1.128). For the adipose tissue mass gain ≥ 5%, main risk factor was overweight/obesity (BMI ≥ 25) at baseline (odds ratio 7.659, 95%-CI 1.789-32.789). Conclusions: The models have potential to assess patients' risk for weight or adipose tissue mass gain during the year after transplantation, but further testing is needed before implementation in clinical practice.
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Affiliation(s)
- Gabriela Schmid-Mohler
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland,Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland,Gabriela Schmid-Mohler, PhD, RN, Center of
Clinical Nursing Science, University Hospital Zurich, Ramistrasse 100, CH-8091,
Zurich, Switzerland.
| | - Sonja Beckmann
- Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Patrizia Zala
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Laura Huber
- Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Ulrike Held
- Department of Biostatistics at Epidemiology, Biostatistics and
Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Thomas Fehr
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland,Department of Internal Medicine, Cantonal Hospital Graubünden, Chur,
Switzerland
| | | | - Heidi Petry
- Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Thomas F. Mueller
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
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4
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Kotta PA, Elango M, Papalois V. Preoperative Cardiovascular Assessment of the Renal Transplant Recipient: A Narrative Review. J Clin Med 2021; 10:2525. [PMID: 34200235 PMCID: PMC8201125 DOI: 10.3390/jcm10112525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/27/2021] [Accepted: 05/29/2021] [Indexed: 12/23/2022] Open
Abstract
Patients with end-stage kidney disease (ESKD) have a high prevalence of cardiovascular disease; it is the leading cause of death in these patients and the optimisation of their cardiovascular health may improve their post-transplant outcomes. Patients awaiting renal transplant often spend significant amounts of time on the waiting list allowing for the assessment and optimisation of their cardiovascular system. Coronary artery disease (CAD) is commonly seen in these patients and we explore the possible functional and anatomical investigations that can help assess and manage CAD in renal transplant candidates. We also discuss other aspects of cardiovascular assessment and management including arrhythmias, impaired ventricular function, valvular disease, lifestyle and pulmonary arterial hypertension. We hope that this review can form a basis for centres hoping to implement an enhanced recovery after surgery (ERAS) protocol for renal transplantation.
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Affiliation(s)
| | - Madhivanan Elango
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK;
| | - Vassilios Papalois
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK;
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5
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Madziarska K, Hap K, Mazanowska O, Sutkowska E. Comprehensive lifestyle modification as
complementary therapy to prevent and manage
post-transplant diabetes mellitus*. POSTEP HIG MED DOSW 2021. [DOI: 10.5604/01.3001.0014.8311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Post-transplant diabetes mellitus (PTDM) is one from the most common metabolic complications
after kidney transplantation. PTDM develops in the early period after transplantation.
The risk factors of PTDM are carbohydrate imbalances occurring in the patient prior to
transplantation, surgery and the inclusion of immunosuppressive treatment. Kidney transplant
patients tend to gain weight, which is associated with an increased risk of post-transplant
diabetes, cardiovascular diseases and abnormal transplanted kidney function.
Patients after kidney transplantation should be advised to adopt a lifestyle based on a proper
diet, exercise, weight control and smoking cessation. The strategy to reduce the risk factors
for PTDM development should start before transplantation and continue after kidney
transplantation. A targeted, non-pharmacological approach to patients already during the
dialysis period may have a significant impact on reducing post-transplantation diabetes.
Lifestyle interventions can effectively reduce the risk of development and inhibit the progression
of post-transplantation diabetes. The article describes elements of comprehensive
non-pharmacological management based on available knowledge of rehabilitation, dietetics
and psychology.
