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Selzler AM, Davoodi PM, Klarenbach S, Lam NN, Smith T, Ackroyd A, Wiebe N, Corradetti B, Ferdinand S, Iyekekpolor D, Smith G, Verdin N, Bello AK, Wen K, Shojai S. Multidisciplinary Support To Access living donor Kidney Transplant (MuST AKT): A Clinical Research Protocol for a Pilot Randomized Controlled Trial to Increase Living Kidney Donation. Can J Kidney Health Dis 2023; 10:20543581231205340. [PMID: 37920779 PMCID: PMC10619336 DOI: 10.1177/20543581231205340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/07/2023] [Indexed: 11/04/2023] Open
Abstract
Background Living donor kidney transplantation (LDKT) is the optimal treatment for eligible patients with kidney failure, although it is underutilized. Contextually tailored patient- and family-centered interventions may be effective to increase LDKT. Objective We outline a protocol to test the feasibility of the Multidisciplinary Support To Access living donor Kidney Transplant (MuST AKT) intervention designed to increase LDKT. Design Non-blinded single-center pilot randomized controlled trial with a qualitative interview component. Setting Academic transplant referral center in Northern Alberta Region with a population of more than 2 million in its catchment area. Patients English-speaking patients of the age range 18 to 75 years who are referred for kidney transplantation are eligible to participate. Measurements Feasibility will be assessed by indicators of recruitment, retention, and completion rates, treatment fidelity, adherence to intervention, engagement in intervention, and acceptability. Methods Participants will be randomly assigned 1:1 to either standard care (control) or the experimental group who receive standard care plus the MuST AKT intervention, a person-centered program designed to assist and enable the kidney transplant candidate to achieve what is required to receive an LDKT. The intervention consists of an introductory session and 4 intervention sessions delivered in-person or virtually. Limitations Inferences cannot be drawn regarding the efficacy/effectiveness of the MuST AKT intervention. This study is non-blinded. Conclusions This pilot study is the first step in our broader initiative to increase LDKT in our health care jurisdiction. The results of this study will be used to inform the development of a future definitive randomized controlled trial. Trial registration number NCT04666545.
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Affiliation(s)
- Anne-Marie Selzler
- Kidney Health Section, Medicine Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | | | - Scott Klarenbach
- Kidney Health Section, Medicine Strategic Clinical Network, Alberta Health Services, Alberta, Canada
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ngan N. Lam
- Division of Nephrology, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Terry Smith
- Kidney Health Section, Medicine Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - Abigail Ackroyd
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Natasha Wiebe
- Kidney Health Research Group, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Bonnie Corradetti
- Kidney Health Section, Medicine Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - Sharron Ferdinand
- Social Work—Transplant Services, University of Alberta Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Dorothy Iyekekpolor
- Social Work—Transplant Services, University of Alberta Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Gordon Smith
- Social Work—Alberta Kidney Care North, Grey Nuns Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Nancy Verdin
- Kidney Health Section, Medicine Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - Aminu K. Bello
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kevin Wen
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Soroush Shojai
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Betriu S, Rovira J, Arana C, García-Busquets A, Matilla-Martinez M, Ramirez-Bajo MJ, Bañon-Maneus E, Lazo-Rodriguez M, Bartoló-Ibars A, Claas FHJ, Mulder A, Heidt S, Juan M, Bayés-Genís B, Campistol JM, Palou E, Diekmann F. Chimeric HLA antibody receptor T cells for targeted therapy of antibody-mediated rejection in transplantation. HLA 2023; 102:449-463. [PMID: 37503860 DOI: 10.1111/tan.15156] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/29/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023]
Abstract
The presence of donor-specific antibodies (DSA), mainly against HLA, increases the risk of allograft rejection. Moreover, antibody-mediated rejection (ABMR) remains an important barrier to optimal long-term outcomes after solid organ transplantation. The development of chimeric autoantibody receptor T lymphocytes has been postulated for targeted therapy of autoimmune diseases. We aimed to develop a targeted therapy for DSA desensitization and ABMR, generating T cells with a chimeric HLA antibody receptor (CHAR) that specifically eliminates DSA-producing B cells. We have genetically engineered an HLA-A2-specific CHAR (A2-CHAR) and transduced it into human T cells. Then, we have performed in vitro experiments such as cytokine measurement, effector cell activation, and cytotoxicity against anti-HLA-A2 antibody-expressing target cells. In addition, we have performed A2-CHAR-Tc cytotoxic assays in an immunodeficient mouse model. A2-CHAR expressing T cells could selectively eliminate HLA-A2 antibody-producing B cells in vitro. The cytotoxic capacity of A2-CHAR expressing T cells mainly depended on Granzyme B release. In the NSG mouse model, A2-CHAR-T cells could identify and eradicate HLA-A2 antibody-producing B cells even when those cells are localized in the bone marrow. This ability is effector:target ratio dependent. CHAR technology generates potent and functional human cytotoxic T cells to target alloreactive HLA class I antibody-producing B cells. Thus, we consider that CHAR technology may be used as a selective desensitization protocol or an ABMR therapy in transplantation.
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Affiliation(s)
- Sergi Betriu
- Department of Immunology, Clinic Barcelona, Barcelona, Spain
| | - Jordi Rovira
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Fundació de Recerca Clinic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Spain
- Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain
| | - Carolt Arana
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Fundació de Recerca Clinic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Spain
- Department of Nephrology and Kidney Transplantation, Institut Clínic de Nefrologia i Urologia (ICNU), Clínic Barcelona, Barcelona, Spain
| | - Ainhoa García-Busquets
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Fundació de Recerca Clinic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Spain
| | - Marina Matilla-Martinez
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Fundació de Recerca Clinic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Spain
| | - Maria J Ramirez-Bajo
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Fundació de Recerca Clinic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Spain
- Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain
| | - Elisenda Bañon-Maneus
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Fundació de Recerca Clinic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Spain
- Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Lazo-Rodriguez
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Fundació de Recerca Clinic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Spain
| | | | - Frans H J Claas
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arend Mulder
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sebastiaan Heidt
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Manel Juan
- Department of Immunology, Clinic Barcelona, Barcelona, Spain
| | - Beatriu Bayés-Genís
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Fundació de Recerca Clinic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Spain
- Department of Nephrology and Kidney Transplantation, Institut Clínic de Nefrologia i Urologia (ICNU), Clínic Barcelona, Barcelona, Spain
| | - Josep M Campistol
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Fundació de Recerca Clinic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Spain
- Department of Nephrology and Kidney Transplantation, Institut Clínic de Nefrologia i Urologia (ICNU), Clínic Barcelona, Barcelona, Spain
| | - Eduard Palou
- Department of Immunology, Clinic Barcelona, Barcelona, Spain
| | - Fritz Diekmann
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Fundació de Recerca Clinic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Spain
- Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Nephrology and Kidney Transplantation, Institut Clínic de Nefrologia i Urologia (ICNU), Clínic Barcelona, Barcelona, Spain
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3
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Piñeiro GJ, Lazo-Rodriguez M, Ventura-Aguiar P, Ramirez-Bajo MJ, Banon-Maneus E, Lozano M, Cid J, Hierro-Garcia N, Cucchiari D, Revuelta I, Montagud-Marrahi E, Palou E, Bayés-Genís B, Campistol JM, Diekmann F, Rovira J. Extracorporeal Photopheresis Improves Graft Survival in a Full-Mismatch Rat Model of Kidney Transplantation. Transpl Int 2023; 36:10840. [PMID: 36713113 PMCID: PMC9876976 DOI: 10.3389/ti.2023.10840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/02/2023] [Indexed: 01/14/2023]
Abstract
Extracorporeal photopheresis (ECP) is an immunomodulatory therapy based on the infusion of autologous cellular products exposed to ultraviolet light (UV) in the presence of a photosensitizer. The study evaluates the ECP efficacy as induction therapy in a full-mismatch kidney transplant rat model. Dark Agouti to Lewis (DA-L) kidney transplant model has been established. ECP product was obtained from Lewis rat recipients after DA kidney graft transplantation (LewDA). Leukocytes of those LewDA rats were exposed to 8-methoxy psoralen, and illuminated with UV-A. The ECP doses assessed were 10 × 106 and 100 × 106 cells/time point. Lewis recipients received seven ECP infusions. DA-L model was characterized by the appearance of donor-specific antibodies (DSA) and kidney function deterioration from day three after kidney transplant. The dysfunction progressed rapidly until graft loss (6.1 ± 0.5 days). Tacrolimus at 0.25 mg/kg prolonged rat survival until 11.4 ± 0.7 days (p = 0.0004). In this context, the application of leukocytes from LewDA sensitized rats accelerated the rejection (8.7 ± 0.45, p = 0.0012), whereas ECP product at high dose extended kidney graft survival until 26.3 ± 7.3 days, reducing class I and II DSA in surviving rats. ECP treatment increases kidney graft survival in full-mismatch rat model of acute rejection and is a suitable immunomodulatory therapy to be explored in kidney transplantation.
