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Chen Q, Guo J, Han S, Wang T, Xia K, Yu B, Liu Y, Qiu T, Zhou J. The impact of donor diabetes on recipient postoperative complications, renal function, and survival rate in deceased donor kidney transplantation: a single-center analysis. Ren Fail 2024; 46:2391067. [PMID: 39177237 PMCID: PMC11346333 DOI: 10.1080/0886022x.2024.2391067] [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: 02/26/2024] [Revised: 07/26/2024] [Accepted: 08/06/2024] [Indexed: 08/24/2024] Open
Abstract
As the global incidence of diabetes rises and diagnoses among younger patients increase, transplant centers worldwide are encountering more organ donors with diabetes. This study examined 80 donors and 160 recipients, including 30 donors with diabetes (DD) and their 60 recipients (DDR). The control group comprised 50 non-diabetic donors (ND) and 100 recipients (NDR). We analyzed clinical, biochemical, and pathological data for both diabetic and control groups, using logistic regression to identify risk factors for delayed graft function (DGF) after kidney transplantation. Results showed that pre-procurement blood urea nitrogen levels were significantly higher in DD [18.20 ± 10.63 vs. 10.86 ± 6.92, p = 0.002] compared to ND. Renal pathological damage in DD was notably more severe, likely contributing to the higher DGF incidence in DDR compared to NDR. Although DDR had poorer renal function during the first three months post-transplant, both groups showed similar renal function thereafter. No significant differences were observed in 1-year or 3-year mortality rates or graft failure rates between DDR and NDR. Notably, according to the Renal Pathology Society (RPS) grading system, kidneys from diabetic donors with a grade > IIb are associated with significantly lower postoperative survival rates. Recipient gender [OR: 5.452 (1.330-22.353), p = 0.013] and pre-transplant PRA positivity [OR: 34.879 (7.698-158.030), p < 0.001] were identified as independent predictors of DGF in DDR. In conclusion, transplant centers may consider utilizing kidneys from diabetic donors, provided they are evaluated pathologically, without adversely impacting recipient survival and graft failure rates.
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Affiliation(s)
- Qi Chen
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
| | - Jiayu Guo
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
| | - Shangting Han
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
| | - Tianyu Wang
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
| | - Kang Xia
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
| | - Bo Yu
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
| | - Yiting Liu
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
| | - Tao Qiu
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
| | - Jiangqiao Zhou
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
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Hori S, Tomizawa M, Inoue K, Yoneda T, Onishi K, Morizawa Y, Gotoh D, Nakai Y, Miyake M, Torimoto K, Tanaka N, Fujimoto K. Trends in Patient Characteristics on the Japanese Waiting Lists for Deceased-Donor Kidney Transplantation. Are There no Eligibility or Ineligibility Criteria for Registration and Renewal? Transplant Proc 2024; 56:1721-1731. [PMID: 39232923 DOI: 10.1016/j.transproceed.2024.08.029] [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: 05/14/2024] [Accepted: 08/24/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Controversial issues in registering candidates for deceased-donor kidney transplantation (DDKT) comprise various factors, including age, life expectancy, and dialysis duration. We investigated patient characteristics on the waiting list and discussed suitable criteria in Japan, which has a long waiting period. METHODS This study included 592 patients on the waiting list for DDKT at our institute between 1982 and 2023. We retrospectively reviewed patients' medical charts and obtained their clinical information. Patient characteristics according to outcomes and eligibility criteria for applying for or renewing registration were investigated. No prisoners were used in the study, and the participants were neither coerced nor paid. RESULTS Approximately 70%, 45%, and 14.5% of the registered patients were aged >60, >70, and 80 years, respectively. The number of patients aged ≥70 years gradually decreased over time. The median waiting periods of patients who underwent and interrupted DDKT were 13 and 7 years, respectively. Patients in their 70s with a >15-year dialysis period tended to have opportunities for DDKT. Living-donor kidney transplantation was performed in patients aged <60 years. Waiting patients were significantly younger and had a shorter dialysis duration. Advanced age at registration was associated with a significantly high risk of interruption. CONCLUSIONS Advanced age and longer dialysis periods were considered at registration because patients with these factors tended to experience interruptions despite the long waiting period and high cost. Although older patients can undergo DDKT, factors including surgical cost and risks are considered. Eligibility/ineligibility criteria should be established for DDKT waiting lists in Japan.
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Affiliation(s)
- Shunta Hori
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Mitsuru Tomizawa
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kuniaki Inoue
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Tatsuo Yoneda
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kenta Onishi
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan; Department of Prostate Brachytherapy, Nara Medical University, Kashihara, Nara, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan.
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Walabh P, Palweni ST, Hajinicolaou C, Meyer A. Disparity in organ distribution in Gauteng province in South Africa: Challenges and solutions. Pediatr Transplant 2024; 28:e14624. [PMID: 37822048 DOI: 10.1111/petr.14624] [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: 06/30/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Despite South Africa's rich heritage as pioneers in organ transplantation, access to organs remains a major issue in the Gauteng province. This is secondary to an array of socioeconomic and political factors that have implications for organ distribution. Our aim was to assess the contribution of the public sector to solid organ transplantation in Gauteng province and compare the distribution of solid organs between the recipient groups. METHODS This was a retrospective registry review of consented brain-dead donors from the public sector within Gauteng from January 1, 2016, to June 30, 2021, coordinated at Charlotte Maxeke Johannesburg Academic Hospital, a tertiary academic hospital. RESULTS Records of 49 deceased donors were analyzed. Mean donor age was 31.5 years with the age group 30-39 years constituting the majority of deceased donors at 15/49 (30.6%); 10/49 (16%) were from pediatric donors. There was a significant discrepancy in allocation between public and private sector in cardiac (p = .012) and liver allocation (p < .001) and adult and pediatric recipients for all solid organs (p < .001). There was a significant increase in the rate and number (p = .0026) of pediatric kidney transplants occurring after March 1, 2020, when there was a transition to a public sector-mandated kidney transplant waitlist. CONCLUSION Current disparities in organ distribution have a significant impact on public sector recipients, especially pediatric patients. This is likely secondary to paucity of legislation and resource limitations which would benefit from improved governmental policies and explicit pediatric prioritization policies in transplant units.
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Affiliation(s)
- Priya Walabh
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
- Gauteng Solid Organ Transplant Division, Gauteng Department of Health, Gauteng, South Africa
| | - Sechaba T Palweni
- Gauteng Solid Organ Transplant Division, Gauteng Department of Health, Gauteng, South Africa
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Christina Hajinicolaou
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Head of Paediatric Gastroenterology, Hepatology and Nutrition, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
- Head of Division of Paediatric Gastroenterology, Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Anja Meyer
- Gauteng Solid Organ Transplant Division, Gauteng Department of Health, Gauteng, South Africa
- Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
- Department of Nursing, University of Witwatersrand, Johannesburg, South Africa
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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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Sharma V, Augustine T, Ainsworth J, van der Veer SN. The evaluation of digital transformation in renal transplantation in the United Kingdom: A national interview study. Int J Med Inform 2022; 164:104800. [DOI: 10.1016/j.ijmedinf.2022.104800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/28/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022]
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Bailey P, Vergis N, Allison M, Riddell A, Massey E. Psychosocial Evaluation of Candidates for Solid Organ Transplantation. Transplantation 2021; 105:e292-e302. [PMID: 33675318 DOI: 10.1097/tp.0000000000003732] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Transplant candidates should undergo an assessment of their mental health, social support, lifestyle, and behaviors. The primary aims of this "psychosocial evaluation" are to ensure that transplantation is of benefit to life expectancy and quality of life, and to allow optimization of the candidate and transplant outcomes. The content of psychosocial evaluations is informed by evidence regarding pretransplant psychosocial predictors of transplant outcomes. This review summarizes the current literature on pretransplant psychosocial predictors of transplant outcomes across differing solid organ transplants and discusses the limitations of existing research. Pretransplant depression, substance misuse, and nonadherence are associated with poorer posttransplant outcomes. Depression, smoking, and high levels of prescription opioid use are associated with reduced posttransplant survival. Pretransplant nonadherence is associated with posttransplant rejection, and nonadherence may mediate the effects of other psychosocial variables such as substance misuse. There is evidence to suggest that social support is associated with likelihood of substance misuse relapse after transplantation, but there is a lack of consistent evidence for an association between social support and posttransplant adherence, rejection, or survival across all organ transplant types. Psychosocial evaluations should be undertaken by a trained individual and should comprise multiple consultations with the transplant candidate, family members, and healthcare professionals. Tools exist that can be useful for guiding and standardizing assessment, but research is needed to determine how well scores predict posttransplant outcomes. Few studies have evaluated interventions designed to improve psychosocial functioning specifically pretransplant. We highlight the challenges of carrying out such research and make recommendations regarding future work.
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Affiliation(s)
- Pippa Bailey
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Renal and Transplant Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Nikhil Vergis
- Liver Services Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Department of Metabolism Digestion and Reproduction, Imperial College London, UK
| | - Michael Allison
- Cambridge Liver Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Amy Riddell
- Renal and Transplant Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
- University of Exeter Medical School, Exeter, UK
| | - Emma Massey
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands
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Park Y, Ko EJ, Chung BH, Yang CW. Kidney transplantation in highly sensitized recipients. Kidney Res Clin Pract 2021; 40:355-370. [PMID: 34233438 PMCID: PMC8476304 DOI: 10.23876/j.krcp.21.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/02/2021] [Indexed: 11/04/2022] Open
Abstract
In kidney transplantation (KT), overcoming donor shortage is particularly challenging in patients with preexisting donor-specific antibodies (DSAs) against human leukocyte antigen (HLA), called HLA-incompatible KT (HLAi KT), carrying the risk of rejection and allograft loss. Thus, it is necessary to accurately evaluate the degree of sensitization before HLAi KT, and undertake appropriate pretreatment strategies. To determine the degree of sensitization, complement-dependent cytotoxicity has been the only method employed; the development of a method using flow cytometry further improved the test sensitivity. However, these tests present disadvantages, including the need for living cells, with a solid-phase assay developed to resolve this problem. Currently, the method using Luminex (Luminex Corp.) is widely used in clinical practice. As this method measures DSAs using single antigen beads, it is possible to classify immunological risks by measuring the type and amount of DSAs. Furthermore, there have been major advances in methods that involve DSA removal before HLAi KT. In the early stages of desensitization, plasmapheresis and intravenous immunoglobulins were the main treatment methods employed; however, the introduction of CD20 monoclonal antibody and proteasome inhibitors further increased the success rate of desensitization. Currently, HLAi KT has been established as an important transplant method, but an understanding of DSAs and a novel desensitization treatment are warranted.