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Affiliation(s)
- Katarzyna Madziarska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Poland
| | - Katarzyna Hap
- Department and Division of Medical Rehabilitation, Wroclaw Medical University, Poland
| | - Oktawia Mazanowska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Poland
| | - Edyta Sutkowska
- Department and Division of Medical Rehabilitation, Wroclaw Medical University, Poland
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6
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Effects of Smoking on Solid Organ Transplantation Outcomes. Am J Med 2019; 132:413-419. [PMID: 30452885 DOI: 10.1016/j.amjmed.2018.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 01/15/2023]
Abstract
Tobacco smoking is the leading preventable cause of death worldwide. Both donor and recipient smoking have been shown to increase graft loss and mortality in solid organ transplant recipients in many studies. Only in lung transplants is smoking a universal contraindication to transplantation. Transplant centers implement different policies regarding smoking recipients and allografts from smoking donors. Due to scarcity of available allografts, the risks of smoking have to be weighed against the risks of a longer transplant waitlist period. Although transplant centers implement different strategies to encourage smoking cessation pre- and post-transplant, not many studies have been published that validate the efficacy of smoking cessation interventions in this vulnerable population. This article summarizes the results of studies investigating prevalence, impact on outcomes, and cessationinterventions for smoking in the transplant population. We report herein a review of the elevated risks of infection, malignancy, graft loss, cardiovascular events, and mortality in solid organ transplant populations.
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7
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Naylor KL, Dixon SN, Garg AX, Kim SJ, Blake PG, Nesrallah GE, McCallum MK, D'Antonio C, Li AH, Knoll GA. Variation in Access to Kidney Transplantation Across Renal Programs in Ontario, Canada. Am J Transplant 2017; 17:1585-1593. [PMID: 28068455 DOI: 10.1111/ajt.14133] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 11/10/2016] [Accepted: 11/12/2016] [Indexed: 01/25/2023]
Abstract
In the United States, kidney transplant rates vary significantly across end-stage renal disease (ESRD) networks. We conducted a population-based cohort study to determine whether there was variability in kidney transplant rates across renal programs in a health care system distinct from the United States. We included incident chronic dialysis patients in Ontario, Canada, from 2003 to 2013 and determined the 1-, 5-, and 10-year cumulative incidence of kidney transplantation in 27 regional renal programs (similar to U.S. ESRD networks). We also assessed the cumulative incidence of kidney transplant for "healthy" dialysis patients (aged 18-50 years without diabetes, coronary disease, or malignancy). We calculated standardized transplant ratios (STRs) using a Cox proportional hazards model, adjusting for patient characteristics (maximum possible follow-up of 11 years). Among 23 022 chronic dialysis patients, the 10-year cumulative incidence of kidney transplantation ranged from 7.4% (95% confidence interval [CI] 4.8-10.7%) to 31.4% (95% CI 16.5-47.5%) across renal programs. Similar variability was observed in our healthy cohort. STRs ranged from 0.3 (95% CI 0.2-0.5) to 1.5 (95% CI 1.4-1.7) across renal programs. There was significant variation in kidney transplant rates across Ontario renal programs despite patients having access to the same publicly funded health care system.
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Affiliation(s)
- K L Naylor
- Institute for Clinical Evaluative Sciences (ICES), London, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - S N Dixon
- Institute for Clinical Evaluative Sciences (ICES), London, Ontario, Canada.,Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - A X Garg
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada.,Division of Nephrology, Western University, London, Ontario, Canada
| | - S J Kim
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - P G Blake
- Division of Nephrology, Western University, London, Ontario, Canada
| | - G E Nesrallah
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Nephrology Program, Humber River Hospital, Toronto, Ontario, Canada
| | - M K McCallum
- Institute for Clinical Evaluative Sciences (ICES), London, Ontario, Canada
| | - C D'Antonio
- Ontario Renal Network, Toronto, Ontario, Canada
| | - A H Li
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada.,Division of Nephrology, Western University, London, Ontario, Canada
| | - G A Knoll
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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8
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Abstract
Cigarette smoking affects many organs. It causes vasoconstriction through activation of sympathetic nervous system which leads to elevation of blood pressure and reduction in glomerular filtration rate and filtration pressure. It also causes thickening of renal arterioles. Cigarette smoking increases the risk of microalbuminuria and accelerates progression of microalbuminuria to macroalbuminuria. Furthermore, it causes rapid loss of glomerular filtration rate in chronic kidney disease patients. After kidney donation, these factors may be injurious to the solitary kidney. Kidney donors with history of cigarette smoking are prone to develop perioperative complications, pneumonia, and wound infection. Postkidney transplantation various stressors including warm and cold ischemia time, delayed graft function, and exposure to calcineurin inhibitors may result in poor graft function. Continuation of cigarette smoking in kidney transplant recipients will add further risk. In this review, we will specifically discuss the effects of cigarette smoking on normal kidneys, live kidney donors, and kidney transplant recipients. This will include adverse effects of cigarette smoking on graft and patient survival, cardiovascular events, rejection, infections, and cancers in kidney transplant recipients. Lastly, the impact of kidney transplantation on behavior and smoking cessation will also be discussed.