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Affiliation(s)
- Gaston J. Piñeiro
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain,Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marta Lazo-Rodriguez
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Pedro Ventura-Aguiar
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain,Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria J. Ramirez-Bajo
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain
| | - Elisenda Banon-Maneus
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain
| | - Miquel Lozano
- Apheresis Unit, Department of Hemotherapy and Hemostasis, IDIBAPS, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Joan Cid
- Apheresis Unit, Department of Hemotherapy and Hemostasis, IDIBAPS, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Natalia Hierro-Garcia
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain
| | - David Cucchiari
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain,Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ignacio Revuelta
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain,Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain
| | - Enrique Montagud-Marrahi
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain,Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Eduard Palou
- Department of Immunology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Beatriu Bayés-Genís
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain,Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Josep M. Campistol
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain,Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Fritz Diekmann
- Department of Nephrology and Kidney Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain,Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain,*Correspondence: Fritz Diekmann, ; Jordi Rovira,
| | - Jordi Rovira
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,*Correspondence: Fritz Diekmann, ; Jordi Rovira,
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4
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Gil-Casares B, Portolés J, López-Sánchez P, Tornero F, Marques M, Rojo-Álvarez JL. Transitions in an integrated model of renal replacement therapy in a regional health system. Nefrologia 2022; 42:438-447. [PMID: 36266230 DOI: 10.1016/j.nefroe.2022.10.002] [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: 02/19/2021] [Accepted: 07/11/2021] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES The choice of renal replacement therapy (RRT) is an important decision that determines the quality of life and survival. Most patients change from one RRT modality to another to adapt RRT to clinical and psychosocial needs. This has been called «integrated model of RRT» that implies new questions about the best sequence of techniques. MATERIAL AND METHODS The study describes the impact of transitions between RRT modalities on survival using the Madrid Registry of Renal Patients (2008-2018). This study used the proportional hazards models and competitive risk models to perform an intention-to-treat (ITT), according to their 1st RRT modality and as-treated (AT) analysis, that consider also their 1st transition. RESULTS A total of 8971 patients started RRT during this period in Madrid (6.6 Million population): 7207 (80.3%) on hemodialysis (HD), 1401 (15.6%) on peritoneal dialysis (PD) and 363 (4.2%) received a pre-emptive kidney transplantation (KT). Incident HD-patients were older (HD group 65.3 years (SD 15.3) vs PD group 58.1 years (SD 14.8) vs KTX group 52 years (SD 17.2); p < 0.001) and had more comorbidities. They presented higher mortality (HD group 40.9% vs PD group 22.8% vs KTX group 8.3%, p < 0.001) and less access to a transplant (HD group 30.4% vs PD group 51.6%; p < 0.001). Transitions between dialysis techniques define different groups of patients with different clinical outcomes. Those who change from HD to PD do it earlier (HD → PD: 0.7 years (SD 1.1) vs PD → HD: 1.5 years (SD 1.4) p < 0.001), are younger (HD → PD: 53.5 years (SD 16.7) vs PD → HD: 61.6 years (SD 14.6); p < 0.001), presented less mortality (HD → PD: 24.5% vs PD → HD: 32.0%; p < 0.001) and higher access to a transplant (HD → PD: 49.4% vs PD → HD: 31.7%; p < 0.001). Survival analysis by competitive risks is essential for integrated RRT models, especially in groups such as PD patients, where 51.6% of the patients were considered as lost follow-up (received a KTX after during the first 2.5 years on PD). In this analysis, survival of patients who change from one technique to another, is more similar to the destination modality than the origin one. CONCLUSION Our data suggest that transitions between RRT-techniques describes different patients, who associate different risks, and could be analyzed in an integrated manner to define improvement actions. This approach should be incorporated into the analysis and reports of renal registries.
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Affiliation(s)
- Beatriz Gil-Casares
- Servicio de Nefrología, Hospital del Sureste, Arganda del Rey, Madrid, Spain; Departamento de Teoría de la Señal y Comunicaciones y Sistemas Telemáticos y de Computación, Universidad Rey Juan Carlos, Fuenlabrada, Madrid, Spain
| | - Jose Portolés
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; REDInREN RETIC ISCIII 16/009/009.
| | - Paula López-Sánchez
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Fernando Tornero
- Servicio de Nefrología, Hospital del Sureste, Arganda del Rey, Madrid, Spain
| | - María Marques
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; REDInREN RETIC ISCIII 16/009/009
| | - José Luis Rojo-Álvarez
- Departamento de Teoría de la Señal y Comunicaciones y Sistemas Telemáticos y de Computación, Universidad Rey Juan Carlos, Fuenlabrada, Madrid, Spain
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5
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Maassen H, Said MY, Frenay ARS, Koning A, Post A, Riphagen IJ, Heiner-Fokkema MR, Drabert K, Fernandez BO, Gans ROB, van den Berg E, Navis G, Tsikas D, Feelisch M, Bakker SJL, van Goor H. Nitric oxide and long-term outcomes after kidney transplantation: Results of the TransplantLines cohort study. Nitric Oxide 2022; 125-126:1-11. [PMID: 35660109 DOI: 10.1016/j.niox.2022.05.005] [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: 02/02/2022] [Revised: 05/22/2022] [Accepted: 05/31/2022] [Indexed: 11/12/2022]
Abstract
Impaired endogenous nitric oxide (NO) production may contribute to graft failure and premature mortality in kidney transplant recipients (KTR). We investigated potential associations of 24-h urinary NOx (NO3- + NO2-) excretion (uNOx) with long-term outcomes. uNOx was determined by HPLC and GC-MS in 698 KTR and in 132 kidney donors before and after donation. Additionally, we measured urinary nitroso species (RXNO) by gas-phase chemiluminescence. Median uNOx was lower in KTR compared to kidney donors (688 [393-1076] vs. 1301 [868-1863] before donation and 1312 [982-1853] μmol/24h after donation, P < 0.001). During median follow-up of 5.4 [4.8-6.1] years, 150 KTR died (61 due to cardiovascular disease) and 83 experienced graft failure. uNOx was inversely associated with all-cause mortality (HR per doubling of uNOx: 0.84 [95% CI 0.75-0.93], P < 0.001) and cardiovascular mortality (HR 0.78 [95% CI 0.67-0.92], P = 0.002). The association of uNOx with graft failure was lost when adjusted for renal function (HR per doubling of uNOx: 0.89 [95% CI 0.76-1.05], P = 0.17). There were no significant associations of urinary RXNO with outcomes. Our study suggests that KTR have lower NO production than healthy subjects and that lower uNOx is associated with a higher risk of all-cause and cardiovascular mortality.
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Affiliation(s)
- Hanno Maassen
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - M Yusof Said
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Anne-Roos S Frenay
- Department of Gynecology and Obstetrics, Amsterdam University Medical Center, University of Amsterdam, the Netherlands
| | - Anne Koning
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Adrian Post
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Ineke J Riphagen
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - M Rebecca Heiner-Fokkema
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Kathrin Drabert
- Institute of Toxicology, Core Unit Proteomics, Hannover Medical School, Hannover, Germany
| | - Bernadette O Fernandez
- Clinical & Experimental Sciences, Faculty of Medicine and NIHR Southampton Biomedical Research Centre, Southampton General Hospital, United Kingdom
| | - Reinold O B Gans
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Else van den Berg
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Gerjan Navis
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Dimitrios Tsikas
- Institute of Toxicology, Core Unit Proteomics, Hannover Medical School, Hannover, Germany
| | - Martin Feelisch
- Clinical & Experimental Sciences, Faculty of Medicine and NIHR Southampton Biomedical Research Centre, Southampton General Hospital, United Kingdom
| | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Harry van Goor
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, the Netherlands.
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6
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Guía de unidades de hemodiálisis 2020. Nefrologia 2021. [DOI: 10.1016/j.nefro.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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7
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Ethier I, Cho Y, Hawley C, Pascoe EM, Roberts MA, Semple D, Nadeau-Fredette AC, Wong G, Lim WH, Sypek MP, Viecelli AK, Campbell S, van Eps C, Isbel NM, Johnson DW. Multicenter registry analysis comparing survival on home hemodialysis and kidney transplant recipients in Australia and New Zealand. Nephrol Dial Transplant 2021; 36:1937-1946. [PMID: 32879952 DOI: 10.1093/ndt/gfaa159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In the era of organ shortage, home hemodialysis (HHD) has been identified as the possible preferential bridge to kidney transplantation. Data are conflicting regarding the comparability of HHD and transplantation outcomes. This study aimed to compare patient and treatment survival between HHD patients and kidney transplant recipients. METHODS The Australia and New Zealand Dialysis and Transplant Registry was used to include incident HHD patients on Day 90 after initiation of kidney replacement therapy and first kidney-only transplant recipients in Australia and New Zealand from 1997 to 2017. Survival times were analyzed using the Kaplan-Meier product-limit method comparing HHD patients with subtypes of kidney transplant recipients using the log-rank test. Adjusted analyses were performed with multivariable Cox proportional hazards regression models for time to all-cause mortality. Time-to-treatment failure or death was assessed as a composite secondary outcome. RESULTS The study compared 1411 HHD patients with 4960 living donor (LD) recipients, 6019 standard criteria donor (SCD) recipients and 2427 expanded criteria donor (ECD) recipients. While LD and SCD recipients had reduced risks of mortality compared with HHD patients [LD adjusted hazard ratio (HR) = 0.57, 95% confidence interval (CI) 0.46-0.71; SCD HR = 0.65 95% CI 0.52-0.79], the risk of mortality was comparable between ECD recipients and HHD patients (HR = 0.90, 95% CI 0.73-1.12). LD, SCD and ECD kidney recipients each experienced superior time-to-treatment failure or death compared with HHD patients. CONCLUSIONS This large registry study showed that kidney transplant offers a survival benefit compared with HHD but that this advantage is not significant for ECD recipients.