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Affiliation(s)
- Yohan Park
- Division of Nephrology, Department of Internal Medicine and Transplantation Research Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Jeong Ko
- Division of Nephrology, Department of Internal Medicine and Transplantation Research Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung Ha Chung
- Division of Nephrology, Department of Internal Medicine and Transplantation Research Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul Woo Yang
- Division of Nephrology, Department of Internal Medicine and Transplantation Research Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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8
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Santos FMRD, Pessoa VLMDP, Florêncio RS, Figueirêdo WMED, Nobre PHP, Sandes-Freitas TVD. [Prevalence and factors associated with non-enrollment for kidney transplant]. CAD SAUDE PUBLICA 2021; 37:e00043620. [PMID: 34105618 DOI: 10.1590/0102-311x00043620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 10/26/2020] [Indexed: 01/02/2023] Open
Abstract
This study evaluated the prevalence and factors associated with lack of enrollment for kidney transplant among patients in chronic dialysis in Greater Metropolitan Fortaleza, Ceará, Brazil. The sample excluded patients with insufficient clinical status and those already in pre-kidney transplant evaluation. A semi-structured questionnaire was applied, including options for the question, "What is the main reason why you are not enrolled for kidney transplant?" Prevalence of patients considered fit but not enrolled or in pre- kidney transplant evaluation was 50.7%. The main reasons were fear of failure/loss of grafting (32.5%), difficulty with transportation or access to tests (20.9%), and temporary personal or family problems (13.7%). In the multivariate analysis, the variables associated with fear of failure or loss of graft were female sex (OR = 1.763; 95%CI: 1.224-2.540) and end-stage renal disease (ESRD) due to hypertension (OR = 1.732; 95%CI: 1.178-2.547), while monthly income (number of minimum wages) showed a protective association (OR = 0.882; 95%CI: 0.785-0.991). Time on dialysis (months) was a risk factor for difficulty with transportation and access to tests (OR = 1.004; 95%CI: 1.001-1.007), and female sex showed a protective association (OR = 0.576; 95%CI: 0.368-0.901). These results show high prevalence of patients in dialysis not enrolled on the kidney transplant waitlist. The main causes were lack of information and lack of access. Female sex, low income, and ESRD due to hypertension were risk factors for lack of enrollment on the kidney transplant waitlist due to fear of loss of graft, resulting from lack of information on this treatment modality. Male sex and longer time on dialysis were risk factors for difficulty in access to kidney transplant.
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9
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Sahin GK, Usta S, Erdogmus S, Ors Sendogan D, Kutlay S, Erturk S, Keven K, Sengul S. Characteristics and Sensitization Risk Factors in Kidney Transplant Wait List Candidates: Panel Reactive Antibodies Status Is Crucial for Successful Kidney Allocation Systems in Turkey. EXP CLIN TRANSPLANT 2021; 21:229-235. [PMID: 33605201 DOI: 10.6002/ect.2020.0304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Kidney transplant is the treatment of choice for end-stage renal disease. Because of the insufficient supply of donor organs for transplant, the number of patients on the transplant wait list is increasing. We analyzed demographic and clinical factors including sensitization status of patients on the kidney transplant wait list in our center. MATERIALS AND METHODS Patients on the kidney transplant wait list at Ankara University School of Medicine by July 2018 were evaluated. Data on demographics, comorbidities, treatment characteristics, and immunologic properties were collected. RESULTS The study included 528 kidney transplant candidates whose mean time on the deceased donor organ wait list was 57 ± 47 months. Enlisted patients were aged 53 ± 13 years, and 95% of them were on dialysis. Dialysis vintage was longer and percentage of patients who had anti-HLA antibodies was higher in women than men (P = .004 and P < .001, respectively). Levels for median fluorescence intensity were higher in women compared with men (class I, P < .001; and class II, P = .011). Transfusion (P < .001), pregnancy (P = .001), transplant (P < .001), longer dialysis vintage (P = .021), and longer time on wait list (P = .001) were associated with anti-HLA antibody positivity. Multiple regression analysis revealed that a history of transplant and blood transfusion were independent risk factors of a positive panel reactive antibodies. CONCLUSIONS In our kidney transplant candidates on the wait list, sensitization by transplant has a significant impact on development of anti-HLA antibodies. Updates of the organ allocation system to consider sensitized candidates and strategies to expand the deceased donor organ pool and donation rates are needed to increase the rate of deceased donor kidney transplant in Turkey.
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Affiliation(s)
- Gizem Kumru Sahin
- From the Ankara University Faculty of Medicine, Department of Nephrology, Ankara, Turkey
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10
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Psychosocial Dimensions in Hemodialysis Patients on Kidney Transplant Waiting List: Preliminary Data. TRANSPLANTOLOGY 2020. [DOI: 10.3390/transplantology1020012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Although the donation rate for deceased and living kidneys has been increasing, the donor organ availability meets only the 30% of kidney needs in Italy. Consequently, hemodialysis patients stay for a long time, an average of 3.2 years, on a waiting list for a kidney transplant with consequent relevant psychological distress or even full-fledged psychiatric disorders, as diagnosed with traditional psychiatric nosological systems. Recent studies report, however, a higher prevalence of other psychosocial syndromes, as diagnosed by using the Diagnostic Criteria for Psychosomatic Research (DCPR) in medically ill and kidney transplant patients. Nevertheless, no data regarding DCPR prevalence are available in patients waitlisted for a renal transplant (WKTs). Thus, the primary aim of this study was to identify sub-threshold or undetected syndromes by using the DCPR and, secondly, to analyze its relationship with physical and psychological symptoms and daily-life problems in WKTs. A total of 30 consecutive WKTs were assessed using the DCPR Interview and the MINI International Neuropsychiatric Interview 6.0. The Edmonton Symptom Assessment System (ESAS) and the Canadian Problem Checklist were used to assess physical and psychological distress symptoms and daily-life problems. A total of 60% of patients met the criteria for at least one DCPR diagnosis; of them, 20% received one DCPR diagnosis (DCPR = 1), and 40% more than one (DCPR > 1), especially the irritability cluster (46.7%), Abnormal Illness Behavior (AIB) cluster (23.3%) and somatization cluster (23.3%). Fifteen patients met the criteria for an ICD diagnosis. Among patients without an ICD-10 diagnosis, 77.8% had at least one DCPR syndrome (p < 0.05). Higher scores on ESAS symptoms (i.e., tiredness, nausea, depression, anxiety, feeling of a lack of well-being and distress), ESAS-Physical, ESAS-Psychological, and ESAS-Total were found among DCPR cases than DCPR non-cases. In conclusion, a high prevalence of DCPR diagnoses was found in WKTs, including those who resulted to be ICD-10 non-cases. The joint use of DCPR and other screening tools (e.g., ESAS) should be evaluated in future research as part of a correct psychosocial assessment of WKTs.
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Francis A, Wong G. Different sized slices of cake: macroeconomic impacts on access to transplantation and graft survival for children. Kidney Int 2020; 98:283-285. [PMID: 32709288 PMCID: PMC7372260 DOI: 10.1016/j.kint.2020.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 11/03/2022]
Abstract
Transplantation for children with end-stage kidney disease confers clear survival, health, and health economic benefits. Access to transplantation and graft survival has been clearly shown to be affected by macroeconomic and patient-level factors in adults. This commentary explores the findings and implications of the "Results in the ESPN/ERA-EDTA Registry Suggest Disparities in Access to Kidney Transplantation but Little Variation in Graft Survival of Children Across Europe" study by Bonthuis et al., including key priorities in future research.
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Affiliation(s)
- Anna Francis
- School of Medicine, University of Queensland, Queensland, Australia.
| | - Germaine Wong
- Centre for Kidney Research, School of Public Health, University of Sydney, Sydney, Australia
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Shaheen FAM, Kurpad R, Shaheen MF, Al Sayyari A. Ways to Overcome Organ Shortage: Increasing Donor Pool by Accepting Suboptimal Kidney Donors. EXP CLIN TRANSPLANT 2020; 18:16-18. [PMID: 32008486 DOI: 10.6002/ect.tond-tdtd2019.l21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Many factors affect organ donations worldwide, including religious factors, legislative decisions, economic factors, presence of organ procurement organizations, cultural issues, the presence of commercial transplant, and other unknown factors. The number of patients with end-stage renal disease has increased by 6% worldwide. Even with more transplant procedures, these numbers have not combated the dramatically increased number of patients on wait lists. With regard to potential living donors, around 50% are either blood group or HLA incompatible with the recipient, which then requires patient desensitization or paired kidney donation or a combination of both. Survival rates of kidney donors and the general population are almost the same 35 to 40 years after donation. Although the renal consequences of diabetes after kidney donation are almost the same as that shown in the general population, other risk factors should be considered, such as hypertension, proteinuria, and low glomerular filtration rate, before donation. It is so far unknown whether donors with impaired glucose tolerance can safely donate. With diabetes, what was considered normal blood sugar in 1960 to 1990 is now considered frank diabetes. What was considered normal blood pressure is now considered hypertension. Because individuals with these parameters were accepted as organ donors in the past and have been shown to maintain good health, it is worth considering the safe use of organs from donors with early diabetes and hypertension. Whereas young donors may have not reached the age at which hypertension, diabetes, and other kidney diseases develop, older donors have the lowest likelihood of developing end-stage renal disease after donation. As a general approach, young donors can be accepted if they have high glomerular filtration rate, but young donors from certain ethnic minorities and/or extensive family history of chronic kidney disease and those less than 18 years old should not be considered.