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9
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Correlates and Outcomes of Posttransplant Smoking in Solid Organ Transplant Recipients. Transplantation 2016; 100:2252-2263. [DOI: 10.1097/tp.0000000000001335] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Cote D, Chirichella T, Noon K, Shafran D, Augustine J, Schulak J, Sanchez E, Woodside K. Abdominal Organ Transplant Center Tobacco Use Policies Vary by Organ Program Type. Transplant Proc 2016; 48:1920-6. [DOI: 10.1016/j.transproceed.2016.02.072] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/16/2016] [Indexed: 10/21/2022]
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11
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Pita-Fernández S, Seijo-Bestilleiro R, Pértega-Díaz S, Alonso-Hernández Á, Fernández-Rivera C, Cao-López M, Seoane-Pillado T, López-Calviño B, González-Martín C, Valdés-Cañedo F. A randomized clinical trial to determine the effectiveness of CO-oximetry and anti-smoking brief advice in a cohort of kidney transplant patients who smoke: study protocol for a randomized controlled trial. Trials 2016; 17:174. [PMID: 27036112 PMCID: PMC4818538 DOI: 10.1186/s13063-016-1311-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 03/23/2016] [Indexed: 11/28/2022] Open
Abstract
Background The cardiovascular risk in renal transplant patients is increased in patients who continue to smoke after transplantation. The aim of the study is to measure the effectiveness of exhaled carbon monoxide (CO) measurement plus brief advisory sessions, in comparison to brief advice, to reduce smoking exposure and smoking behavior in kidney transplant recipients who smoke. The effectiveness will be measured by: (1) abandonment of smoking, (2) increase in motivation to stop smoking, and (3) reduction in the number of cigarettes smoked per day. Methods/design Design: a randomized, controlled, open clinical trial with blinded evaluation. Scope: A Coruña Hospital (Spain), reference to renal transplantation in the period 2012–2015. Inclusion criteria: renal transplant patients who smoke in the precontemplation, contemplation or preparation stages according to the Prochaska and DiClemente’s Stages of Change model, and who give their consent to participate. Exclusion criteria: smokers attempting to stop smoking, patients with terminal illness or mental disability that prevents them from participating. Randomization: patients will be randomized to the control group (brief advisory session) or the intervention group (brief advisory session plus measuring exhaled CO). The sample target size is n = 112, with 56 patients in each group. Allowing for up to 10 % loss to follow-up, this would provide 80 % power to detect a 13 % difference in attempting to give up smoking outcomes at a two-tailed significance level of 5 %. Measurements: sociodemographic characteristics, cardiovascular risk factors, treatment, rejection episodes, infections, self-reported smoking habit, drug use, level of dependence (the Fagerström test), stage of change (Prochaska and DiClemente’s Stages of Change model), and motivation to giving up smoking (the Richmond test). Response: the effectiveness will be evaluated every 3, 6, 9 and 12 months as: pattern of tobacco use (self-reported tobacco use), smoking cessation rates, carbon monoxide (CO) levels in exhaled air measured by CO-oximetry, urinary cotinine tests, nicotine dependence (Fagerström test), motivational stages of change (Prochaska and DiClemente’s stages) and motivation to stop smoking (the Richmond test). Analysis: descriptive statistics and linear/logistic multiple regression models will be performed. Clinical relevance will be measured as relative risk reduction, absolute risk reduction and the number needed to treat. Ethics: informed consent of the patients and Ethical Review Board was obtained (code 2011/061). Discussion Tobacco is a modifiable risk factor that increase the risk of morbidity and mortality in kidney transplant recipients. If effectiveness of CO-oximetry is confirmed to reduce tobacco exposure, we would have an intervention that is easy to use, low cost and with great implications about cardiovascular risk prevention in these patients. Trial registration Current Controlled Trials ISRCTN16615772. EudraCT number: 2015-002009-12.