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Affiliation(s)
- Isabelle Ethier
- Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Carmel Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Matthew A Roberts
- Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - David Semple
- Department of Renal Medicine, Auckland District Health Board, Auckland, New Zealand.,School of Medicine, University of Auckland, Auckland, New Zealand
| | - Annie-Claire Nadeau-Fredette
- Division of Nephrology, Hôpital Maisonneuve-Rosemont and Research Center, Université de Montréal, Montréal, Canada
| | - Germaine Wong
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.,School of Public Health, University of Sydney, Sydney, Australia
| | - Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia.,School of Medicine, University of Western Australia, Perth, Australia
| | - Matthew P Sypek
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Scott Campbell
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Carolyn van Eps
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Nicole M Isbel
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
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8
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Gil-Casares B, Portolés J, López-Sánchez P, Tornero F, Marques M, Rojo-Álvarez JL. Transitions in an integrated model of renal replacement therapy in a regional health system. Nefrologia 2021; 42:S0211-6995(21)00149-1. [PMID: 34481678 DOI: 10.1016/j.nefro.2021.07.004] [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: 02/19/2021] [Revised: 06/01/2021] [Accepted: 07/11/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES The choice of renal replacement therapy (RRT) is an important decision that determines the quality of life and survival. Most patients change from one RRT modality to another to adapt RRT to clinical and psychosocial needs. This has been called «integrated model of RRT» that implies new questions about the best sequence of techniques. MATERIAL AND METHODS The study describes the impact of transitions between RRT modalities on survival using the Madrid Registry of Renal Patients (2008-2018). This study used the proportional hazards models and competitive risk models to perform an intention-to-treat (ITT), according to their 1st RRT modality and as-treated (AT) analysis, that consider also their 1st transition. RESULTS A total of 8971 patients started RRT during this period in Madrid (6.6 Million population): 7207 (80.3%) on hemodialysis (HD), 1401 (15.6%) on peritoneal dialysis (PD) and 363 (4.2%) received a pre-emptive kidney transplantation (KTX). Incident HD-patients were older (HD group 65.3 years (SD 15.3) vs PD group 58.1 years (SD 14.8) vs KTX group 52 years (SD 17.2); p<0.001) and had more comorbidities. They presented higher mortality (HD group 40.9% vs PD group 22.8% vs 8.3% KTX group, p<0.001) and less access to a transplant (HD group 30.4% vs DP group 51.6%; p<0.001). Transitions between dialysis techniques define different groups of patients with different clinical outcomes. Those who change from HD to PD do it earlier (HD→PD: 0.7 years (SD 1.1) vs PD→HD: 1.5 years (SD 1.4) p<0.001), are younger (HD→PD: 53.5 years (SD 16.7) vs PD→HD: 61.6 years (SD 14.6); p<0.001), presented less mortality (HD→PD: 24.5% vs PD→HD: 32.0%; p<0.001) and higher access to a transplant (HD→PD: 49.4% vs PD→HD: 31.7%; p<0.001). Survival analysis by competitive risks is essential for integrated RRT models, especially in groups such as PD patients, where 51.6% of the patients were considered as lost follow-up (received a KTX after during the first 2.5 years on PD). In this analysis, survival of patients who change from one technique to another, is more similar to the destination modality than the origin one. CONCLUSION Our data suggest that transitions between RRT-techniques describes different patients, who associate different risks, and could be analyzed in an integrated manner to define improvement actions. This approach should be incorporated into the analysis and reports of renal registries.
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Affiliation(s)
- Beatriz Gil-Casares
- Servicio de Nefrología, Hospital del Sureste, Arganda del Rey, Madrid, España; Departamento de Teoría de la Señal y Comunicaciones y Sistemas Telemáticos y de Computación, Universidad Rey Juan Carlos, Fuenlabrada, Madrid, España
| | - Jose Portolés
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España; REDInREN RETIC ISCIII 16/009/009.
| | - Paula López-Sánchez
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Fernando Tornero
- Servicio de Nefrología, Hospital del Sureste, Arganda del Rey, Madrid, España
| | - María Marques
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España; REDInREN RETIC ISCIII 16/009/009
| | - José Luis Rojo-Álvarez
- Departamento de Teoría de la Señal y Comunicaciones y Sistemas Telemáticos y de Computación, Universidad Rey Juan Carlos, Fuenlabrada, Madrid, España
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9
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Morin C, Gionest I, Laurin LP, Goupil R, Nadeau-Fredette AC. Risk of hospitalization, technique failure, and death with increased training duration in 3-days-a-week home hemodialysis. Hemodial Int 2021; 25:457-464. [PMID: 34169633 DOI: 10.1111/hdi.12956] [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: 11/11/2020] [Revised: 06/01/2021] [Accepted: 06/10/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Quality training is a core component of successful home hemodialysis (HHD) and training duration varies significantly between dialysis centers as well as at the patient level. This study aimed to assess the adverse outcomes associated with HHD training duration. METHODS All HHD patients successfully trained in a single dialysis center between January 2005 and July 2017 were included. A multivariable multiple-events (Andersen-Gill) survival model was built to evaluate the association between training time and main adverse events, including hospitalizations, technique failure, and death on HHD. Potential confounding factors were defined a priori (age, diabetes, coronary artery disease, and year of training start). Adjusted risk of vascular interventions (arteriovenous fistula angioplasties and central venous catheter replacements) was assessed as the secondary outcome in a negative binomial regression. FINDINGS Forty-eight patients were included in the study. Median HHD training duration was 86 (67-108) days, using a thrice weekly training schedule. Over a follow-up median time of 2.0 (0.7-3.3) years, three patients died while on HHD, 10 had a definitive transfer to HD, and 18 experienced a least 1 hospitalization (38 hospitalizations in total). Training duration was associated with a higher risk of hospitalization, technique failure, and death in unadjusted (hazard ratio [HR] 1.16 per month, 95% confidence interval [CI] 1.08-1.24) and adjusted multiple events model (HR 1.21, 95% CI 1.04-1.43). Risk of vascular access intervention was also significantly higher with increased training time (adjusted incidence rate ratio 1.31, 95% CI 1.03-1.64, per training month). DISCUSSION In this single-center observational study, HHD training duration was associated with a higher risk of adverse events including, death, technique failure, hospitalizations, and vascular access intervention. Enhanced clinical follow-up and home support should be offered to these more vulnerable patients to mitigate this heightened risk.
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Affiliation(s)
- Catherine Morin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Isabelle Gionest
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Louis-Philippe Laurin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.,Research Center, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Rémi Goupil
- Hospital and Research Center, Sacré-Coeur de Montreal Hospital, Montreal, Quebec, Canada
| | - Annie-Claire Nadeau-Fredette
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.,Research Center, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
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10
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Tennankore KK, Nadeau-Fredette AC, Vinson AJ. Survival comparisons in home hemodialysis: Understanding the present and looking to the future. Nephrol Ther 2021; 17S:S64-S70. [PMID: 33910701 DOI: 10.1016/j.nephro.2020.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/13/2020] [Indexed: 10/21/2022]
Abstract
A number of studies have compared relative survival for home hemodialysis patients (including longer hours/more frequent schedules) and other forms of renal replacement therapy. While informative, many of these studies have been limited by issues pertaining to their observational design including selection bias and residual confounding. Furthermore the few randomized controlled trials that have been conducted have been underpowered to detect a survival difference. Finally, in the face of a growing recognition of the value of patient-important outcomes beyond survival, the focus of comparisons between dialysis modalities may be changing. In this review, we will discuss the determinants of survival for patients receiving home hemodialysis and address the various studies that have compared relative survival for differing home hemodialysis schedules to each of in-center hemodialysis, peritoneal dialysis and transplantation. We will conclude this review by discussing whether there is an ongoing role for survival analyses in home hemodialysis.
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Affiliation(s)
- Karthik K Tennankore
- Dalhousie University/Nova Scotia Health Authority, 5082 Dickson Building, 5820, University Avenue, NS B3H 1V8 Halifax, Canada.
| | | | - Amanda J Vinson
- Dalhousie University/Nova Scotia Health Authority, 5082 Dickson Building, 5820, University Avenue, NS B3H 1V8 Halifax, Canada
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11
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Chanliau J, Durand PY. Lowering dialysis sessions duration may be dangerous. BULLETIN DE LA DIALYSE À DOMICILE 2021. [DOI: 10.25796/bdd.v4i1.60263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Dialysis session in less duration - either to give a better quality of life for the patient or to optimize the organization the dialysis institution - may have bad repercussions on the quality of the treatment and therefore the quality of life of the patient.
According to the result of the publications listed in this work, we conclude that it is necessary to perform either longer sessions or more frequent treatments to limit the interval time between two sessions.
As this is difficult to perform by the providers, we recommend to develop home dialysis to obtain the best result.
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12
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A Propensity Score-weighted Comparison of Outcomes Between Living and Standard Criteria Deceased Donor Kidney Transplant Recipients. Transplantation 2021; 104:e317-e327. [PMID: 32496358 DOI: 10.1097/tp.0000000000003337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Consider a theoretical situation in which 2 patients with similar baseline characteristics receive a kidney transplant on the same day: 1 from a standard criteria deceased donor, the other from a living donor. Which kidney transplant will last longer? METHODS We conducted a population-based cohort study using linked administrative healthcare databases from Ontario, Canada, from January 1, 2005, to March 31, 2014, to evaluate several posttransplant outcomes in individuals who received a kidney transplant from a standard criteria deceased donor (n = 1523) or from a living donor (n = 1373). We used PS weighting using overlap weights, a novel weighting method that emphasizes the population of recipients with the most overlap in baseline characteristics. RESULTS Compared with recipients of a living donor, the rate of all-cause graft failure was not statistically higher for recipients of a standard criteria deceased donor (hazard ratio, 1.1; 95% confidence interval [CI], 0.8-1.6). Recipients of a standard criteria deceased donor, compared with recipients of a living donor had a higher rate of delayed graft function (23.6% versus 18.7%; odds ratio, 1.3; 95% CI, 1.0-1.6) and a longer length of stay for the kidney transplant surgery (mean difference, 1.7 d; 95% CI, 0.5-3.0). CONCLUSIONS After accounting for many important donor and recipient factors, we failed to observe a large difference in the risk of all-cause graft failure for recipients of a standard criteria deceased versus living donor. Some estimates were imprecise, which meant we could not rule out the presence of smaller clinically important effects.