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Affiliation(s)
- Faissal A M Shaheen
- From the Department of Nephrology, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
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13
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Kakani E, Sloan D, Sawaya BP, El-Husseini A, Malluche HH, Rao M. Long-term outcomes and management considerations after parathyroidectomy in the dialysis patient. Semin Dial 2019; 32:541-552. [PMID: 31313380 DOI: 10.1111/sdi.12833] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Parathyroidectomy (PTX) remains an important intervention for dialysis patients with poorly controlled secondary hyperparathyroidism (SHPT), though there are only retrospective and observational data that show a mortality benefit to this procedure. Potential consequences that we seek to avoid after PTX include persistent or recurrent hyperparathyroidism, and parathyroid insufficiency. There is considerable subjectivity in defining and diagnosing these conditions, given that we poorly understand the optimal PTH targets (particularly post PTX) needed to maintain bone and vascular health. While lowering PTH after PTX decreases bone turnover, long-term changes in bone activity have been poorly explored. High turnover bone disease, usually present at the time a PTX is considered, often swings to a state of low turnover in the setting of sufficiently low PTH levels. It remains unclear if all low bone turnover equate with disease. However, such changes in bone turnover appear to predispose to vascular calcification, with positive calcium balance after PTX being a potential contributor. We know little of how the post-PTX state resets calcium balance, how calcium and VDRA requirements change or what kind of adjustments are needed to avoid calcium loading. The current consensus cautions against excessive reduction of PTH although there is insufficient evidence-based guidance regarding the management of chronic kidney disease - mineral bone disease (CKD-MBD) parameters in the post-PTX state. This article aims to compile existing research, provide an overview of current practice with regard to PTX and post-PTX chronic management. It highlights gaps and controversies and aims to re-orient the focus to clinically relevant contemporary priorities in CKD-MBD management after PTX.
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Affiliation(s)
- Elijah Kakani
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY, USA
| | - David Sloan
- Division of Endocrine Surgery, University of Kentucky, Lexington, KY, USA
| | - B Peter Sawaya
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY, USA
| | - Amr El-Husseini
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY, USA
| | - Hartmut H Malluche
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY, USA
| | - Madhumathi Rao
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY, USA
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14
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Pladys A, Morival C, Couchoud C, Jacquelinet C, Laurain E, Merle S, Vigneau C, Bayat S. Outcome‐dependent geographic and individual variations in the access to renal transplantation in incident dialysed patients: a French nationwide cohort study. Transpl Int 2018; 32:369-386. [DOI: 10.1111/tri.13376] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/16/2018] [Accepted: 11/08/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Adélaïde Pladys
- EA 7449 REPERES EHESP Rennes, Sorbonne Paris Cité Rennes France
| | - Camille Morival
- EHESP High School of Public Health Rennes Sorbonne Paris Cité Rennes France
| | - Cécile Couchoud
- Renal Epidemiology and Information Network (REIN) Biomedicine Agency La Plaine Saint‐Denis France
| | - Christian Jacquelinet
- Renal Epidemiology and Information Network (REIN) Biomedicine Agency La Plaine Saint‐Denis France
- INSERM U1018 Villejuif France
| | | | - Sylvie Merle
- Martinique Regional Observatory on Health of Martinique Le Lamentin France
| | - Cécile Vigneau
- INSERM U1085‐IRSET University of Rennes 1 Rennes France
- Department of Nephrology CHU Pontchaillou Rennes France
| | - Sahar Bayat
- EA 7449 REPERES EHESP Rennes, Sorbonne Paris Cité Rennes France
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15
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Bejic M, Déglise S, Venetz JP, Nseir G, Dubuis C, Saucy F, Berard X, Meuwly JY, Corpataux JM. Use of Intraoperative Duplex Ultrasound and Resistance Index Reduces Complications in Living Renal Donor Transplantation. Transplant Proc 2018; 50:3192-3198. [PMID: 30577184 DOI: 10.1016/j.transproceed.2018.08.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/05/2018] [Accepted: 08/29/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The treatment of choice in end-stage renal disease is transplantation. Hemodynamic disturbances can evoke graft loss, while early ultrasound identification of vascular problems improves outcome. The aim of this study was to identify differences in postoperative complications with and without systematic intraoperative Doppler ultrasound use. METHODS The primary outcome was the postoperative rate of complications and the secondary aim was to find a predictive resistance index cut-off value, which would show where surgical reintervention was necessary. Over a 10-year period, 108 renal transplants were performed from living donors at our institution. In group 1 (n = 67), intraoperative duplex ultrasound and intraparenchymatous resistance index measurements assessed patients, while in group 2 (n = 41), no ultrasound was performed. RESULTS There were no intergroup differences in the overall postoperative complication rate or in benefit to graft or patient survival with Doppler use. However, significantly more vascular complications (10% vs 0%, P = .02) and more acute rejections (37% vs 10%) occurred in group 2 than in group 1. Therefore, an intraoperative cut-off value of the resistance index 0.5 was proposed to justify immediate surgical revision. CONCLUSIONS This is the first report demonstrating benefits of systematic intraoperative Doppler ultrasound on postoperative complications in renal transplantation from living donors. Our results support surgical revision with a resistance index <0.5.
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Affiliation(s)
- M Bejic
- Department of Vascular Surgery, University Hospital (CHUV), Lausanne, Switzerland
| | - S Déglise
- Department of Vascular Surgery, University Hospital (CHUV), Lausanne, Switzerland.
| | - J P Venetz
- Center of Organ Transplantation, University Hospital (CHUV), Lausanne, Switzerland
| | - G Nseir
- Center of Organ Transplantation, University Hospital (CHUV), Lausanne, Switzerland
| | - C Dubuis
- Department of Vascular Surgery, University Hospital (CHUV), Lausanne, Switzerland
| | - F Saucy
- Department of Vascular Surgery, University Hospital (CHUV), Lausanne, Switzerland
| | - X Berard
- Vascular Surgery Department, Bordeaux University Hospital, Bordeaux, France
| | - J Y Meuwly
- Department of Radiology, University Hospital (CHUV), Lausanne, Switzerland
| | - J M Corpataux
- Department of Vascular Surgery, University Hospital (CHUV), Lausanne, Switzerland
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16
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Shimizu M, Doi S, Nakashima A, Naito T, Masaki T. N-terminal pro brain natriuretic peptide as a cardiac biomarker in Japanese hemodialysis patients. Int J Artif Organs 2018; 41:135-143. [DOI: 10.1177/0391398817752294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This study examined the clinical significance of N-terminal pro brain natriuretic peptide level as a cardiac marker in Japanese hemodialysis patients. Methods: This was a multicenter cross-sectional study involving 1428 Japanese hemodialysis patients. Ultrasonic cardiography data at post-hemodialysis were obtained from 395 patients. We examined whether serum N-terminal pro brain natriuretic peptide levels were associated with cardiac parameters and assessed cut-off values and investigated factors associated with a reduced ratio of N-terminal pro brain natriuretic peptide levels pre- and post-hemodialysis. Results: Multivariate logistic regression analysis showed that pre- and post-hemodialysis N-terminal pro brain natriuretic peptide levels were associated with left ventricular hypertrophy on electrocardiogram (odds ratio: 3.10; p < 0.001 at pre-hemodialysis and odds ratio: 2.70; p < 0.001 at post-hemodialysis) and left ventricular hypertrophy on ultrasonic cardiography (odds ratio: 3.06; p < 0.001 at pre-hemodialysis and odds ratio: 3.15; p < 0.001 at post-hemodialysis). Post-N-terminal pro brain natriuretic peptide levels were also significantly associated with ejection fraction on urine chorionic gonadotrophin (ultrasonic cardiography; odds ratio: 35.83; p < 0.001). Receiver operating characteristic curves for predicting the presence of left ventricular hypertrophy on electrocardiogram and ultrasonic cardiography showed similar sensitivity (57.7%, 57.3% at pre-hemodialysis and 63.9%, 48.2% at post-hemodialysis) and specificity (66.5%, 72.9% at pre-hemodialysis and 59.2%, 81.9% at post-hemodialysis). Decreased ejection fraction on ultrasonic cardiography showed better sensitivity (78.6%) and specificity (88.7%). The N-terminal pro brain natriuretic peptide reduction ratio during a hemodialysis session correlated with Kt/V, membrane area, membrane type, modality, body weight gain ratio, treatment time, and ultrafiltration rate with multiple linear regression ( R: 0.53; p < 0.001 except for ultrafiltration rate ( p = 0.003)). Conclusion: Both pre- and post-hemodialysis N-terminal pro brain natriuretic peptide are associated with the presence of left ventricular hypertrophy in this population. The post-hemodialysis N-terminal pro brain natriuretic peptide level is a useful marker for systolic dysfunction.
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Affiliation(s)
- Minako Shimizu
- Department of Nephrology, Hiroshima University Hospital, Hiroshima, Japan
| | - Shigehiro Doi
- Department of Nephrology, Hiroshima University Hospital, Hiroshima, Japan
| | - Ayumu Nakashima
- Department of Nephrology, Hiroshima University Hospital, Hiroshima, Japan
| | - Takayuki Naito
- Nephrology and Dialysis Division, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Takao Masaki
- Department of Nephrology, Hiroshima University Hospital, Hiroshima, Japan
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17
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Zhang Y, Gerdtham UG, Rydell H, Jarl J. Socioeconomic Inequalities in the Kidney Transplantation Process: A Registry-Based Study in Sweden. Transplant Direct 2018; 4:e346. [PMID: 29464207 PMCID: PMC5811275 DOI: 10.1097/txd.0000000000000764] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 11/16/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Few studies have examined the association between individual-level socioeconomic status and access to kidney transplantation. This study aims to investigate the association between predialysis income and education, and access to (i) the kidney waitlist (first listing), and (ii) kidney transplantation conditional on waitlist placement. Adjustment will be made for a number of medical and nonmedical factors. METHODS The Swedish Renal Register was linked to national registers for adult patients in Sweden who started dialysis during 1995 to 2013. We employed Cox proportional hazards models. RESULTS Nineteen per cent of patients were placed on the waitlist. Once on the waitlist, 80% received kidney transplantation. After adjusting for covariates, patients in the highest income quintile were found to have higher access to both the waitlist (hazard ratio [HR], 1.73; 95% confidence interval [CI], 1.53-1.96) and kidney transplantation (HR, 1.33; 95% CI, 1.16-1.53) compared with patients in the lowest income quintile. Patients with higher education also had better access to the waitlist and kidney transplantation (HR, 2.16; 95% CI, 1.94-2.40; and HR, 1.16; 95% CI, 1.03-1.30, respectively) compared with patients with mandatory education. CONCLUSIONS Socioeconomic status-related inequalities exist with regard to both access to the waitlist, and kidney transplantation conditional on listing. However, the former inequality is substantially larger and is therefore expected to contribute more to societal inequalities. Further studies are needed to explore the potential mechanisms and strategies to reduce these inequalities.