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Affiliation(s)
- Salvador Pita-Fernández
- Clinical Epidemiology and Biostatistics Unit, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, Hotel de Pacientes, 7a, As Xubias, 84, 15006, A Coruña, Spain.
| | - Rocío Seijo-Bestilleiro
- Clinical Epidemiology and Biostatistics Unit, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, Hotel de Pacientes, 7a, As Xubias, 84, 15006, A Coruña, Spain
| | - Sonia Pértega-Díaz
- Clinical Epidemiology and Biostatistics Unit, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, Hotel de Pacientes, 7a, As Xubias, 84, 15006, A Coruña, Spain
| | - Ángel Alonso-Hernández
- Nephrology Department, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain
| | - Constantino Fernández-Rivera
- Nephrology Department, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain
| | - Mercedes Cao-López
- Nephrology Department, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain
| | - Teresa Seoane-Pillado
- Clinical Epidemiology and Biostatistics Unit, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, Hotel de Pacientes, 7a, As Xubias, 84, 15006, A Coruña, Spain
| | - Beatriz López-Calviño
- Clinical Epidemiology and Biostatistics Unit, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, Hotel de Pacientes, 7a, As Xubias, 84, 15006, A Coruña, Spain
| | - Cristina González-Martín
- Clinical Epidemiology Research Group, Health Sciences Department, Escuela Universitaria de Enfermería y Podología, Universidade da Coruña (UDC), Campus de Ferrol, 15471, Ferrol, Spain
| | - Francisco Valdés-Cañedo
- Nephrology Department, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain
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Béchade C, Le Maître B, Lobbedez T, Bouvier N, Hurault de Ligny B, Châtelet V. Étude PRETAGREF : prévalence et facteurs associés au tabagisme chez les patients transplantés rénaux. Nephrol Ther 2016; 12:48-55. [DOI: 10.1016/j.nephro.2015.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 10/22/2022]
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13
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Alba MM, Citarelli AN, Menni F, Agricola M, Braicovich A, De Horta E, De Rosa F, Filanino G, Gaggiotti R, Junqueras N, Martinelli S, Milan A, Morales ME, Setti S, Villalba DO. Tobacco and end stage renal disease: a multicenter, cross-sectional study in Argentinian Northern Patagonia. Tob Induc Dis 2015; 13:28. [PMID: 26327820 PMCID: PMC4553923 DOI: 10.1186/s12971-015-0051-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 08/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoking and chronic kidney disease are major public health problems with common features -high prevalence and mortality, high cardiovascular risk, gender differences and high prevalence in low income people-, but the link between them is poorly recognized. Our objectives were to investigate the exposure of dialysis patients to tobacco and to know their smoking behavior. METHODS We performed a multicenter, cross-sectional study in nine dialysis units in the Argentinian Northern Patagonia. We investigated smoker status, lifetime tobacco consumption, current tobacco use, breath carbon monoxide and % carboxyhaemoglobin. Fagerström and Richmond tests were performed for active smokers. STATISTICAL ANALYSIS one way ANOVA and Tukey's test for post hoc test. For exploratory analysis, frequency tables through chi-square distribution and single correspondence analysis were performed. RESULTS Six hundred thirty six patients (60.9 % males, 39.1 % females) were interviewed. Almost 70 % of them had had tobacco exposure. Excluding light smokers, the lifetime consumption was significantly different (p = 0.0052) between sexes (33.1 ± 2.4 pack/years in males and 18.2 ± 2.1 pack/years in females) The distribution of etiologies changed significantly (χ (2) p < 0.0001) with smoker status and the dose of tobacco smoking, with an increase in the diagnosis of nephrosclerosis in patients with high and very high lifetime consumption (from 16.1 % in non-smokers to 28.2 and 27 % respectively), and in passive smokers (from 16.1 to 27.3 %). The male preponderance of end-stage renal disease disappeared when only non-smokers were considered and grew with the increase in the lifetime consumption. Active smokers have small consumption, both low CO level and % COHb, low dependence and a good motivation to quit, but a high lifetime consumption. CONCLUSIONS Exposure of dialysis patients to tobacco is high and could be related to the progression to the final stage of the renal disease. It seems that tobacco renal damage is mostly hidden in the diagnosis of nephrosclerosis. The gender difference observed in these patients could also have a nexus with the men's higher tobacco exposure. Active smokers have a low current consumption but a high lifetime tobacco dose.