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13
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Deliège PG, Braconnier A, Chaix F, Renard Y, Petrache A, Guyot-Colosio C, Kazes I, Mokri L, Barbe C, Rieu P. Skeletal Muscle Index as a Prognostic Marker for Kidney Transplantation in Older Patients. J Ren Nutr 2020; 31:286-295. [PMID: 33139208 DOI: 10.1053/j.jrn.2020.08.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/05/2020] [Accepted: 08/30/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Low skeletal muscle mass has emerged as a risk factor for mortality after liver transplantation. We evaluated the prognostic value of muscle mass on length of hospitalization and adverse outcomes after kidney transplantation in aging end-stage renal disease patients. METHODS One hundred twenty-two patients aged 60 years or older at the time of transplantation were retrospectively analyzed. Skeletal muscle index (SMI), evaluated by computed tomography scan, was calculated from total muscle surface area at L3 vertebral level divided by body height squared. Outcomes were compared according to SMI (namely, length of hospitalization, wound complications, combined endpoint comprising all-cause mortality, and graft failure within 1 year). RESULTS In male patients, by multivariate analysis, a low SMI (<42 cm2/m2) was associated with longer immediate post-transplantation hospitalization (β = 17.03 ± 4.3; P = .0002), longer total hospitalization during the first year (β = 34.3 ± 10.7; P = .002), higher rate of wound complications (odds ratio = 12.1 [1.9-77.0]; P = .008), and higher rate of the combined endpoint of graft loss or death (odds ratio = 3.4 [3.0-399.5]; P = .004). In female patients, low SMI was not associated with length of hospitalization or adverse outcomes after transplantation. CONCLUSION SMI is an independent marker of morbidity and mortality after kidney transplantation in older men and could help thereby nephrologists better select aging candidates for kidney transplantation with a view to improving post-transplant outcomes.
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Affiliation(s)
| | | | - Floriane Chaix
- Department of Nephrology, University Hospital of Reims, Reims, France
| | - Yohann Renard
- Department of General and Digestive Surgey, University Hospital of Reims, Reims, France
| | - Andreaa Petrache
- Department of Nephrology, University Hospital of Reims, Reims, France
| | | | - Isabelle Kazes
- Department of Nephrology, University Hospital of Reims, Reims, France
| | - Laetitia Mokri
- Department of Nephrology, University Hospital of Reims, Reims, France
| | - Coralie Barbe
- Department of Biostatistics, University Hospital of Reims, Reims, France
| | - Philippe Rieu
- Department of Nephrology, University Hospital of Reims, Reims, France; Laboratory of Nephrology, UMR CNRS URCA, 7369 (Matrice Extracellulaire et Dynamique Cellulaire, MEDyC), Reims, France
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14
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Quantifying the Treatment Effect of Kidney Transplantation Relative to Dialysis on Survival Time: New Results Based on Propensity Score Weighting and Longitudinal Observational Data from Sweden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197318. [PMID: 33036407 PMCID: PMC7578980 DOI: 10.3390/ijerph17197318] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 11/17/2022]
Abstract
Using observational data to assess the treatment effects on outcomes of kidney transplantation relative to dialysis for patients on renal replacement therapy is challenging due to the non-random selection into treatment. This study applied the propensity score weighting approach in order to address the treatment selection bias of kidney transplantation on survival time compared with dialysis for patients on the waitlist. We included 2676 adult waitlisted patients who started renal replacement therapy in Sweden between 1 January 1995, and 31 December 2012. Weibull and logistic regression models were used for the outcome and treatment models, respectively. The potential outcome mean and the average treatment effect were estimated using an inverse-probability-weighted regression adjustment approach. The estimated survival times from start of renal replacement therapy were 23.1 years (95% confidence interval (CI): 21.2-25.0) and 9.3 years (95% CI: 7.8-10.8) for kidney transplantation and dialysis, respectively. The survival advantage of kidney transplantation compared with dialysis was estimated to 13.8 years (95% CI: 11.4-16.2). There was no significant difference in the survival advantage of transplantation between men and women. Controlling for possible immortality bias reduced the survival advantage to 9.1-9.9 years. Our results suggest that kidney transplantation substantially increases survival time compared with dialysis in Sweden and that this consequence of treatment is equally distributed over sex.
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15
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Dano S, Pokarowski M, Liao B, Tang E, Ekundayo O, Li V, Edwards N, Ford H, Novak M, Mucsi I. Evaluating symptom burden in kidney transplant recipients: validation of the revised Edmonton Symptom Assessment System for kidney transplant recipients - a single-center, cross-sectional study. Transpl Int 2020; 33:423-436. [PMID: 31919903 DOI: 10.1111/tri.13572] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/20/2019] [Accepted: 01/06/2020] [Indexed: 12/14/2022]
Abstract
We assessed the validity of the Edmonton Symptom Assessment System (ESAS-r) in kidney transplant recipients (KTR). A cross-sectional sample of 252 KTR was recruited. Individual ESAS-r symptom scores and symptom domain scores were evaluated. Internal consistency, convergent validity, and construct validity were assessed with Cronbach's α, Spearman's rank correlations, and a priori-defined risk group comparisons. Mean (SD) age was 51 (16), 58% were male, and 58% Caucasian. ESAS-r Physical, Emotional, and Global Symptom Scores demonstrated good internal consistency (α > 0.8 for all). ESAS-r Physical and Global Symptom Scores strongly correlated with PHQ-9 scores (0.72, 95% CI: 0.64-0.78 and 0.74, 95% CI: 0.67-0.80). For a priori-defined risk groups, individual ESAS-r symptom score differed between groups with lower versus higher eGFR [pain: 1 (0-3) vs. 0 (0-2), delta = 0.18; tiredness: 3 (1-5) vs. 1.5 (0-4), delta = 0.21] and lower versus higher hemoglobin [tiredness: 3 (1-6) vs. 2 (0-4), delta = 0.27]. ESAS-r Global and Physical Symptom Scores differed between groups with lower versus higher hemoglobin [13 (6-29) vs. 6.5 (0-18.5), delta = 0.3, and 9 (2-19) vs. 4 (0-13), delta = 0.24] and lower versus higher eGFR [11 (4-20) vs. 6.5 (2-13), delta = 0.21, and 7 (2-16) vs. 3 (0-9), delta = 0.26]. These data support reliability and construct validity of ESAS-r in KTR. Future studies should explore its clinical utility for symptom assessment among KTR.
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Affiliation(s)
- Sumaya Dano
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Martha Pokarowski
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Betty Liao
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Evan Tang
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Oladapo Ekundayo
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Vernon Li
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Nathaniel Edwards
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Heather Ford
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Marta Novak
- Centre for Mental Health, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Istvan Mucsi
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
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16
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Nishio-Lucar AG, Bose S, Lyons G, Awuah KT, Ma JZ, Lockridge RS. Intensive Home Hemodialysis Survival Comparable to Deceased Donor Kidney Transplantation. Kidney Int Rep 2020; 5:296-306. [PMID: 32154451 PMCID: PMC7056865 DOI: 10.1016/j.ekir.2019.12.019] [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: 05/19/2019] [Revised: 12/18/2019] [Accepted: 12/31/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction Kidney transplantation (KT) remains the treatment of choice for end-stage kidney disease (ESKD), but access to transplantation is limited by a disparity between supply and demand for suitable organs. This organ shortfall has resulted in the use of a wider range of donor kidneys and, in parallel, a reexamination of potential alternative renal replacement therapies. Previous studies comparing Canadian intensive home hemodialysis (IHHD) with deceased donor (DD) KT in the United States reported similar survival, suggesting IHHD might be a plausible alternative. Methods Using data from the Scientific Registry of Transplant Recipients and an experienced US-based IHHD program in Lynchburg, VA, we retrospectively compared mortality outcomes of a cohort of IHHD patients with transplant recipients within the same geographic region between October 1997 and June 2014. Results We identified 3073 transplant recipients and 116 IHHD patients. Living donor KT (n = 1212) had the highest survival and 47% reduction in risk of death compared with IHHD (hazard ratio [HR]: 0.53; 95% confidence interval [CI]: 0.34–0.83). Survival of IHHD patients did not statistically differ from that of DD transplant recipients (n = 1834) in adjusted analyses (HR: 0.96; 95% CI: 0.62–1.48) or when exclusively compared with marginal (Kidney Donor Profile Index >85%) transplant recipients (HR: 1.35; 95% CI: 0.84–2.16). Conclusion Our study showed comparable overall survival between IHHD and DD KT. For appropriate patients, IHHD could serve as bridging therapy to transplant and a tenable long-term renal replacement therapy.
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Affiliation(s)
- Angie G Nishio-Lucar
- Division of Nephrology, Department of Medicine, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Subhasish Bose
- Division of Nephrology, Department of Medicine, University of Virginia Medical Center, Charlottesville, Virginia, USA.,Lynchburg Nephrology Physicians, PLLC, Lynchburg, Virginia, USA
| | - Genevieve Lyons
- Division of Nephrology, Department of Medicine, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Kwabena T Awuah
- Division of Nephrology, Department of Medicine, University of Virginia Medical Center, Charlottesville, Virginia, USA.,Lynchburg Nephrology Physicians, PLLC, Lynchburg, Virginia, USA
| | - Jennie Z Ma
- Division of Nephrology, Department of Medicine, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Robert S Lockridge
- Division of Nephrology, Department of Medicine, University of Virginia Medical Center, Charlottesville, Virginia, USA.,Lynchburg Nephrology Physicians, PLLC, Lynchburg, Virginia, USA
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17
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Slon Roblero MF, Borman N, Bajo Rubio MA. Integrated care: enhancing transition from renal replacement therapy options to home haemodialysis. Clin Kidney J 2019; 13:105-110. [PMID: 32082558 PMCID: PMC7025339 DOI: 10.1093/ckj/sfz140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/09/2019] [Indexed: 12/18/2022] Open
Abstract
Transition is an intrinsic process in the life of a patient with kidney disease and should be planned and anticipated when possible. A single therapy option might not be adequate across a patient’s entire lifespan and many patients will require a switch in their treatment modality to adapt the treatment to their clinical and psychosocial needs. There are several reasons behind changing a patient’s treatment modality, and the consequences of each decision should be evaluated, considering both short- and long-term benefits and risks. Dialysis modality transition is not only to allow for technical optimization or improved patient survival, the patient’s experience associated with the transition should also be taken into account. Transition should not be considered as treatment failure, but rather as an expected progression in the patient’s treatment options.