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Affiliation(s)
- Ye Zhang
- Health Economics Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Ulf-G. Gerdtham
- Health Economics Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Economics, Lund University, Lund, Sweden
- Centre for Economic Demography, Lund University, Lund, Sweden
| | - Helena Rydell
- Department of Nephrology Skåne University Hospital, Lund University, Lund, Sweden
- Institution of Clinical Sciences, Lund University, Lund, Sweden
- Swedish Renal Registry, Jönköping, Sweden
| | - Johan Jarl
- Health Economics Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
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18
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Borda B, Németh T, Ottlakan A, Keresztes C, Kemény É, Lázár G. Post-transplantation morphological and functional changes in kidneys from expanded criteria donors. Physiol Int 2017; 104:329-333. [PMID: 29278028 DOI: 10.1556/2060.104.2017.4.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction Despite an increase in the number of cadaver donors and overall organ transplantations, the dramatic increase in the waiting list makes it necessary to reconsider donor criteria. The authors wanted to examine whether differences could exist in the function and/or morphology of transplanted kidneys originated from expanded criteria donors (ECDs) and ideal donors 1 and 5 years after transplantation. Methods Kidney function and histopathologic findings were analyzed and compared 1 and 5 years after transplantation in 97 patients having ECD kidneys and in 178 patients who received ideal donor kidneys (IDK). Results Serum creatinine level was significantly higher (p = 0.001) and estimated glomerular filtration rate was significantly lower (p = 0.003) in patients having ECD kidneys as compared with those with IDK 5 years after transplantation. Morphological changes in the transplanted kidneys, such as tubulitis (p = 0.025) and interstitial inflammation (p = 0.002), were significantly more frequently present in patients with ECD kidneys than in those with IDK 1 year after transplantation. Conclusion Despite an absence of differences in kidney function 1 year after kidney transplantation between patients having ECD and IDK, morphological differences in the transplanted kidneys can be detected between the two groups of patients.
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Affiliation(s)
- B Borda
- 1 Faculty of Medicine, Department of Surgery, University of Szeged , Szeged, Hungary
| | - T Németh
- 1 Faculty of Medicine, Department of Surgery, University of Szeged , Szeged, Hungary
| | - A Ottlakan
- 1 Faculty of Medicine, Department of Surgery, University of Szeged , Szeged, Hungary
| | - C Keresztes
- 2 Department for Medical Translation and Communication, University of Szeged , Szeged, Hungary
| | - É Kemény
- 3 Faculty of Medicine, Institute of Pathology, University of Szeged , Szeged, Hungary
| | - G Lázár
- 1 Faculty of Medicine, Department of Surgery, University of Szeged , Szeged, Hungary
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19
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Trébern-Launay K, Kessler M, Bayat-Makoei S, Quérard AH, Briançon S, Giral M, Foucher Y. Horizontal mixture model for competing risks: a method used in waitlisted renal transplant candidates. Eur J Epidemiol 2017; 33:275-286. [PMID: 29086099 DOI: 10.1007/s10654-017-0322-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 10/06/2017] [Indexed: 11/30/2022]
Abstract
When a patient is registered on renal transplant waiting list, she/he expects a clear information on the likelihood of being transplanted. Nevertheless, this event is in competition with death and usual models for competing events are difficult to interpret for non-specialists. We used a horizontal mixture model. Data were extracted from two French dialysis and transplantation registries. The "Ile-de-France" region was used for external validation. The other patients were randomly divided for training and internal validation. Seven variables were associated with decreased long-term probability of transplantation: age over 40 years, comorbidities (diabetes, cardiovascular disease, malignancy), dialysis longer than 1 year before registration and blood groups O or B. We additionally demonstrated longer mean time-to-transplantation for recipients under the age of 50, overweight recipients, recipients with blood group O or B and with pre-transplantation anti-HLA class I or II immunization. Our model can be used to predict the long-term probability of transplantation and the time in dialysis among transplanted patients, two easily interpretable parts. Discriminative capacities were validated on both the internal and external (AUC at 5 years = 0.72, 95% CI from 0.68 to 0.76) validation samples. However, calibration issues were highlighted and illustrated the importance of complete re-estimation of the model for other countries. We illustrated the ease of interpretation of horizontal modelling, which constitutes an alternative to sub-hazard or cause-specific approaches. Nevertheless, it would be useful to test this in practice, for instance by questioning both the physicians and the patients. We believe that this model should also be used in other chronic diseases, for both etiologic and prognostic studies.
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Affiliation(s)
- Katy Trébern-Launay
- Centre de Recherche en Transplantation et immunologue, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Nephrologie, CHU Nantes, Nantes, France.,Université de Nantes, Université de Tours, INSERM, SPHERE (INSERM U1246): methodS in Patient-centered outcomes and HEalth ResEarch - IRS2, 22 Boulevard Bénoni Goullin, 44200, Nantes, France.,Fondation Centaure, Nantes, France
| | - Michèle Kessler
- Nephrology Unit, Nancy-Brabois University Hospital, Vandœuvre-lès-Nancy, France
| | - Sahar Bayat-Makoei
- Epidemiology and Biostatistics Unit, EHESP School of Public Health, Rennes, France
| | - Anne-Hélène Quérard
- Centre de Recherche en Transplantation et immunologue, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Nephrologie, CHU Nantes, Nantes, France.,Université de Nantes, Université de Tours, INSERM, SPHERE (INSERM U1246): methodS in Patient-centered outcomes and HEalth ResEarch - IRS2, 22 Boulevard Bénoni Goullin, 44200, Nantes, France.,Nephrology Hemodialysis, Transplantation, Vendée Departmental Hospital, La Roche sur Yon, France
| | - Serge Briançon
- Clinical Epidemiology, INSERM CIC-EC, Nancy-Brabois University Hospital, Vandoeuvre-lès-Nancy, Lorraine University, and Paris Descartes University, Nancy, France
| | - Magali Giral
- Centre de Recherche en Transplantation et immunologue, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Nephrologie, CHU Nantes, Nantes, France.,Université de Nantes, Université de Tours, INSERM, SPHERE (INSERM U1246): methodS in Patient-centered outcomes and HEalth ResEarch - IRS2, 22 Boulevard Bénoni Goullin, 44200, Nantes, France.,Fondation Centaure, Nantes, France
| | - Yohann Foucher
- Université de Nantes, Université de Tours, INSERM, SPHERE (INSERM U1246): methodS in Patient-centered outcomes and HEalth ResEarch - IRS2, 22 Boulevard Bénoni Goullin, 44200, Nantes, France. .,CHU Nantes, Nantes, France.
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20
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Bailey PK, Tomson CRV, MacNeill S, Marsden A, Cook D, Cooke R, Biggins F, O'Sullivan J, Ben-Shlomo Y. A multicenter cohort study of potential living kidney donors provides predictors of living kidney donation and non-donation. Kidney Int 2017; 92:1249-1260. [PMID: 28709642 DOI: 10.1016/j.kint.2017.04.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/28/2017] [Accepted: 04/13/2017] [Indexed: 12/15/2022]
Abstract
This multicenter prospective potential living kidney donor cohort study investigated which sociodemographic and other factors predict progression to living kidney donation or donor withdrawal as little is known on this topic. Therefore, we examined data on individuals undergoing living donor assessment at seven hospitals in the United Kingdom. Multivariable logistic regression was used to explore the relationships between donor and recipient characteristics and likelihood of kidney donation. A total of 805 individuals presented for directed donation to 498 intended recipients, of which 112 received a transplant from a living donor. Potential donors were less likely to donate if their intended recipient was female rather than male with an odds ratio of 0.60, a friend rather than relative 0.18, or had renal failure due to a systemic disease rather than another cause 0.41. The most socioeconomically deprived quintile was less likely to donate than the least 0.49, but the trend with deprivation was consistent with chance. Higher body mass index was associated with a lower likelihood of donation (odds ratio per each kg/m2 increase, 0.92). Younger potential donors (odds ratio per each year increase 0.97), those of nonwhite ethnicity 2.98, and friend donors 2.43 were more likely to withdraw from work-up. This is the first study in the United Kingdom of potential living kidney donors to describe predictors of non-donation. Qualitative work with individuals who withdraw might identify possible ways of supporting those who wish to donate but experience difficulties doing so.
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Affiliation(s)
- Phillippa K Bailey
- University of Bristol and Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
| | - Charles R V Tomson
- The Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Ann Marsden
- University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - Dominique Cook
- University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - Rhian Cooke
- University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - Fiona Biggins
- Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Jim O'Sullivan
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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21
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Taylor DM, Fraser SD, Bradley JA, Bradley C, Draper H, Metcalfe W, Oniscu GC, Tomson CR, Ravanan R, Roderick PJ. A Systematic Review of the Prevalence and Associations of Limited Health Literacy in CKD. Clin J Am Soc Nephrol 2017; 12:1070-1084. [PMID: 28487346 PMCID: PMC5498363 DOI: 10.2215/cjn.12921216] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 04/07/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES The self-management and decision-making skills required to manage CKD successfully may be diminished in those with low health literacy. A 2012 review identified five papers reporting the prevalence of limited health literacy in CKD, largely from United States dialysis populations. The literature has expanded considerably since. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We used systematic review, pooled prevalence analysis, metaregression, and exploration of heterogeneity in studies of patients with CKD (all stages). RESULTS From 433 studies, 15 new studies met the inclusion criteria and were analyzed together with five studies from the 2012 review. These included 13 cross-sectional surveys, five cohort studies (using baseline data), and two using baseline clinical trial data. Most (19 of 20) were from the United States. In total, 12,324 patients were studied (3529 nondialysis CKD, 5289 dialysis, 2560 transplant, and 946 with unspecified CKD; median =198.5; IQR, 128.5-260 per study). Median prevalence of limited health literacy within studies was 23% (IQR, 16%-33%), and pooled prevalence was 25% (95% confidence interval, 20% to 30%) with significant between-study heterogeneity (I2=97%). Pooled prevalence of limited health literacy was 25% (95% confidence interval, 16% to 33%; I2=97%) among patients with CKD not on dialysis, 27% (95% confidence interval, 19% to 35%; I2=96%) among patients on dialysis, and 14% (95% confidence interval, 7% to 21%; I2=97%) among patients with transplants. A higher proportion of nonwhite participants was associated with increased limited health literacy prevalence (P=0.04), but participant age was not (P=0.40). Within studies, nonwhite ethnicity and low socioeconomic status were consistently and independently associated with limited health literacy. Studies were of low or moderate quality. Within-study participant selection criteria had potential to introduce bias. CONCLUSIONS Limited health literacy is common in CKD, especially among individuals with low socioeconomic status and nonwhite ethnicity. This has implications for the design of self-management and decision-making initiatives to promote equity of care and improve quality. Lower prevalence among patients with transplants may reflect selection of patients with higher health literacy for transplantation either because of less comorbidity in this group or as a direct effect of health literacy on access to transplantation.