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Affiliation(s)
- Maria M Alba
- Northern Patagonia Association of Nephrology, Entre Ríos 651, Neuquén, 8300 Argentina ; Unidad Renal Cipolletti, España 885, Cipolletti 8332 Río Negro, Argentina
| | - Alicia N Citarelli
- Northern Patagonia Association of Nephrology, Entre Ríos 651, Neuquén, 8300 Argentina
| | - Fernanda Menni
- Department of Economy and Statistics of INTA (National Institute of Agrological Technology) Estación Experimental Alto Valle del Río Negro, Ruta Nacional 22 Km 1190, 8332 Allen Río Negro, Argentina
| | - Maria Agricola
- Northern Patagonia Association of Nephrology, Entre Ríos 651, Neuquén, 8300 Argentina
| | - Alejandra Braicovich
- Northern Patagonia Association of Nephrology, Entre Ríos 651, Neuquén, 8300 Argentina
| | - Eduardo De Horta
- Northern Patagonia Association of Nephrology, Entre Ríos 651, Neuquén, 8300 Argentina
| | - Fernando De Rosa
- Northern Patagonia Association of Nephrology, Entre Ríos 651, Neuquén, 8300 Argentina
| | - Graciela Filanino
- Northern Patagonia Association of Nephrology, Entre Ríos 651, Neuquén, 8300 Argentina
| | - Raul Gaggiotti
- Northern Patagonia Association of Nephrology, Entre Ríos 651, Neuquén, 8300 Argentina
| | - Nelson Junqueras
- Northern Patagonia Association of Nephrology, Entre Ríos 651, Neuquén, 8300 Argentina
| | - Sandra Martinelli
- Northern Patagonia Association of Nephrology, Entre Ríos 651, Neuquén, 8300 Argentina
| | - Adriana Milan
- Northern Patagonia Association of Nephrology, Entre Ríos 651, Neuquén, 8300 Argentina
| | - Mabel E Morales
- Northern Patagonia Association of Nephrology, Entre Ríos 651, Neuquén, 8300 Argentina
| | - Silvia Setti
- Northern Patagonia Association of Nephrology, Entre Ríos 651, Neuquén, 8300 Argentina
| | - Daniel O Villalba
- Unidad Renal Cipolletti, España 885, Cipolletti 8332 Río Negro, Argentina
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Abstract
Over the last two decades in particular there has been a remarkable increase in the number of solid organ transplants being performed worldwide alongside improvements in long-term survival rates. However, the infrastructure at transplant centres has been unable to keep pace with the current volume of the transplant patient work load. These pressures on transplant specialist centres has led to calls for an increased role of the general practitioner (GP) managing particular aspects of transplant patients' medical care. Indeed, many aspects of follow-up care such as screening for malignancies, preventing infection through immunisation programmes, and managing cardiovascular risk factors are already important aspects of family practice medicine. This paper aims to review some of the aspects of transplant patient care that is important for healthcare workers in family practice to manage.