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Affiliation(s)
- Maria Fernanda Slon Roblero
- Department of Nephrology, Complejo Hospitalario Navarra, Navarre, Spain.,Cardiovascular Department, IdisNa, Navarre, Spain
| | - Natalie Borman
- Wessex Renal and Transplantation Unit, Queen Alexandra Hospital, Portsmouth, Portsmouth, UK
| | - Maria Auxiliadora Bajo Rubio
- Department of Nephrology, Hospital Universitario La Paz, Madrid, Spain.,Department of Nephrology, IdiPAZ, Madrid, Spain
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18
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Angell J, Dodds N, Darweish-Mednuik AM, Lewis S, Pyke M, Mitchell DC, Hamilton K, White P, Tolchard S. Characterising recovery from renal transplantation and live-related donation using cardiopulmonary exercise testing. Disabil Rehabil 2019; 43:1692-1698. [PMID: 31600094 DOI: 10.1080/09638288.2019.1674387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND An association between end-stage renal failure and exercise intolerance exists. Whether live kidney donation impacts on exercise tolerance is unknown. Here recovery post renal transplant and donation using cardiopulmonary exercise testing is investigated. METHODS Renal donors (n = 28) and recipients (n = 24) undertook a cardiopulmonary exercise test, Duke activity score index and patient reported health score questionnaires pre-operatively and in the 7th and 14th week post-operatively. Anaerobic threshold, peak oxygen uptake and ventilatory equivalents were measured in relation to activity and reported health scores. Haemoglobin and renal function was recorded. RESULTS Recipients showed impaired cardiopulmonary function compared to donors with lower anaerobic threshold (10.5 vs. 14.4 ml/kg/min) and peak oxygen uptake (18.5 vs 23.0 ml/kg/min). Post-operatively the anaerobic threshold of recipients improved and normalised by the 14th week, whereas that in donors fell by ∼20% by the 7th (mean 11.4 ml/kg/min), recovering by the 14th (mean 15.6 ml/kg/min). Reported health but not activity scores showed similar changes. CONCLUSIONS Recovery following renal transplantation and donation differ. Transplantation improves renal function resulting in an increase in anaerobic threshold and peak oxygen uptake which essentially normalise by the 14th week post-operatively. Donors suffer a 20% reduction in cardiopulmonary reserve post-operatively, which recovers by the 14th week, suggesting no associated chronic exercise intolerance.IMPLICATIONS FOR REHABILITATIONCardiopulmonary exercise testing is a real-time predictor of functional capacity and thus is used as a pre-operative tool to measure physiological fitness and predict outcomes.Renal failure is associated with exercise intolerance and transplantation is transformational in terms of quality of life, longevity and healthcare cost.Live - related renal donation is increasingly available but whether donation itself carries a long-term health burden has not been previously well established.This study suggests that renal donation is not associated with long-term cardiopulmonary compromise and patients who donate their kidneys recover their previous fitness within 14 weeks.
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Affiliation(s)
- Johanna Angell
- ASCC Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Nicholas Dodds
- ASCC Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Simon Lewis
- ASCC Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Mark Pyke
- ASCC Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - David C Mitchell
- ASCC Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Kay Hamilton
- ASCC Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Paul White
- Applied Statistics Group, University of the West of England, Bristol, UK
| | - Stephen Tolchard
- ASCC Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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19
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Vedadi A, Bansal A, Yung P, Famure O, Mitchell M, Waterman AD, Singh SK, Novak M, Kim SJ, Mucsi I. Ethnic background is associated with no live kidney donor identified at the time of first transplant assessment-an opportunity missed? A single-center retrospective cohort study. Transpl Int 2019; 32:1030-1043. [PMID: 31250484 DOI: 10.1111/tri.13476] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 04/29/2019] [Accepted: 06/24/2019] [Indexed: 12/31/2022]
Abstract
Patients from ethnocultural minorities have reduced access to live donor kidney transplant (LDKT). To explore early pretransplant ethnocultural disparities in LDKT readiness, and the impact of the interactions with the transplant program, we assessed if patients had a potential live donor (LD) identified at first pretransplant assessment, and if patients with no LD initially received LDKT subsequently. Single-center, retrospective cohort of adults referred for kidney transplant (KT) assessment. Multivariable logistic regression assessed the association between ethnicity and having a potential LD. Cox proportional hazard analysis assessed the association between no potential LD initially and subsequent LDKT. Of 1617 participants, 66% of Caucasians indicated having a potential LD, compared with 55% of South Asians, 44% of African Canadians, and 41% of East Asians (P < 0.001). In multivariable logistic regression analysis, the odds of having a potential LD identified was significantly lower for African, East and South Asian Canadians. No potential LD at initial KT assessment was associated with lower likelihood of LDKT subsequently (hazard ratio [HR], 0.14; [0.10-0.19]). Compared to Caucasians, African, East and South Asian and African Canadians are less likely to have a potential LD identified at first KT assessment, which predicts a lower likelihood of subsequent LDKT.
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Affiliation(s)
- Ali Vedadi
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Aarushi Bansal
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Priscilla Yung
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Olusegun Famure
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Margot Mitchell
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Amy D Waterman
- Division of Nephrology, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Sunita K Singh
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Marta Novak
- Centre for Mental Health, University Health Network and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sang Joseph Kim
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Istvan Mucsi
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
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Gillespie A. Together We Can Improve Outcomes in Kidney Failure: Examining Social Networks in Hemodialysis. Kidney Med 2019; 1:79-82. [PMID: 32734941 PMCID: PMC7380405 DOI: 10.1016/j.xkme.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Avrum Gillespie
- Division of Nephrology, Hypertension, and Kidney Transplantation, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
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21
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Huang ST, Yu TM, Chuang YW, Chung MC, Wang CY, Fu PK, Ke TY, Li CY, Lin CL, Wu MJ, Kao CH. The Risk of Stroke in Kidney Transplant Recipients with End-Stage Kidney Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030326. [PMID: 30682846 PMCID: PMC6388105 DOI: 10.3390/ijerph16030326] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/22/2019] [Accepted: 01/22/2019] [Indexed: 12/11/2022]
Abstract
Background: The incidence of stroke after kidney transplantation is poorly understood. Our study aimed to determine the incidence and predictors of stroke as well as mortality from stroke in kidney transplant recipients (KTRs). Methods: This retrospective cohort study used the National Health Insurance Research Database in Taiwan to study KTRs (N = 4635), patients with end-stage renal disease (ESRD; N = 69,297), and patients from the general population who were chronic kidney disease (CKD)-free and matched by comorbidities (N = 69,297) for the years 2000 through 2010. The risk of stroke was analyzed using univariate and multivariate Cox regression models and compared between study cohorts. Findings: Compared with the ESRD subgroup, KTRs had a significantly lower risk of overall stroke (adjusted hazard ratio (aHR) = 0.37, 95% confidence interval (CI) = 0.31⁻0.44), ischemic stroke (aHR = 0.45, 95% CI = 0.37⁻0.55), and hemorrhagic stroke (aHR = 0.20, 95% CI = 0.14⁻0.29). The risk patterns for each type of stroke in the KTR group were not significantly different than those of the CKD-free control subgroup. The predictors of stroke were age and diabetes in KTRs. All forms of stroke after transplantation independently predicted an increased risk of subsequent mortality, and the strongest risk was related to hemorrhagic events. Interpretation: KTRs had a lower risk of stroke than ESRD patients, but this risk was not significantly different from that of the CKD-free comorbidities-matched general population group. Although stroke was relatively uncommon among cardiovascular events, it predicted unfavorable outcome in KTRs.
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Affiliation(s)
- Shih-Ting Huang
- Division of Nephrology, Taichung Veterans General Hospital, Taichung 407, Taiwan.
- Graduate Institute of Public Health, China Medical University, Taichung 404, Taiwan.
| | - Tung-Min Yu
- Division of Nephrology, Taichung Veterans General Hospital, Taichung 407, Taiwan.
- Graduate Institute of Biomedical Sciences, School of Medicine, College of Medicine, China Medical University, Taichung 404, Taiwan.
| | - Ya-Wen Chuang
- Division of Nephrology, Taichung Veterans General Hospital, Taichung 407, Taiwan.
- Graduate Institute of Public Health, China Medical University, Taichung 404, Taiwan.
| | - Mu-Chi Chung
- Division of Nephrology, Taichung Veterans General Hospital, Taichung 407, Taiwan.
| | - Chen-Yu Wang
- Department of Critical Care, Taichung Veterans General Hospital, Taichung 407, Taiwan.
| | - Pin-Kuei Fu
- Department of Critical Care, Taichung Veterans General Hospital, Taichung 407, Taiwan.
| | - Tai-Yuan Ke
- Division of Nephrology, Ministry of Health and Welfare Chiayi Hospital, Chiayi 600, Taiwan.
| | - Chi-Yuan Li
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung 404, Taiwan.
- Department of Anesthesiology, China Medical University Hospital, Taichung 404, Taiwan.
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan.
- College of Medicine, China Medical University, Taichung 404, Taiwan.
| | - Ming-Ju Wu
- Division of Nephrology, Taichung Veterans General Hospital, Taichung 407, Taiwan.
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences, School of Medicine, College of Medicine, China Medical University, Taichung 404, Taiwan.
- Department of Nuclear Medicine and PET Center, China Medical University, Taichung 404, Taiwan.
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung 404, Taiwan.