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Affiliation(s)
- Dominic M. Taylor
- Department of Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
- Richard Bright Renal Service, North Bristol National Health Service Trust, Bristol, United Kingdom
| | - Simon D.S. Fraser
- Department of Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - J. Andrew Bradley
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - Clare Bradley
- Health Psychology Research Unit, Royal Holloway, University of London, London, United Kingdom
| | - Heather Draper
- Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | | | - Gabriel C. Oniscu
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; and
| | - Charles R.V. Tomson
- Department of Renal Medicine, Freeman Hospital, Newcastle-upon Tyne, United Kingdom
| | - Rommel Ravanan
- Richard Bright Renal Service, North Bristol National Health Service Trust, Bristol, United Kingdom
| | - Paul J. Roderick
- Department of Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
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23
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Are There Inequities in Treatment of End-Stage Renal Disease in Sweden? A Longitudinal Register-Based Study on Socioeconomic Status-Related Access to Kidney Transplantation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14020119. [PMID: 28134798 PMCID: PMC5334673 DOI: 10.3390/ijerph14020119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/13/2017] [Accepted: 01/20/2017] [Indexed: 11/29/2022]
Abstract
Socioeconomic status-related factors have been associated with access to kidney transplantation, yet few studies have investigated both individual income and education as determinates of access to kidney transplantation. Therefore, this study aims to explore the effects of both individual income and education on access to kidney transplantation, controlling for both medical and non-medical factors. We linked the Swedish Renal Register to national registers for a sample of adult patients who started Renal Replacement Therapy (RRT) in Sweden between 1 January 1995, and 31 December 2013. Using uni- and multivariate logistic models, we studied the association between pre-RRT income and education and likelihood of receiving kidney transplantation. For non-pre-emptive transplantation patients, we also used multivariate Cox proportional hazards regression analysis to assess the association between treatment and socioeconomic factors. Among the 16,215 patients in the sample, 27% had received kidney transplantation by the end of 2013. After adjusting for covariates, the highest income group had more than three times the chance of accessing kidney transplantation compared with patients in the lowest income group (odds ratio (OR): 3.22; 95% confidence interval (CI): 2.73–3.80). Patients with college education had more than three times higher chance of access to kidney transplantation compared with patients with mandatory education (OR: 3.18; 95% CI: 2.77–3.66). Neither living in the county of the transplantation center nor gender was shown to have any effect on the likelihood of receiving kidney transplantation. For non-pre-emptive transplantation patients, the results from Cox models were similar with what we got from logistic models. Sensitive analyses showed that results were not sensitive to different conditions. Overall, socioeconomic status-related inequities exist in access to kidney transplantation in Sweden. Additional studies are needed to explore the possible mechanisms and strategies to mitigate these inequities.
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Pladys A, Vigneau C, Hourmant M, Duneau G, Couchoud C, Bayat S. Association between daily haemodialysis, access to renal transplantation and patients' survival in France. Nephrology (Carlton) 2016; 23:269-278. [PMID: 27905676 DOI: 10.1111/nep.12974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/24/2016] [Accepted: 11/24/2016] [Indexed: 11/28/2022]
Abstract
AIM Daily haemodialysis improves patients' quality of life and blood purification, but its effect on survival remains controversial. The aim of this study was to analyze the association between daily haemodialysis and renal transplantation and survival in France. METHODS This was an observational cohort study based on the French REIN registry. All incident patients ≥18 years old who started daily haemodialysis in France between 2003 and 2012 were included. Using a propensity score, 575 patients on daily haemodialysis were matched with 1696 patients receiving thrice-weekly haemodialysis. Survival analysis was performed using the Cox model. Access to the renal transplant waiting list and renal transplantation were analyzed using the Fine and Gray model. RESULTS Daily haemodialysis was not independently associated with reduced access to transplant waiting list, whereas, major comorbidities remained associated with restricted waitlisting after multivariate analysis adjusted for confounding factors. After being waitlisted, the cumulative incidence of renal transplantation was lower for the daily haemodialysis than for the thrice-weekly haemodialysis group (SHR = 0.72, 95%CI: 0.56-0.91). The risk of death was significantly higher in the daily haemodialysis group (HRadjusted = 1.58, 95%CI: 1.4-1.8). Major comorbidities were associated with higher risk of death and lower likelihood of receiving a renal transplant during the follow-up period. CONCLUSION Our study showed that in France, the likelihood of undergoing renal transplantation after being waitlisted was lower for patients on daily haemodialysis than those on thrice-weekly haemodialysis. Moreover, daily haemodialysis was associated with higher risk of death, even after taking into account age and all major comorbidities.
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Affiliation(s)
- Adélaïde Pladys
- High French School of Public Health (EHESP: Ecole des Hautes Etude de Sante Publique), Rennes, France.,University of Rennes 1, UMR CNRS 6290, Rennes, France
| | - Cécile Vigneau
- University of Rennes 1, UMR CNRS 6290, Rennes, France.,Service of Nephrology, Pontchaillou hospital, Rennes, France
| | | | | | - Cécile Couchoud
- REIN (Renal Epidemiology and Information Network) registry, Biomedecine Agency, Saint Denis La Plaine, France
| | - Sahar Bayat
- High French School of Public Health (EHESP: Ecole des Hautes Etude de Sante Publique), Rennes, France
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Lefort M, Vigneau C, Laurent A, Lebbah S, Le Meur N, Jais JP, Daugas E, Bayat S. Facilitating access to the renal transplant waiting list does not increase the number of transplantations: comparative study of two French regions. Clin Kidney J 2016; 9:849-857. [PMID: 27994866 PMCID: PMC5162409 DOI: 10.1093/ckj/sfw078] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 07/14/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND In France, there are important regional disparities of access to the renal transplant waiting list and transplantation. Our objectives were to compare the characteristics of patients with end-stage renal disease (ESRD) of two French regions (Ile-de-France and Bretagne) and to identify determinants of access to the waiting list and subsequent transplantation, with a focus on temporary inactive status (TIS) periods. METHODS All 18-80-year-old incident patients who started dialysis in Ile-de-France or Bretagne between 2006 and 2009 were included (n = 6160). Associations between patients' characteristics and placement on the waiting list or transplantation were assessed using a Fine and Gray model to take into account the competing risk of death and living donor transplantation. RESULTS At the end of the follow-up (31 December 2013), more patients had undergone transplantation in Bretagne than in Ile-de-France (30 versus 27%), although the percentage of waitlisted patients was higher in Ile-de-France than in Bretagne (47 versus 33%). More patients were on TIS and with a longer median TIS duration in Ile-de-France. Independent of age and clinical characteristics, patients in Bretagne were less likely to be waitlisted than those in Ile-de-France [subdistribution hazard ratio 0.77 (95% confidence interval 0.7-0.9)]. After waitlisting, patients in Bretagne were four times more likely to be transplanted. CONCLUSIONS Our study highlights clinical practice differences in Bretagne and Ile-de-France and shows that facilitating access to the waiting list is not sufficient to improve access to renal transplantation, which also depends on organ availability.
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Affiliation(s)
- Mathilde Lefort
- EHESP, Sorbonne Paris Cité, METIS, Avenue du professeur Léon Bernard, 35043 Rennes, France
| | - Cécile Vigneau
- CHU Pontchaillou, Service de Néphrologie, Rennes, France
| | - Annelen Laurent
- EHESP, Sorbonne Paris Cité, METIS, Avenue du professeur Léon Bernard, 35043 Rennes, France
| | - Saïd Lebbah
- Université Paris Descartes, Sorbonne Paris Cité, INSERM UMRS 1138 team 22; CHU Necker-Enfants Malades, Biostatistics Unit, Paris, France
| | - Nolwenn Le Meur
- EHESP, Sorbonne Paris Cité, METIS, Avenue du professeur Léon Bernard, 35043 Rennes, France
| | - Jean-Philippe Jais
- Université Paris Descartes, Sorbonne Paris Cité, INSERM UMRS 1138 team 22; CHU Necker-Enfants Malades, Biostatistics Unit, Paris, France
| | - Eric Daugas
- Hôpital Bichat – Claude-Bernard, Service de Néphrologie, Université Paris Diderot, DHU FIRE, INSERM U1149, Paris, France
| | - Sahar Bayat
- EHESP, Sorbonne Paris Cité, METIS, Avenue du professeur Léon Bernard, 35043 Rennes, France
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Koopman JJE, Kramer A, van Heemst D, Åsberg A, Beuscart JB, Buturović-Ponikvar J, Collart F, Couchoud CG, Finne P, Heaf JG, Massy ZA, De Meester JMJ, Palsson R, Steenkamp R, Traynor JP, Jager KJ, Putter H. Measuring senescence rates of patients with end-stage renal disease while accounting for population heterogeneity: an analysis of data from the ERA-EDTA Registry. Ann Epidemiol 2016; 26:773-779. [PMID: 27665405 DOI: 10.1016/j.annepidem.2016.08.010] [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: 04/07/2016] [Revised: 08/05/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Although a population's senescence rate is classically measured as the increase in mortality rate with age on a logarithmic scale, it may be more accurately measured as the increase on a linear scale. Patients on dialysis, who suffer from accelerated senescence, exhibit a smaller increase in their mortality rate on a logarithmic scale, but a larger increase on a linear scale than patients with a functioning kidney transplant. However, this comparison may be biased by population heterogeneity. METHODS Follow-up data on 323,308 patients on dialysis and 91,679 patients with a functioning kidney transplant were derived from the ERA-EDTA Registry. We measured the increases in their mortality rates using Gompertz frailty models that allow individual variation in this increase. RESULTS According to these models, the senescence rate measured as the increase in mortality rate on a logarithmic scale was smaller in patients on dialysis, while the senescence rate measured as the increase on a linear scale was larger in patients on dialysis than patients with a functioning kidney transplant. CONCLUSIONS Also when accounting for population heterogeneity, a population's senescence rate is more accurately measured as the increase in mortality rate on a linear scale than a logarithmic scale.