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Affiliation(s)
- Lloyd D. Hughes
- Department of Ageing and Health, Academic Foundation Doctor, NHS Tayside and University of Dundee, 1 Albert Crescent, Newport on Tay, Kingdom of Fife, DD6 8DT, Scotland
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15
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Abstract
Smoking, both by donors and by recipients, has a major impact on outcomes after organ transplantation. Recipients of smokers' organs are at greater risk of death (lungs hazard ratio [HR], 1.36; heart HR, 1.8; and liver HR, 1.25), extended intensive care stays, and greater need for ventilation. Kidney function is significantly worse at 1 year after transplantation in recipients of grafts from smokers compared with nonsmokers. Clinicians must balance the use of such higher-risk organs with the consequences on waiting list mortality if the donor pool is reduced further by exclusion of such donors. Smoking by kidney transplant recipients significantly increases the risk of cardiovascular events (29.2% vs. 15.4%), renal fibrosis, rejection, and malignancy (HR, 2.56). Furthermore, liver recipients who smoke have higher rates of hepatic artery thrombosis, biliary complications, and malignancy (13% vs. 2%). Heart recipients with a smoking history have increased risk of developing coronary atherosclerosis (21.2% vs. 12.3%), graft dysfunction, and loss after transplantation. Self-reporting of smoking is commonplace but unreliable, which limits its use as a tool for selection of transplant candidates. Despite effective counseling and pharmacotherapy, recidivism rates after transplantation remain high (10-40%). Transplant services need to be more proactive in educating and implementing effective smoking cessation strategies to reduce rates of recidivism and the posttransplantation complications associated with smoking. The adverse impact of smoking by the recipient supports the requirement for a 6-month period of abstinence in lung recipients and cessation before other solid organs.
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16
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[Smoking cessation in case of chronic kidney disease]. Nephrol Ther 2012. [PMID: 23199888 DOI: 10.1016/j.nephro.2012.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Smoking is one of the main causes of morbidity and mortality around the world. In France, despite increase of cost of cigarettes and exclusion of smoking in public places, daily smoking consummation remains high, particularly in women and young. Now, smoking is considered as a compartmental and/or psychologic and/or physic addiction. There are many categories of smokers and smoking cessation strategies must be tailored to individual level. Whatever the etiology of chronic kidney disease, in dialysis patient as transplanted, hypertension and vascular diseases are strong determinants of prognosis. In this way, there is a need for stronger involvement of nephrologists in the process of smoking cessation of their patients. Therapeutics and strategies are reviewed.
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17
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Alves SA, Carlos CP, Mendes GEF, Oliveira SM, Luz MAM, Souza RPS, Matimoto RL, Coimbra TM, Burdmann EA. Previous exposure to cigarette smoke aggravates experimental cyclosporine-induced nephrotoxicity. Am J Nephrol 2012; 36:334-41. [PMID: 23018139 DOI: 10.1159/000342337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 08/02/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS The effects of cigarette smoke (CS) on cyclosporine (CsA)-induced nephrotoxicity are poorly studied. This study aims to assess the effects of previous exposure to CS on CsA nephrotoxicity. METHODS Rats were either exposed to CS or sham (S) procedures for 10 min twice a day for 20 weeks. From the 16th to the 20th week, they received a low-salt diet. Beginning with the 17th week, they were given 2.5 mg/day CsA or vehicle (VH) for 3 weeks. The final groups were VH/CS, CsA/CS, VH/S, and CsA/S. On day 141, glomerular filtration rate (GFR), renal blood flow (RBF), renal vascular resistance (RVR), tubulointerstitial fibrosis, and CsA blood levels were measured and immunohistochemistry was analyzed for renal α-smooth muscle actin (SMA), nitrotyrosine, and vimentin. RESULTS CsA decrease in GFR was enhanced by CS exposure. CsA associated with CS induced higher periglomerular α-SMA and renal nitrotyrosine expression. CsA decreased RBF, but increased RVR, tubulointerstitial fibrosis, and α-SMA and renal vimentin expression. These changes and the CsA blood levels were not affected by CS exposure. CONCLUSION CS aggravated the CsA-induced impairment of GFR and CS associated with CsA caused the development of periglomerular structural lesions and oxidative stress in a rat model of CsA nephrotoxicity.