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Propensity Score-Matched Analysis of the Survival Benefit from Kidney Transplantation in Patients with End-Stage Renal Disease. J Clin Med 2018; 7:jcm7110388. [PMID: 30373110 PMCID: PMC6262546 DOI: 10.3390/jcm7110388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 10/19/2018] [Accepted: 10/24/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Several comparison studies have suggested that kidney transplantation (KT) could reduce mortality in patients with end-stage renal disease (ESRD). Selection criteria bias is common in the selection of dialysis patients for control groups. In this study, we compared the survival outcome between KT recipients and comparable propensity score-matched dialysis patients. METHODS We used Taiwan's National Health Insurance Research Database to identify patients newly diagnosed with ESRD between 2000 and 2010. We separated them into two groups: a KT group and non-KT dialysis-only group. To evaluate the survival outcome, we compared each patient with KT to a patient on dialysis without KT using propensity score matching. RESULTS In total, 1276 KT recipients and 1276 propensity score-matched dialysis patients were identified. Compared with the propensity score-matched dialysis patients, the patients who underwent KT exhibited significantly higher 5-year and 10-year survival rates (88% vs. 92% and 74% vs. 87%, both p < 0.05). The crude and adjusted hazard ratios for mortality were 0.55 and 0.52 in patients with KT (both p < 0.001). Mortality was insignificantly higher for patients who were on dialysis for longer than 1 year prior to KT compared with those on dialysis for less than 1 year. CONCLUSION This study used a propensity score-matched cohort to confirm that KT is associated with lower risk of mortality than dialysis alone in patients newly diagnosed with ESRD.
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Cyborgs, Robots and Society: Implications for the Future of Society from Human Enhancement with In-The-Body Technologies. TECHNOLOGIES 2018. [DOI: 10.3390/technologies6020050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
The use of frequent hemodialysis (HD) is growing, with the hope of improving outcomes in end-stage renal disease. We narratively review the three randomized trials, 15 comparative cohort studies, and several case series of frequent HD that empirically demonstrate the potential efficacy and adverse effects of these regimens. Taken together, the randomized studies suggest frequent HD may result in left ventricular mass regression. This effect is most pronounced when left ventricular mass is abnormal, but attenuated by significant residual urine output. Both frequent short and long HD consistently improved blood pressure control and reduced antihypertensive use, despite greater weekly interdialytic weight gains. Serum phosphate was lowered. Frequent short daytime HD improved health-related quality of life, while frequent long overnight HD did not. Regarding adverse effects, frequent HD patients underwent significantly more procedures to salvage arteriovenous vascular accesses. An absolute increase in hypotensive episodes was observed with frequent short HD, while frequent long HD accelerated residual renal function loss and increased perceived caregiver burden. The effect of frequent HD on mortality is controversial, due to conflicting results and limitations of published studies. Finally, pregnancy outcomes may be substantially better with frequent long HD. On the basis of these data, we suggest frequent HD is most likely to benefit patients with left ventricular hypertrophy particularly if there is minimal urine output, those unable to attain dry weight on a thrice weekly schedule, and pregnant women. All patients receiving frequent HD should be advised of and monitored for potential risks.
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Affiliation(s)
- Rita S Suri
- Department of Medicine, University of Montreal, Montreal, Canada
| | - Alan S Kliger
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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25
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Roldán-Reina AJ, Egea-Guerrero JJ, Palomo-López N, Cuenca-Apolo DX, Adriaensens-Pérez M, Martín-Villén L. Kidney transplantation in the Intensive Care Unit: Graft evaluation using imaging tests. Med Intensiva 2017; 43:384-386. [PMID: 29110916 DOI: 10.1016/j.medin.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/20/2017] [Accepted: 09/04/2017] [Indexed: 11/19/2022]
Affiliation(s)
- A J Roldán-Reina
- UGC de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - J J Egea-Guerrero
- UGC de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España; Coordinación de Trasplantes, Hospital Universitario Virgen del Rocío, Sevilla, España; IBiS-CSIC-Universidad de Sevilla, Sevilla, España
| | - N Palomo-López
- UGC de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - D X Cuenca-Apolo
- UGC de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M Adriaensens-Pérez
- UGC de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - L Martín-Villén
- UGC de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España; Coordinación de Trasplantes, Hospital Universitario Virgen del Rocío, Sevilla, España
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Ethnic Background Is a Potential Barrier to Living Donor Kidney Transplantation in Canada: A Single-Center Retrospective Cohort Study. Transplantation 2017; 101:e142-e151. [PMID: 28207634 DOI: 10.1097/tp.0000000000001658] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND We examined if African or Asian ethnicity was associated with lower access to kidney transplantation (KT) in a Canadian setting. METHODS Patients referred for KT to the Toronto General Hospital from January 1, 2003, to December 31, 2012, who completed social work assessment, were included (n = 1769). The association between ethnicity and the time from referral to completion of KT evaluation or receipt of a KT were examined using Cox proportional hazards models. RESULTS About 54% of the sample was white, 13% African, 11% East Asian, and 11% South Asian; 7% had "other" (n = 121) ethnic background. African Canadians (hazard ratio [HR], 0.75; 95% CI: 0.62-0.92]) and patients with "other" ethnicity (HR, 0.71; 95% CI, 0.55-0.92) were less likely to complete the KT evaluation compared with white Canadians, and this association remained statistically significant in multivariable adjusted models. Access to KT was significantly reduced for all ethnic groups assessed compared with white Canadians, and this was primarily driven by differences in access to living donor KT. The adjusted HRs for living donor KT were 0.35 (95% CI, 0.24-0.51), 0.27 (95% CI, 0.17-0.41), 0.43 (95% CI, 0.30-0.61), and 0.34 (95% CI, 0.20-0.56) for African, East or South Asian Canadians and for patients with "other" ethnic background, respectively. CONCLUSIONS Similar to other jurisdictions, nonwhite patients face barriers to accessing KT in Canada. This inequity is very substantial for living donor KT. Further research is needed to identify if these inequities are due to potentially modifiable barriers.
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Perl J, Dember LM, Bargman JM, Browne T, Charytan DM, Flythe JE, Hickson LJ, Hung AM, Jadoul M, Lee TC, Meyer KB, Moradi H, Shafi T, Teitelbaum I, Wong LP, Chan CT. The Use of a Multidimensional Measure of Dialysis Adequacy-Moving beyond Small Solute Kinetics. Clin J Am Soc Nephrol 2017; 12:839-847. [PMID: 28314806 PMCID: PMC5477210 DOI: 10.2215/cjn.08460816] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Urea removal has become a key measure of the intensity of dialysis treatment for kidney failure. Small solute removal, exemplified by Kt/Vurea, has been broadly applied as a means to quantify the dose of thrice weekly hemodialysis. Yet, the reliance on small solute clearances alone as a measure of dialysis adequacy fails fully to quantify the intended clinical effects of dialysis therapy. This review aims to (1) understand the strengths and limitations of small solute kinetics as a surrogate marker of dialysis dose, and (2) present the prospect of a more comprehensive construct for dialysis dose, one that considers more broadly the goals of ESRD care to maximize both quality of life and survival. On behalf of the American Society of Nephrology Dialysis Advisory Group, we propose the need to ascertain the validity and utility of a multidimensional measure that moves beyond small solute kinetics alone to quantify optimal dialysis derived from both patient-reported and comprehensive clinical and dialysis-related measures.
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Affiliation(s)
- Jeffrey Perl
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Knight SR, Metcalfe L, O’Donoghue K, Ball ST, Beale A, Beale W, Hilton R, Hodkinson K, Lipkin GW, Loud F, Marson LP, Morris PJ. Defining Priorities for Future Research: Results of the UK Kidney Transplant Priority Setting Partnership. PLoS One 2016; 11:e0162136. [PMID: 27776143 PMCID: PMC5077146 DOI: 10.1371/journal.pone.0162136] [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: 06/10/2016] [Accepted: 07/24/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND It has been suggested that the research priorities of those funding and performing research in transplantation may differ from those of end service users such as patients, carers and healthcare professionals involved in day-to-day care. The Kidney Transplant Priority Setting Partnership (PSP) was established with the aim of involving all stakeholders in prioritising future research in the field. METHODS The PSP methodology is as outlined by the James Lind Alliance. An initial survey collected unanswered research questions from patients, carers and clinicians. Duplicate and out-of-scope topics were excluded and the existing literature searched to identify topics answered by current evidence. An interim prioritisation survey asked patients and professionals to score the importance of the remaining questions to create a ranked long-list. These were considered at a final consensus workshop using a modified nominal group technique to agree a final top ten. RESULTS The initial survey identified 497 questions from 183 respondents, covering all aspects of transplantation from assessment through to long-term follow-up. These were grouped into 90 unanswered "indicative" questions. The interim prioritisation survey received 256 responses (34.8% patients/carers, 10.9% donors and 54.3% professionals), resulting in a ranked list of 25 questions that were considered during the final workshop. Participants agreed a top ten priorities for future research that included optimisation of immunosuppression (improved monitoring, choice of regimen, personalisation), prevention of sensitisation and transplanting the sensitised patient, management of antibody-mediated rejection, long-term risks to live donors, methods of organ preservation, induction of tolerance and bioengineering of organs. There was evidence that patient and carer involvement had a significant impact on shaping the final priorities. CONCLUSIONS The final list of priorities relates to all stages of the transplant process, including access to transplantation, living donation, organ preservation, post-transplant care and management of the failing transplant. This list of priorities will provide an invaluable resource for researchers and funders to direct future activity.