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Affiliation(s)
- Jacob J E Koopman
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
| | - Anneke Kramer
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Diana van Heemst
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Anders Åsberg
- Norwegian Renal Registry, Department of Transplant Medicine, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Jean-Baptiste Beuscart
- University of Lille, EA2694, Santé publique: épidémiologie et qualité des soins, Lille, France; CHU Lille, Geriatric Department, Lille, France
| | - Jadranka Buturović-Ponikvar
- Department of Nephrology, Ljubljana University Medical Center, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Frederic Collart
- Department of Nephrology and Dialysis, Brugmann University Hospital, Brussels, Belgium
| | - Cécile G Couchoud
- Renal Epidemiology and Information Network (REIN) Registry, French Biomedical Agency, Saint-Denis-la-Plaine, France
| | - Patrik Finne
- Finnish Registry for Kidney Diseases, Helsinki, Finland; Department of Nephrology, Helsinki University Central Hospital, Helsinki, Finland
| | - James G Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Hospital, University of Paris Ouest-Versailles-St-Quentin-en-Yvelines, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, Research Centre in Epidemiology and Population Health (CESP), Villejuif, France
| | - Johan M J De Meester
- Department of Nephrology, Dialysis, and Hypertension, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Runolfur Palsson
- Division of Nephrology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Jamie P Traynor
- The Scottish Renal Registry, Information Services Division Scotland, Glasgow, UK
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Hein Putter
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
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Abstract
BACKGROUND Currently, potential kidney transplant patients more often suffer from comorbidities. The Charlson Comorbidity Index (CCI) was developed in 1987 and is the most used comorbidity score. We questioned to what extent number and severity of comorbidities interfere with graft and patient survival. Besides, we wondered whether the CCI was best to study the influence of comorbidity in kidney transplant patients. METHODS In our center, 1728 transplants were performed between 2000 and 2013. There were 0.8% cases with missing values. Nine pretransplant comorbidity covariates were defined: cardiovascular disease, cerebrovascular accident, peripheral vascular disease, diabetes mellitus, liver disease, lung disease, malignancy, other organ transplantation, and human immunodeficiency virus positivity. The CCI used was unadjusted for recipient age. The Rotterdam Comorbidity in Kidney Transplantation score was developed, and its influence was compared to the CCI. Kaplan-Meier analysis and multivariable Cox proportional hazards analysis, corrected for variables with a known significant influence, were performed. RESULTS We noted 325 graft failures and 215 deaths. The only comorbidity covariate that significantly influenced graft failure censored for death was peripheral vascular disease. Patient death was significantly influenced by cardiovascular disease, other organ transplantation, and the total comorbidity scores. Model fit was best with the Rotterdam Comorbidity in Kidney Transplantation score compared to separate comorbidity covariates and the CCI. In the population with the highest comorbidity score, 50% survived more than 10 years. CONCLUSIONS Despite the negative influence of comorbidity, patient survival after transplantation is remarkably good. This means that even patients with extensive comorbidity should be considered for transplantation.
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Francis A, Didsbury M, Lim WH, Kim S, White S, Craig JC, Wong G. The impact of socioeconomic status and geographic remoteness on access to pre-emptive kidney transplantation and transplant outcomes among children. Pediatr Nephrol 2016; 31:1011-9. [PMID: 26692022 DOI: 10.1007/s00467-015-3279-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 11/06/2015] [Accepted: 11/10/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Low socioeconomic status (SES) and geographic disparity have been associated with worse outcomes and poorer access to pre-emptive transplantation in the adult end-stage kidney disease (ESKD) population, but little is known about their impact in children with ESKD. The aim of our study was to determine whether access to pre-emptive transplantation and transplant outcomes differ according to SES and geographic remoteness in Australia. METHODS Using data from the Australia and New Zealand Dialysis and Transplant Registry (1993-2012), we compared access to pre-emptive transplantation, the risk of acute rejection and graft failure, based on SES and geographic remoteness among Australian children with ESKD (≤ 18 years), using adjusted logistic and Cox proportional hazard modelling. RESULTS Of the 768 children who commenced renal replacement therapy, 389 (50.5%) received living donor kidney transplants and 28.5% of these (111/389) were pre-emptive. There was no significant association between SES quintiles and access to pre-emptive transplantation, acute rejection or allograft failure. Children residing in regional or remote areas were 35% less likely to receive a pre-emptive transplant compared to those living in major cities [adjusted odds ratio (OR) 0.65, 95% confidence interval (CI) 0.45-1.0]. There was no significant association between geographic disparity and acute rejection (adjusted OR 1.03, 95% CI 0.68-1.57) or graft loss (adjusted hazard ratio 1.05, 95% CI 0.74-1.41). CONCLUSIONS In Australia, children from regional or remote regions are much less likely to receive pre-emptive kidney transplantation. Strategies such as improved access to nephrology services through expanding the scope of outreach clinics, and support for regional paediatricians to promote early referral may ameliorate this inequity.
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Affiliation(s)
- Anna Francis
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia, 2006
| | - Madeleine Didsbury
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia, 2006
| | - Wai H Lim
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Siah Kim
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia, 2006
| | - Sarah White
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia, 2006
| | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia, 2006
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia, 2006.
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Kihal-Talantikite W, Vigneau C, Deguen S, Siebert M, Couchoud C, Bayat S. Influence of Socio-Economic Inequalities on Access to Renal Transplantation and Survival of Patients with End-Stage Renal Disease. PLoS One 2016; 11:e0153431. [PMID: 27082113 PMCID: PMC4833352 DOI: 10.1371/journal.pone.0153431] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 03/29/2016] [Indexed: 11/18/2022] Open
Abstract
Background Public and scientific concerns about the social gradient of end-stage renal disease and access to renal replacement therapies are increasing. This study investigated the influence of social inequalities on the (i) access to renal transplant waiting list, (ii) access to renal transplantation and (iii) patients’ survival. Methods All incident adult patients with end-stage renal disease who lived in Bretagne, a French region, and started dialysis during the 2004–2009 period were geocoded in census-blocks. To each census-block was assigned a level of neighborhood deprivation and a degree of urbanization. Cox proportional hazards models were used to identify factors associated with each study outcome. Results Patients living in neighborhoods with low level of deprivation had more chance to be placed on the waiting list and less risk of death (HR = 1.40 95%CI: [1.1–1.7]; HR = 0.82 95%CI: [0.7–0.98]), but this association did not remain after adjustment for the patients’ clinical features. The likelihood of receiving renal transplantation after being waitlisted was not associated with neighborhood deprivation in univariate and multivariate analyses. Conclusions In a mixed rural and urban French region, patients living in deprived or advantaged neighborhoods had the same chance to be placed on the waiting list and to undergo renal transplantation. They also showed the same mortality risk, when their clinical features were taken into account.
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Affiliation(s)
| | - Cécile Vigneau
- CHU Pontchaillou, Service de néphrologie, Rennes, France
- Université de Rennes 1, UMR 6290, équipe Kyca, Rennes, France
| | - Séverine Deguen
- EHESP School of Public Health, Sorbonne Paris Cité, Rennes, France
| | - Muriel Siebert
- CHU Pontchaillou, Service de néphrologie, Rennes, France
| | - Cécile Couchoud
- REIN Registry, Agence de la biomédecine, Saint Denis La Plaine, France
| | - Sahar Bayat
- EHESP School of Public Health, Sorbonne Paris Cité, EA MOS, Rennes, France
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de Roij van Zuijdewijn CLM, Grooteman MPC, Bots ML, Blankestijn PJ, Steppan S, Büchel J, Groenwold RHH, Brandenburg V, van den Dorpel MA, ter Wee PM, Nubé MJ, Vervloet MG. Serum Magnesium and Sudden Death in European Hemodialysis Patients. PLoS One 2015; 10:e0143104. [PMID: 26600017 PMCID: PMC4658157 DOI: 10.1371/journal.pone.0143104] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/30/2015] [Indexed: 12/18/2022] Open
Abstract
Despite suggestions that higher serum magnesium (Mg) levels are associated with improved outcome, the association with mortality in European hemodialysis (HD) patients has only scarcely been investigated. Furthermore, data on the association between serum Mg and sudden death in this patient group is limited. Therefore, we evaluated Mg in a post-hoc analysis using pooled data from the CONvective TRAnsport STudy (CONTRAST, NCT00205556), a randomized controlled trial (RCT) evaluating the survival risk in dialysis patients on hemodiafiltration (HDF) compared to HD with a mean follow-up of 3.1 years. Serum Mg was measured at baseline and 6, 12, 24 and 36 months thereafter. Cox proportional hazards models, adjusted for confounders using inverse probability weighting, were used to estimate hazard ratios (HRs) of baseline serum Mg on all-cause mortality, cardiovascular mortality, non-cardiovascular mortality and sudden death. A generalized linear mixed model was used to investigate Mg levels over time. Out of 714 randomized patients, a representative subset of 365 (51%) were analyzed in the present study. For every increase in baseline serum Mg of 0.1 mmol/L, the HR for all-cause mortality was 0.85 (95% CI 0.77–94), the HR for cardiovascular mortality 0.73 (95% CI 0.62–0.85) and for sudden death 0.76 (95% CI 0.62–0.93). These findings did not alter after extensive correction for potential confounders, including treatment modality. Importantly, no interaction was found between serum phosphate and serum Mg. Baseline serum Mg was not related to non-cardiovascular mortality. Mg decreased slightly but statistically significant over time (Δ -0.011 mmol/L/year, 95% CI -0.017 to -0.009, p = 0.03). In short, serum Mg has a strong, independent association with all-cause mortality, cardiovascular mortality and sudden death in European HD patients. Serum Mg levels decrease slightly over time.