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Affiliation(s)
- Sueli A Alves
- Division of Nephrology, São Jose do Rio Preto Medical School, São Jose do Rio Preto, Brazil
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18
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Agarwal PK, Hellemons ME, Zelle DM, van Ree RM, van den Born J, van der Heide JJH, Gans ROB, van Son WJ, Navis G, Bakker SJL. Smoking is a risk factor for graft failure and mortality after renal transplantation. Am J Nephrol 2011; 34:26-31. [PMID: 21659736 DOI: 10.1159/000328903] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 04/30/2011] [Indexed: 12/29/2022]
Abstract
BACKGROUND Smoking in renal transplant recipients (RTR) is an acknowledged cardiovascular risk factor. It is, however, unclear whether smoking also increases the risk of graft failure (GF). METHOD In this study, we prospectively assessed the association of current smoking versus past and never smoking with GF and mortality in 604 RTR (age 51.5 ± 12.1 years, 55% male). RESULTS At inclusion, 133 (22%) were current smokers, 255 (42%) were past smokers and 216 (36%) never smoked. During follow-up of 5.3 (4.7-5.7) years, 41 (7%) RTR experienced GF and 95 RTR (16%) died. Current smoking RTR had higher risk for GF compared to never smoking RTR (hazard ratio, HR = 3.3, 95% CI 1.5-7.1, p = 0.002). Past smoking RTR had similar risk of GF as never smoking RTR (HR = 1.1, 95% CI 0.5-2.6, p = 0.7). Current smoking RTR and past smoking RTR were at higher risk for death than never smoking RTR (HR = 2.1, 95% CI 1.1-3.8, p = 0.016, and HR = 2.4, 95% CI 1.4-4.0, p = 0.001, respectively). CONCLUSION Smoking after renal transplantation is associated with risk for GF and mortality. Since past smoking is a risk factor for mortality but not for GF, smoking cessation may be beneficial to RTR in delaying GF in long term.
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Affiliation(s)
- Pramod K Agarwal
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
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19
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Gronwald W, Klein MS, Zeltner R, Schulze BD, Reinhold SW, Deutschmann M, Immervoll AK, Böger CA, Banas B, Eckardt KU, Oefner PJ. Detection of autosomal dominant polycystic kidney disease by NMR spectroscopic fingerprinting of urine. Kidney Int 2011; 79:1244-53. [PMID: 21389975 DOI: 10.1038/ki.2011.30] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is a frequent cause of kidney failure; however, urinary biomarkers for the disease are lacking. In a step towards identifying such markers, we used multidimensional-multinuclear nuclear magnetic resonance (NMR) spectroscopy with support vector machine-based classification and analyzed urine specimens of 54 patients with ADPKD and slightly reduced estimated glomerular filtration rates. Within this cohort, 35 received medication for arterial hypertension and 19 did not. The results were compared with NMR profiles of 46 healthy volunteers, 10 ADPKD patients on hemodialysis with residual renal function, 16 kidney transplant patients, and 52 type 2 diabetic patients with chronic kidney disease. Based on the average of 51 out of 701 NMR features, we could reliably discriminate ADPKD patients with moderately advanced disease from ADPKD patients with end-stage renal disease, patients with chronic kidney disease of other etiologies, and healthy probands with an accuracy of >80%. Of the 35 patients with ADPKD receiving medication for hypertension, most showed increased excretion of proteins and also methanol. In contrast, elevated urinary methanol was not found in any of the control and other patient groups. Thus, we found that NMR fingerprinting of urine differentiates ADPKD from several other kidney diseases and individuals with normal kidney function. The diagnostic and prognostic potential of these profiles requires further evaluation.
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Affiliation(s)
- Wolfram Gronwald
- Institute of Functional Genomics, University of Regensburg, Germany.