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Affiliation(s)
- Simon R. Knight
- Centre for Evidence in Transplantation, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Leanne Metcalfe
- James Lind Alliance, National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre, University of Southampton, Southampton, United Kingdom
| | - Katriona O’Donoghue
- Centre for Evidence in Transplantation, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
| | - Simon T. Ball
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- British Renal Society, Lichfield, United Kingdom
| | - Angela Beale
- National Kidney Federation, Worksop, United Kingdom
| | | | - Rachel Hilton
- Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
- British Transplantation Society, Macclesfield, United Kingdom
| | | | - Graham W. Lipkin
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Renal Association, Petersfield, United Kingdom
| | - Fiona Loud
- British Kidney Patient Association, Alton, United Kingdom
| | - Lorna P. Marson
- Kidney Research UK, Peterborough, United Kingdom
- University of Edinburgh, Edinburgh, United Kingdom
| | - Peter J. Morris
- Centre for Evidence in Transplantation, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
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Molnar MZ, Ravel V, Streja E, Kovesdy CP, Mehrotra R, Kalantar-Zadeh K. Racial Differences in Survival of Incident Home Hemodialysis and Kidney Transplant Patients. Transplantation 2016; 100:2203-10. [PMID: 26588010 PMCID: PMC4873468 DOI: 10.1097/tp.0000000000001005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Previous studies have indicated that patients on maintenance hemodialysis have worse survival compared with kidney transplant (KTx) recipients. However, none of these studies have compared mortality of the US patients using alternative dialysis modalities such as home hemodialysis (HHD) with KTx recipients. METHODS Comparing patients who started HHD with those who received kidney transplantation in the United States between 2007 and 2011, we created a 1:1 propensity score-matched cohort of 4000 patients and examined the association between treatment modality and all-cause mortality using Cox proportional hazard models. RESULTS The mean ± SD age of the propensity score-matched HHD and KTx patients at baseline were 54 ± 15 years and 54 ± 14 years, 65% were men (both groups), 70% and 72% of patients were whites, and 19% were African American (both groups), respectively. Over 5 years of follow-up, HHD patients had 4 times higher mortality risk compared with KTx recipients in the entire patient population (hazard ratio [HR], 4.06; 95% confidence interval [95% CI], 3.27-5.04); total event number, 411), and similar difference was found across each race stratum. However, during the first year of therapy, although the white HHD patients had higher mortality risk (HR, 4.21; 95% CI, 3.10-5.73; total event number, 332) compared with their KTx counterparts, there was no significant difference in mortality risk between African American HHD and KTx patients (HR, 1.62; 95% CI, 0.77-3.39; total event number, 55). This result was consistent across different types of kidney donors. CONCLUSIONS The HHD patients appear to have 4 times higher mortality compared with KTx recipients regardless of the type of kidney donor. Further studies are needed to understand the reasons underlying racial differenes during the first year of therapy.
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Affiliation(s)
- Miklos Z Molnar
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Vanessa Ravel
- Division of Nephrology, University of California, Irvine, CA, USA
| | - Elani Streja
- Division of Nephrology, University of California, Irvine, CA, USA
| | - Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, TN, USA
| | - Rajnish Mehrotra
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, WA, USA
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Molnar MZ, Ravel V, Streja E, Kovesdy CP, Rivara MB, Mehrotra R, Kalantar-Zadeh K. Survival of Elderly Adults Undergoing Incident Home Hemodialysis and Kidney Transplantation. J Am Geriatr Soc 2016; 64:2003-2010. [PMID: 27612017 DOI: 10.1111/jgs.14321] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare the mortality of elderly adults with end-stage renal disease (ESRD) treated with home hemodialysis (HD) with that of those receiving a kidney transplant (KTx). DESIGN Prospective cohort. SETTING Pertinent data for the two groups were obtained from electronic medical records from a large dialysis provider and the U.S. Renal Data System. PARTICIPANTS Using data from elderly adults (aged ≥65) who started home HD and underwent KTx in the US between 2007 and 2011, a 1:1 propensity score (PS)-matched cohort of 960 elderly adults was created, and the association between treatment modality and all-cause mortality was examined using Cox proportional hazards and competing risk regression survival models using modality failure as a competing event. MEASUREMENTS Modality of renal replacement therapy. RESULTS The baseline mean age ± standard deviation of the PS-matched individuals undergoing home HD was 71 ± 6, and that of KTx recipients was 71 ± 5, 69% of both groups were male, 81% of those undergoing home HD and 79% of KTx recipients were white, and 11% and 12%, respectively, were African American. Median follow-up time was 205 days (interquartile range (IQR) 78-364 days) for those undergoing home HD and 795 days (IQR 366-1,221 days) for KTx recipients. There were 97 deaths (20%, 253/1,000 patient-years, 95% confidence interval (CI) = 207-309/1,000 patient-years) in the home HD group and 48 deaths (10%, 45/1,000 patient-years, 95% CI = 34-60/1,000 patient-years) in the KTx group. Elderly adults undergoing home HD had a risk of mortality that was almost five times as high as that of KTx recipients (hazard ratio = 4.74, 95% CI = 3.25-6.91). Similar results were seen in competing risk regression analyses (subhazard ratio = 4.71, 95% CI = 3.27-6.79). Results were consistent across different types of kidney donors and subgroups divided according to various recipient characteristics. CONCLUSION Elderly adults with ESRD who receive a KTx have greater survival than those who undergo home HD. Further studies are needed to assess whether KTx receipt is associated with other benefits such as better quality of life and lower hospitalization rates.
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Affiliation(s)
- Miklos Z Molnar
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
| | - Vanessa Ravel
- Division of Nephrology, University of California, Irvine, California
| | - Elani Streja
- Division of Nephrology, University of California, Irvine, California
| | - Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.,Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee
| | - Matthew B Rivara
- Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington
| | - Rajnish Mehrotra
- Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington
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Mitsides N, Mitra S, Cornelis T. Clinical, patient-related, and economic outcomes of home-based high-dose hemodialysis versus conventional in-center hemodialysis. Int J Nephrol Renovasc Dis 2016; 9:151-9. [PMID: 27462173 PMCID: PMC4940011 DOI: 10.2147/ijnrd.s89411] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Despite technological advances in renal replacement therapy, the preservation of health and quality of life for individuals on dialysis still remains a challenge. The high morbidity and mortality in dialysis warrant further research and insight into the clinical domains of the technique and practice of this therapy. In the last 20 years, the focus of development in the field of hemodialysis (HD) has centered around adequate removal of urea and other associated toxins. High-dose HD offers an opportunity to improve mortality, morbidity, and quality of life of patients with end-stage kidney disease. However, the uptake of this modality is low, and the risk associated with the therapy is not fully understood. Recent studies have highlighted the evidence base and improved our understanding of this technique of dialysis. This article provides a review of high-dose and home HD, its clinical impact on patient outcome, and the controversies that exist.
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Affiliation(s)
- Nicos Mitsides
- Department of Renal Medicine, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Center, Manchester; National Institute for Healthcare Research Devices for Dignity Healthcare Co-operative, Sheffield, UK
| | - Sandip Mitra
- Department of Renal Medicine, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Center, Manchester; National Institute for Healthcare Research Devices for Dignity Healthcare Co-operative, Sheffield, UK
| | - Tom Cornelis
- Department of Nephrology, Jessa Hospital, Hasselt, Belgium
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Harhay MN, Hill AS, Wang W, Even-Shoshan O, Mussell AS, Bloom RD, Feldman HI, Karlawish JH, Silber JH, Reese PP. Measures of Global Health Status on Dialysis Signal Early Rehospitalization Risk after Kidney Transplantation. PLoS One 2016; 11:e0156532. [PMID: 27257680 PMCID: PMC4892690 DOI: 10.1371/journal.pone.0156532] [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: 07/20/2015] [Accepted: 05/16/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Early rehospitalization (<30 days) after discharge from kidney transplantation (KT) is associated with poor outcomes. We explored summary metrics of pre-transplant health status that may improve the identification of KT recipients at risk for early rehospitalization and mortality after transplant. MATERIALS AND METHODS We performed a retrospective cohort study of 8,870 adult (≥ 18 years) patients on hemodialysis who received KT between 2000 and 2010 at United States transplant centers. We linked Medicare data to United Network for Organ Sharing data and data from a national dialysis provider to examine pre-KT (1) Elixhauser Comorbidity Index, (2) physical function (PF) measured by the Short Form 36 Health Survey, and (3) the number of hospitalizations during the 12 months before KT as potential predictors of early rehospitalization after KT. We also explored whether these metrics are confounders of the known association between early rehospitalization and post-transplant mortality. RESULTS The median age was 52 years (interquartile range [IQR] 41, 60) and 63% were male. 29% were rehospitalized in <30 days, and 20% died during a median follow-up time of five years (IQR 3.6-6.5). In a multivariable logistic model, kidney recipients with more pre-KT Elixhauser comorbidities (adjusted odds ratio [aOR] 1.09 per comorbidity, 95% Confidence Interval [CI] 1.07-1.11), the poorest pre-KT PF (aOR 1.24, 95% CI 1.08-1.43), or >1 pre-KT hospitalizations (aOR 1.32, 95% CI 1.17-1.49) were more likely to be rehospitalized. All three health status metrics and early rehospitalization were independently associated with post-KT mortality in a multivariable Cox model (adjusted hazard ratio for rehospitalization: 1.41, 95% CI 1.28-1.56). CONCLUSIONS Pre-transplant metrics of health status, measured by dialysis providers or administrative data, are independently associated with early rehospitalization and mortality risk after KT. Transplant providers may consider utilizing metrics of pre-KT global health status as early signals of vulnerability when transitioning care after KT.
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Affiliation(s)
- Meera N. Harhay
- Division of Nephrology, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Alexander S. Hill
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Wei Wang
- Department of Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California, United States of America
| | - Orit Even-Shoshan
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Adam S. Mussell
- University of Pennsylvania, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Roy D. Bloom
- Renal Electrolyte & Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Harold I. Feldman
- University of Pennsylvania, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Renal Electrolyte & Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Jason H. Karlawish
- Division of Geriatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Jeffrey H. Silber
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Peter P. Reese
- University of Pennsylvania, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Renal Electrolyte & Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Rosenthal MM, Molzahn AE, Chan CT, Cockfield SL, Kim SJ, Pauly RP. Why take the chance? A qualitative grounded theory study of nocturnal haemodialysis recipients who decline kidney transplantation. BMJ Open 2016; 6:e011951. [PMID: 27194322 PMCID: PMC4874163 DOI: 10.1136/bmjopen-2016-011951] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The objective of this study was to examine the factors that influence decision-making to forgo transplantation in favour of remaining on nocturnal haemodialysis (NHD). DESIGN A grounded theory approach using in-depth telephone interviewing was used. SETTING Participants were identified from 2 tertiary care renal programmes in Canada. PARTICIPANTS The study participants were otherwise eligible patients with end-stage renal disease who have opted to remain off of the transplant list. A total of 7 eligible participants were interviewed. 5 were male. The mean age was 46 years. ANALYSIS A constant comparative method of analysis was used to identify a core category and factors influencing the decision-making process. RESULTS In this grounded theory study of people receiving NHD who refused kidney transplantation, the core category of 'why take a chance when things are going well?' was identified, along with 4 factors that influenced the decision including 'negative past experience', 'feeling well on NHD', 'gaining autonomy' and 'responsibility'. CONCLUSIONS This study provides insight into patients' thought processes surrounding an important treatment decision. Such insights might help the renal team to better understand, and thereby respect, patient choice in a patient-centred care paradigm. Findings may also be useful in the development of education programmes addressing the specific concerns of this population of patients.