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Affiliation(s)
- Camiel L. M. de Roij van Zuijdewijn
- Department of Nephrology, VU University Medical Center, Amsterdam, the Netherlands
- Institute for Cardiovascular Research, VU University Medical Center (ICaR-VU), VU University Medical Center, Amsterdam, the Netherlands
- * E-mail:
| | - Muriel P. C. Grooteman
- Department of Nephrology, VU University Medical Center, Amsterdam, the Netherlands
- Institute for Cardiovascular Research, VU University Medical Center (ICaR-VU), VU University Medical Center, Amsterdam, the Netherlands
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter J. Blankestijn
- Department of Nephrology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sonja Steppan
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Janine Büchel
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Rolf H. H. Groenwold
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Vincent Brandenburg
- Department of Cardiology and Vascular Medicine, University Hospital Aachen, Aachen, Germany
| | | | - Piet M. ter Wee
- Department of Nephrology, VU University Medical Center, Amsterdam, the Netherlands
- Institute for Cardiovascular Research, VU University Medical Center (ICaR-VU), VU University Medical Center, Amsterdam, the Netherlands
| | - Menso J. Nubé
- Department of Nephrology, VU University Medical Center, Amsterdam, the Netherlands
- Institute for Cardiovascular Research, VU University Medical Center (ICaR-VU), VU University Medical Center, Amsterdam, the Netherlands
| | - Marc G. Vervloet
- Department of Nephrology, VU University Medical Center, Amsterdam, the Netherlands
- Institute for Cardiovascular Research, VU University Medical Center (ICaR-VU), VU University Medical Center, Amsterdam, the Netherlands
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Clinical Practice Guideline on management of patients with diabetes and chronic kidney disease stage 3b or higher (eGFR <45 mL/min). Nephrol Dial Transplant 2015; 30 Suppl 2:ii1-142. [PMID: 25940656 DOI: 10.1093/ndt/gfv100] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Bayat S, Macher MA, Couchoud C, Bayer F, Lassalle M, Villar E, Caillé Y, Mercier S, Joyeux V, Noel C, Kessler M, Jacquelinet C. Individual and regional factors of access to the renal transplant waiting list in france in a cohort of dialyzed patients. Am J Transplant 2015; 15:1050-60. [PMID: 25758788 DOI: 10.1111/ajt.13095] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 10/10/2014] [Accepted: 11/01/2014] [Indexed: 01/25/2023]
Abstract
Several studies have investigated geographical variations in access to renal transplant waiting lists, but none has assessed the impact on these variations of factors at both the patient and geographic levels. The objective of our study was to identify medical and non-medical factors at both these levels associated with these geographical variations in waiting-list placement in France. We included all incident patients aged 18-80 years in 11 French regions who started dialysis between January 1, 2006, and December 31, 2008. Both a multilevel Cox model with shared frailty and a competing risks model were used for the analyses. At the patient level, old age, comorbidities, diabetic nephropathy, non-autonomous first dialysis, and female gender were the major determinants of a lower probability of being waitlisted. At the regional level, the only factor associated with this probability was an increase in the number of patients on the waiting list from 2005 to 2009. This finding supports a slight but significant impact of a regional organ shortage on waitlisting practices. Our findings demonstrate that patients' age has a major impact on waitlisting practices, even for patients with no comorbidity or disability, whose survival would likely be improved by transplantation compared with dialysis.
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Affiliation(s)
- S Bayat
- Département d'Epidémiologie-Biostatistiques, EA MOS, EHESP, Rennes, France
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Beuscart JB, Pagniez D, Boulanger E, Duhamel A. Registration on the renal transplantation waiting list and mortality on dialysis: an analysis of the French REIN registry using a multi-state model. J Epidemiol 2014; 25:133-41. [PMID: 25721069 PMCID: PMC4310874 DOI: 10.2188/jea.je20130193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Access to the renal transplantation (RT) waiting list depends on factors related to lower mortality rates and often occurs after dialysis initiation. The aim of the study was to use a flexible regression model to determine if registration on the RT waiting list is associated with mortality on dialysis, independent of the comorbidities associated with such registration. METHODS Data from the French REIN registry on 7138 incident hemodialysis (HD) patients were analyzed. A multi-state model including four states ('HD, not wait-listed', 'HD, wait-listed', 'death', and 'RT') was used to estimate the effect of being wait-listed on the probability of death. RESULTS During the study, 1392 (19.5%) patients were wait-listed. Of the 2954 deaths observed in the entire cohort during follow-up, 2921 (98.9%) were observed in the not wait-listed group compared with only 33 (1.1%) in the wait-listed group. In the multivariable analysis, the adjusted hazard ratio for death associated with non-registration on the waiting list was 3.52 (95% CI, 1.70-7.30). The risk factors for death identified for not wait-listed patients were not found to be significant risk factors for wait-listed patients, with the exception of age. CONCLUSIONS The use of a multi-state model allowed a flexible analysis of mortality on dialysis. Patients who were not wait-listed had a much higher risk of death, regardless of co-morbidities associated with being wait-listed, and did not share the same risk factors of death as wait-listed patients. Registration on the waiting list should therefore be taken into account in survival analysis of patients on dialysis.
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The Preferences and Perspectives of Nephrologists on Patients’ Access to Kidney Transplantation. Transplantation 2014; 98:682-91. [DOI: 10.1097/tp.0000000000000336] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Satyavani K, Kothandan H, Jayaraman M, Viswanathan V. Direct costs associated with chronic kidney disease among type 2 diabetic patients in India. Indian J Nephrol 2014; 24:141-7. [PMID: 25120290 PMCID: PMC4127832 DOI: 10.4103/0971-4065.132000] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to estimate the direct costs of medical care among hospitalized type 2 diabetic patients with chronic kidney disease (CKD). A total of 209 (M:F, 133:76) patients were divided into groups based on the severity of kidney disease. Group 1 subjects had undergone renal transplantation (n = 12), group 2 was CKD patients on hemodialysis (n = 45), group 3 was patients with CKD, prior to end-stage renal disease (ESRD) (n = 66), and group 4 (n = 86) consisted of subjects without any complications. Details about expenditure per hospitalization, length of stay during admission, direct medical and nonmedical cost, expenditure for the previous two years, and source of bearing the expenditure were recorded in a questionnaire. Diabetic patients with CKD prior to ESRD spend more per hospitalization than patients without any complications. [Median ₹ 12,664 vs. 3,214]. The total median cost of CKD patients on hemodialysis was significantly higher than other CKD patients (INR 61,170 vs. 12,664). The median cost involved in kidney transplantation was ₹ 392,920. The total expenditure for hospital admissions in two years was significantly higher for dialysis than transplantation. Patients on hemodialysis or kidney transplantation tend to stay longer as inpatient admissions. The source of funds for the expenditure was mainly personal savings (46%). The expenditure on hospital admissions for CKD was considerably higher, and so, there is a need to develop a protocol on a cost-effective strategy for the treatment of CKD.
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Affiliation(s)
- K Satyavani
- Department of Diabetology, M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre (WHO Collaborating Centre for Research, Education and Training in Diabetes), Royapuram, Chennai, Tamil Nadu, India
| | - H Kothandan
- Department of Diabetology, M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre (WHO Collaborating Centre for Research, Education and Training in Diabetes), Royapuram, Chennai, Tamil Nadu, India
| | - M Jayaraman
- Department of Diabetology, M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre (WHO Collaborating Centre for Research, Education and Training in Diabetes), Royapuram, Chennai, Tamil Nadu, India
| | - V Viswanathan
- Department of Diabetology, M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre (WHO Collaborating Centre for Research, Education and Training in Diabetes), Royapuram, Chennai, Tamil Nadu, India
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Richie C. Global Health Care Justice, Delivery Doctors and Assisted Reproduction: Taking a Note From Catholic Social Teachings. Dev World Bioeth 2014; 15:179-90. [PMID: 24750593 DOI: 10.1111/dewb.12060] [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: 11/28/2022]
Abstract
This article will examine the Catholic concept of global justice within a health care framework as it relates to women's needs for delivery doctors in the developing world and women's demands for assisted reproduction in the developed world. I will first discuss justice as a theory, situating it within Catholic social teachings. The Catholic perspective on global justice in health care demands that everyone have access to basic needs before elective treatments are offered to the wealthy. After exploring specific discrepancies in global health care justice, I will point to the need for delivery doctors in the developing world to provide basic assistance to women who hazard many pregnancies as a priority before offering assisted reproduction to women in the developed world. The wide disparities between maternal health in the developing world and elective fertility treatments in the developed world are clearly unjust within Catholic social teachings. I conclude this article by offering policy suggestions for moving closer to health care justice via doctor distribution.
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Norman SP, Kommareddi M, Luan FL. Inactivity on the kidney transplant wait-list is associated with inferior pre- and post-transplant outcomes. Clin Transplant 2014; 27:E435-41. [PMID: 23923971 DOI: 10.1111/ctr.12173] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND The majority of kidney transplant (KT) candidates spend some time on the transplant wait-list (WL) prior to kidney transplantation. We examined the impact of WL inactivity on clinical outcomes. METHODS All adult KT candidates first actively wait-listed between January 1, 1996, and December 31, 2005, in the United States were grouped by frequency of inactivity on the WL. Transplantation rate, pre- and post-transplant patient survival and death-censored kidney graft survival were compared. RESULTS Of 159,774 candidates who were placed on the WL, 48,598 (30.4%) experienced one or more periods of inactivity. Candidates with inactivity once or more on the WL had 42% and 27% less likelihood of KT, respectively (HR 0.58, 95% CI 0.57, 0.59 and HR 0.73, 95% CI 0.71, 0.75). WL inactivity once or more was associated with a higher likelihood of death (HR 1.94, 95% CI 1.88, 2.00 and HR 2.13, 95% CI 2.02, 2.24). Among KT recipients, inactivity more than once on the WL was associated with a higher risk of death (HR 1.14, 95% CI 1.05, 1.23). CONCLUSIONS Periods of inactivity on the WL predict increased mortality pre- and post-transplantation. A better understanding of the reasons for WL inactivity is essential to improve WL management and post-transplant outcomes.
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Affiliation(s)
- Silas Prescod Norman
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
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Kiberd BA, Tennankore KK, West K. Eligibility for the kidney transplant wait list: a model for conceptualizing patient risk. Transplant Res 2014; 3:2. [PMID: 24401550 PMCID: PMC3895784 DOI: 10.1186/2047-1440-3-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 12/20/2013] [Indexed: 12/03/2022] Open
Abstract
Background Determining eligibility for a kidney transplant is one of the most important decisions facing nephrologists. It is assumed that the harm of kidney transplantation is minimal and most will benefit. The purpose of this study was to quantify the probability of ‘no benefit’ as defined by death on the wait list; ‘harm’, defined by the probability that a transplanted patient would live less than the average wait listed patient; and ‘benefit’ for the probability a transplanted patient would outlive the average wait listed patient. Methods A computerized model was developed to replicate observed patient survival outcomes in deceased donor kidney transplantation. Three sequential periods of risk for the transplanted recipient compared to the wait listed cohort (increased, equivalent and reduced risk) were modeled. Results The model predicted that wait listed patients with a baseline mortality of 28 deaths per 100 patient years were equally likely to benefit or be harmed with a transplant. However if 20% of patients on the wait list were on hold (assuming a 2.2-fold higher mortality than those who were transplanted), then the baseline mortality rate for equal harm or benefit decreases to 22 deaths per 100 patient years (equivalent life expectancy 4.5 years). Conclusion Patients with limited life expectancies are more likely to suffer some harm than derive benefit from kidney transplantation.