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20
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Banas MC, Banas B, Orth SR, Langer V, Reinhold SW, Weingart C, Jung B, Krüger B, Krämer BK. Traditional and Nontraditional Cardiovascular Risk Factors and Estimated Risk for Coronary Artery Disease in Renal Transplant Recipients: A Single-Center Experience. ACTA ACUST UNITED AC 2011; 119:c227-35. [DOI: 10.1159/000327616] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Accepted: 03/11/2011] [Indexed: 11/19/2022]
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21
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Gupta G, Unruh ML, Nolin TD, Hasley PB. Primary care of the renal transplant patient. J Gen Intern Med 2010; 25:731-40. [PMID: 20422302 PMCID: PMC2881977 DOI: 10.1007/s11606-010-1354-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Revised: 11/30/2009] [Accepted: 03/26/2010] [Indexed: 12/25/2022]
Abstract
There has been a remarkable rise in the number of kidney transplant recipients (KTR) in the US over the last decade. Increasing use of potent immunosuppressants, which are also potentially diabetogenic and atherogenic, can result in worsening of pre-existing medical conditions as well as development of post-transplant disease. This, coupled with improving long-term survival, is putting tremendous pressure on transplant centers that were not designed to deliver primary care to KTR. Thus, increasing numbers of KTR will present to their primary care physicians (PCP) post-transplant for routine medical care. Similar to native chronic kidney disease patients, KTRs are vulnerable to cardiovascular disease as well as a host of other problems including bone disease, infections and malignancies. Deaths related to complications of cardiovascular disease and malignancies account for 60-65% of long-term mortality among KTRs. Guidelines from the National Kidney Foundation and the European Best Practice Guidelines Expert Group on the management of hypertension, dyslipidemia, smoking, diabetes and bone disease should be incorporated into the long-term care plan of the KTR to improve outcomes. A number of transplant centers do not supply PCPs with protocols and guidelines, making the task of the PCP more difficult. Despite this, PCPs are expected to continue to provide general preventive medicine, vaccinations and management of chronic medical problems. In this narrative review, we examine the common medical problems seen in KTR from the PCP's perspective. Medical management issues related to immunosuppressive medications are also briefly discussed.
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Affiliation(s)
- Gaurav Gupta
- Nephrology Division, Department of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA.
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22
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van der Heide F, Dijkstra G, Porte RJ, Kleibeuker JH, Haagsma EB. Smoking behavior in liver transplant recipients. Liver Transpl 2009; 15:648-55. [PMID: 19479809 DOI: 10.1002/lt.21722] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Long-term morbidity and survival after orthotopic liver transplantation (OLT) are to a large degree determined by cardiovascular disease and cancer. Tobacco use is a well-known risk factor for both. The aim of this study was to examine smoking behavior before and after OLT and to define groups at risk for resuming tobacco use after OLT. In addition, we looked for a relation between smoking and morbidity after OLT. All 401 adult patients with a follow-up of at least 2 years after OLT were included. Data were collected from the charts. A questionnaire about smoking habits at 4 time points before and after OLT was sent to all 326 patients alive, and 301 (92%) patients responded. Both before and after OLT, 53% of patients never used tobacco, and around 17% were active smokers. Of the active smokers during the evaluation for OLT, almost one-third succeeded in cessation, often during the waiting time for OLT. Twelve percent of former smokers restarted smoking, mainly after OLT. Tobacco use was the highest in patients with alcoholic liver disease (52% were active smokers before OLT, and 44% were after OLT) and the lowest in patients with primary sclerosing cholangitis (1.4% were active smokers before OLT). At 10 years, the cumulative rate of malignancies was 12.7% in active smokers versus 2.1% in nonsmokers (P = 0.019). No effect on skin cancer or cardiovascular disease was found. In conclusion, smoking is a serious problem after OLT and increases the risk for malignancy. Prevention programs should focus not only on active smokers but also on former smokers.
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Affiliation(s)
- Frans van der Heide
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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