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Affiliation(s)
- Bryce A Kiberd
- Division of Nephrology, Department of Medicine, Dalhousie University, Room 5082 Dickson Building, Queen Elizabeth II HSC-VG site, 5280 University Avenue, Halifax B3H 1V8, NS, Canada.
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Sultan H, Famure O, Phan NTA, Van JAD, Kim SJ. Performance measures for the evaluation of patients referred to the Toronto General Hospital's kidney transplant program. Healthc Manage Forum 2013; 26:184-190. [PMID: 24696942 DOI: 10.1016/j.hcmf.2013.09.008] [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] [Indexed: 06/03/2023]
Abstract
Given the increasing number of patients with end-stage renal disease in Ontario, there is a need to improve the efficiency and effectiveness of the pretransplant evaluation, to allow for a seamless progression through the various steps in the process. Toronto General Hospital's kidney transplant program is evaluating various performance measures, specifically looking at waiting times from referral to initial evaluation and initial evaluation to final disposition, to use as metrics for monitoring program performance and stimulate quality improvement.
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Goodkin DA, Bieber B, Gillespie B, Robinson BM, Jadoul M. Hepatitis C infection is very rarely treated among hemodialysis patients. Am J Nephrol 2013; 38:405-12. [PMID: 24192505 DOI: 10.1159/000355615] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 09/16/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is associated with increased mortality among hemodialysis (HD) patients. Guidelines from Kidney Disease: Improving Global Outcomes recommend that infected HD patients awaiting renal transplantation be treated for HCV and that clinicians decide whether to treat other infected patients on a case-by-case basis. We evaluated the extent and outcome of HCV therapy among HD patients. METHODS The Dialysis Outcomes and Practice Patterns Study is an observational study; 49,762 HD patients in 12 nations enrolled between 1996 and 2011. We reviewed HCV status, use of interferon or ribavirin, and survival over a median 1.4 years per study phase. RESULTS 4,735 patients (9.5%) were HCV+. Only 48 (1.0%) of the 4,589 HCV+ patients with prescription data were receiving antiviral medication. Among the subset of 617 HCV+ patients also known to be on a waiting list for renal transplantation, only 3.7% were receiving treatment. After restricting to HCV+ patients with overlapping propensity for antiviral treatment, 4 (9.5%) of 42 treated patients and 638 (21.0%) of 3,037 untreated patients died. The hazard ratio for adjusted mortality comparing treated patients with untreated patients was 0.47 (95% CI, 0.17-1.26). CONCLUSIONS HD patients with hepatitis C infection very rarely receive antiviral therapy. Increased intervention might prolong survival for some patients and in particular might improve the prospects for those awaiting renal transplantation.
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Affiliation(s)
- David A Goodkin
- Arbor Research Collaborative for Health, Ann Arbor, Mich., USA
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Clinical practice guidelines on wait-listing for kidney transplantation: consistent and equitable? Transplantation 2012; 94:703-13. [PMID: 22948443 DOI: 10.1097/tp.0b013e3182637078] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Apparent variability in wait-listing criteria globally has raised concern about inequitable access to kidney transplantation. This study aimed to compare the quality, the scope, and the consistency of international guidelines on wait-listing for kidney transplantation. METHODS Electronic databases and guideline registries were searched to December 2011. The Appraisal of Guidelines for Research and Evaluation II instrument and textual synthesis was used to assess and compare recommendations. RESULTS Fifteen guidelines published from 2001 to 2011 were included. Methodological rigor and scope were variable. We identified 4 major criteria across guidelines: recipient age and life expectancy, medical criteria, social and lifestyle circumstances, and psychosocial considerations. Whereas some recommendations were consistent, there were differences in age cutoffs, estimated life expectancy (2-5 years), and glomerular filtration rate at listing (15-20 mL/min/1.73 m). Cardiovascular contraindications were broadly defined. Recommended cancer-free periods also varied substantially, and whereas uncontrolled infections were universally contraindicated, human immunodeficiency virus thresholds and adherence to highly active antiretroviral therapy were inconsistent. Most guidelines recommended psychological screening but were not augmented with specific clinical assessment tools. CONCLUSIONS Wait-listing recommendations in current guidelines are based on life expectancy, comorbidities, lifestyle, and psychosocial factors. Some recommendations are different across guidelines or broadly defined. There is a case for developing comprehensive, methodologically robust, and regularly updated guidelines on wait-listing for kidney transplantation.
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Borda B. [Comparison of functional and morphological changes of transplanted kidneys from marginal and ideal donors]. Orv Hetil 2012; 153:1793-6. [PMID: 23123327 DOI: 10.1556/oh.2012.29486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Despite an increased number of cadaver donors and organ transplantations, there is a marked increase in the number of patients included in the transplantation waiting list. AIM AND METHOD The aim of the study was to evaluate functional and morphologic changes of kidney allografts obtained from marginal (n = 63) and "ideal" donors (n = 186). In patients with kidneys from marginal donors, the impact of donor age and the presence of hypertension in donors on kidney function were also studied. RESULTS One year after kidney transplantation, kidney function was similar in patients transplanted with kidneys from marginal and "ideal" donors, although significant morphologic differences were observed between the two groups. However, five years after transplantation serum creatinine (p = 0.0001) and eGFR (p = 0.003) were significantly different between patients transplanted with kidneys from marginal and "ideal" donors. There was also a significant difference in serum creatinine level of patients who received kidneys from donors older than 55 years of age compared to patients whose kidney allografts were obtained form donor who has hypertension (p = 0.0003). Acute rejection episodes (p = 0.0004) and interstitial fibrosis/tubular atrophy (p = 0.002) occurred more frequently in patients with kidneys from marginal compared to those from "ideal" donors. CONCLUSION One year after kidney transplantation renal function is similar in patients transplanted with kidneys from marginal and "ideal" donors, but patients with kidneys from marginal donors have significantly more impaired renal function five years after kidney transplantation.
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Affiliation(s)
- Bernadett Borda
- Szegedi Tudományegyetem, Általános Orvostudományi Kar Sebészeti Klinika, Szeged, Pécsi u. 6. 6720.
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Transplantation rates for living- but not deceased-donor kidneys vary with socioeconomic status in Australia. Kidney Int 2012; 83:138-45. [PMID: 22895516 DOI: 10.1038/ki.2012.304] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Socioeconomic disadvantage has been linked to reduced access to kidney transplantation. To understand and address potential barriers to transplantation, we used the Australia and New Zealand Dialysis and Transplant Registry and examined primary kidney-only transplantation among adult non-Indigenous patients who commenced chronic renal replacement therapy in Australia during 2000-2010. Socioeconomic status was derived from residential postcodes using standard indices. Among the 21,190 patients who commenced renal replacement therapy, 4105 received a kidney transplant (2058 from living donors (660 preemptive) or 2047 from deceased donors) by the end of 2010. Compared with the most socioeconomic disadvantaged quartile, patients from the most advantaged quartile were more likely to receive a preemptive transplant (relative rate 1.93), and more likely to receive a living-donor kidney (adjusted subhazard ratio 1.34) after commencing dialysis. Socioeconomic status was not associated with deceased-donor transplantation. Thus, the association between socioeconomic status and living- but not deceased-donor transplantation suggests that potential donors (rather than recipients) from disadvantaged areas may face barriers to donation. Although the deceased-donor organ allocation process appears essentially equitable, it differs between Australian states.
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Johansen KL, Zhang R, Huang Y, Patzer RE, Kutner NG. Association of race and insurance type with delayed assessment for kidney transplantation among patients initiating dialysis in the United States. Clin J Am Soc Nephrol 2012; 7:1490-7. [PMID: 22837273 DOI: 10.2215/cjn.13151211] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The extent to which racial and socioeconomic disparities in access to kidney transplantation are related to not being assessed for transplant suitability before or shortly after the time of initiation of dialysis is not known. The aims of this study were to determine whether there were disparities based on race, ethnicity, or type of insurance in delayed assessment for transplantation and whether delayed assessment was associated with lower likelihood of waitlisting and kidney transplantation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This retrospective cohort study used data from the US Renal Data System and included 426,489 adult patients beginning dialysis in the United States between January 1, 2005 and September 30, 2009 without prior kidney transplant. RESULTS Overall, 12.5% of patients had reportedly not been assessed for transplantation. Patients without private insurance were more likely to be reported as not assessed (multivariable adjusted odds ratio=1.33, 95% confidence interval=1.28-1.40 for Medicaid), with a pronounced racial disparity but no ethnic disparity among patients aged 18 to <35 years (odds ratio=1.27, 95% confidence interval=1.13-1.43; P<0.001 for interaction with age). Not being assessed for transplant around the time of dialysis initiation was associated with lower likelihood of waitlisting in multivariable analysis (hazard ratio=0.59, 95% confidence interval=0.57-0.62 in the first year) and transplantation (hazard ratio=0.46, 95% confidence interval=0.41-0.51 in the first year), especially within the first 2 years. CONCLUSIONS Racial and insurance-related disparities in transplant assessment potentially delay transplantation, particularly among younger patients.
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Affiliation(s)
- Kirsten L Johansen
- US Renal Data System Rehabilitation/Quality of Life Special Studies Center, Emory University, Atlanta, Georgia, USA.
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Ojo AO, Morales JM, Gonzalez-Molina M, Steffick DE, Luan FL, Merion RM, Ojo T, Moreso F, Arias M, Campistol JM, Hernandez D, Seron D. Comparison of the long-term outcomes of kidney transplantation: USA versus Spain. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs287 and 1=1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ojo AO, Morales JM, Gonzalez-Molina M, Steffick DE, Luan FL, Merion RM, Ojo T, Moreso F, Arias M, Campistol JM, Hernandez D, Seron D. Comparison of the long-term outcomes of kidney transplantation: USA versus Spain. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs287 and 1=1-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ojo AO, Morales JM, Gonzalez-Molina M, Steffick DE, Luan FL, Merion RM, Ojo T, Moreso F, Arias M, Campistol JM, Hernandez D, Seron D. Comparison of the long-term outcomes of kidney transplantation: USA versus Spain. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs287 or(1=2)-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ojo AO, Morales JM, Gonzalez-Molina M, Steffick DE, Luan FL, Merion RM, Ojo T, Moreso F, Arias M, Campistol JM, Hernandez D, Seron D. Comparison of the long-term outcomes of kidney transplantation: USA versus Spain. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs287 and 1=1#] [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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