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Affiliation(s)
- Meagen M Rosenthal
- Department of Pharmacy Administration, University of Mississippi, Oxford, Mississippi, USA
| | - Anita E Molzahn
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Christopher T Chan
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sandra L Cockfield
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - S Joseph Kim
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert P Pauly
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
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Marshall MR, Polkinghorne KR, Kerr PG, Hawley CM, Agar JW, McDonald SP. Intensive Hemodialysis and Mortality Risk in Australian and New Zealand Populations. Am J Kidney Dis 2016; 67:617-28. [DOI: 10.1053/j.ajkd.2015.09.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 09/21/2015] [Indexed: 11/11/2022]
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Nadeau-Fredette AC, Hawley C, Pascoe E, Chan CT, Leblanc M, Clayton PA, Polkinghorne KR, Boudville N, Johnson DW. Predictors of Transfer to Home Hemodialysis after Peritoneal Dialysis Completion. Perit Dial Int 2015; 36:547-54. [PMID: 26526050 DOI: 10.3747/pdi.2015.00121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/09/2015] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND The aim of the present study was to evaluate the predictors of transfer to home hemodialysis (HHD) after peritoneal dialysis (PD) completion. ♦ METHODS All Australian and New Zealand patients treated with PD on day 90 after initiation of renal replacement therapy between 2000 and 2012 were included. Completion of PD was defined by death, transplantation, or hemodialysis (HD) for 180 days or more. Patients were categorized as "transferred to HHD" if they initiated HHD fewer than 180 days after PD had ended. Multivariable logistic regression was used to evaluate predictors of transfer to HHD in a restricted cohort experiencing PD technique failure; a competing-risks analysis was used in the unrestricted cohort. ♦ RESULTS Of 10 710 incident PD patients, 3752 died, 1549 underwent transplantation, and 2915 transferred to HD, among whom 156 (5.4%) started HHD. The positive predictors of transfer to HHD in the restricted cohort were male sex [odds ratio (OR): 2.81], obesity (OR: 2.20), and PD therapy duration (OR: 1.10 per year). Negative predictors included age (OR: 0.95 per year), infectious cause of technique failure (OR: 0.48), underweight (OR: 0.50), kidney disease resulting from hypertension (OR: 0.38) or diabetes (OR: 0.32), race being Maori (OR: 0.65) or Aboriginal and Torres Strait Islander (OR: 0.30). Comparable results were obtained with a competing-risks model. ♦ CONCLUSIONS Transfer to HHD after completion of PD is rare and predicted by patient characteristics at baseline and at the time of PD end. Transition to HHD should be considered more often in patients using PD, especially when they fulfill the identified characteristics.
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Affiliation(s)
- Annie-Claire Nadeau-Fredette
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Université de Montreal, Montreal, Quebec, Canada
| | - Carmel Hawley
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Centre for Kidney Disease Research, Translational Research Institute, University of Queensland, Brisbane, Australia
| | - Elaine Pascoe
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Christopher T Chan
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Philip A Clayton
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Sydney Medical School, University of Sydney, Sydney
| | - Kevan R Polkinghorne
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Department of Nephrology, Monash Medical Centre Monash Health, Clayton Department of Medicine and of Epidemiology and Preventive Medicine, Monash University, Melbourne
| | - Neil Boudville
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - David W Johnson
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Centre for Kidney Disease Research, Translational Research Institute, University of Queensland, Brisbane, Australia
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Daugirdas JT, Depner TA, Inrig J, Mehrotra R, Rocco MV, Suri RS, Weiner DE, Greer N, Ishani A, MacDonald R, Olson C, Rutks I, Slinin Y, Wilt TJ, Rocco M, Kramer H, Choi MJ, Samaniego-Picota M, Scheel PJ, Willis K, Joseph J, Brereton L. KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 Update. Am J Kidney Dis 2015; 66:884-930. [DOI: 10.1053/j.ajkd.2015.07.015] [Citation(s) in RCA: 603] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 07/31/2015] [Indexed: 12/13/2022]
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Strigo TS, Ephraim PL, Pounds I, Hill-Briggs F, Darrell L, Ellis M, Sudan D, Rabb H, Segev D, Wang NY, Kaiser M, Falkovic M, Lebov JF, Boulware LE. The TALKS study to improve communication, logistical, and financial barriers to live donor kidney transplantation in African Americans: protocol of a randomized clinical trial. BMC Nephrol 2015; 16:160. [PMID: 26452366 PMCID: PMC4600221 DOI: 10.1186/s12882-015-0153-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/22/2015] [Indexed: 11/10/2022] Open
Abstract
Background Live donor kidney transplantation (LDKT), an optimal therapy for many patients with end-stage kidney disease, is underutilized, particularly by African Americans. Potential recipient difficulties initiating and sustaining conversations about LDKT, identifying willing and medically eligible donors, and potential donors’ logistical and financial hurdles have been cited as potential contributors to race disparities in LDKT. Few interventions specifically targeting these factors have been tested. Methods/Design We report the protocol of the Talking about Living Kidney Donation Support (TALKS) study, a study designed to evaluate the effectiveness of behavioral, educational and financial assistance interventions to improve access to LDKT among African Americans on the deceased donor kidney transplant recipient waiting list. We adapted a previously tested educational and social worker intervention shown to improve consideration and pursuit of LDKT among patients and their family members for its use among patients on the kidney transplant waiting list. We also developed a financial assistance intervention to help potential donors overcome logistical and financial challenges they might face during the pursuit of live kidney donation. We will evaluate the effectiveness of these interventions by conducting a randomized controlled trial in which patients on the deceased donor waiting list receive 1) usual care while on the transplant waiting list, 2) the educational and social worker intervention, or 3) the educational and social worker intervention plus the option of participating in the financial assistance program. The primary outcome of the randomized controlled trial will measure potential recipients’ live kidney donor activation (a composite rate of live donor inquiries, completed new live donor evaluations, or live kidney donation) at 1 year. Discussion The TALKS study will rigorously assess the effectiveness of promising interventions to reduce race disparities in LDKT. Trial registration NCT02369354.
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Affiliation(s)
- Tara S Strigo
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, 27701, USA.
| | - Patti L Ephraim
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - Iris Pounds
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, 27701, USA.
| | - Felicia Hill-Briggs
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institution and Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Linda Darrell
- Department of Social Work, Morgan State University, Baltimore, MD, USA.
| | - Matthew Ellis
- Division of Nephrology, Duke University School of Medicine, Durham, NC, USA.
| | - Debra Sudan
- Division of Transplantation, Duke University School of Medicine, Durham, NC, USA.
| | - Hamid Rabb
- Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Dorry Segev
- Division of Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Nae-Yuh Wang
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institution and Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Mary Kaiser
- Division of Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Margaret Falkovic
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, 27701, USA.
| | - Jill F Lebov
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, 27701, USA.
| | - L Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, 27701, USA.
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Marshall MR, Polkinghorne KR, Kerr PG, Agar JW, Hawley CM, McDonald SP. Temporal Changes in Mortality Risk by Dialysis Modality in the Australian and New Zealand Dialysis Population. Am J Kidney Dis 2015; 66:489-98. [DOI: 10.1053/j.ajkd.2015.03.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 03/05/2015] [Indexed: 12/16/2022]
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Nadeau-Fredette AC, Chan CT, Cho Y, Hawley CM, Pascoe EM, Clayton PA, Polkinghorne KR, Boudville N, Leblanc M, Johnson DW. Outcomes of integrated home dialysis care: a multi-centre, multi-national registry study. Nephrol Dial Transplant 2015; 30:1897-904. [PMID: 26044832 DOI: 10.1093/ndt/gfv132] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 04/06/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The 'integrated home dialysis' model involving initiation of peritoneal dialysis (PD) first followed by home haemodialysis (HHD) has previously been proposed as an optimal form of dialysis that maximizes the advantages of both modalities. While this model has great potential, its clinical outcomes, especially compared with direct HHD initiation, remain uncertain. METHODS All incident home dialysis patients from the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry between 2000 and 2012 were included. Propensity score matching was performed to evaluate patients initially treated with PD followed by HHD ('PD + HHD'), PD without subsequent transition to HHD ('PD only') and HHD without subsequent transition to PD ('HHD only'). The composite primary outcome was death and home dialysis technique failure (defined as transfer to facility haemodialysis for 90 days). Groups were compared using a Cox proportional hazards model. RESULTS The 2:1 matched cohort included 84 patients in the 'PD + HHD' group, 168 patients in the 'HHD only' group and 168 patients in the 'PD only' group. Compared with the 'PD + HHD' group, death and home dialysis technique failure was similar for patients treated with 'HHD only' [hazard ratio (HR) 0.92, 95% confidence interval (CI) 0.52-1.62; P = 0.77] and higher for those treated with 'PD only' (HR 3.22, 95% CI 1.97-5.25; P < 0.001). CONCLUSION Patients treated with PD first followed by HHD had a risk of death and home dialysis technique failure that was comparable to those treated with HHD as the only home dialysis modality and inferior to those treated with PD as the only home dialysis modality. These results support the 'integrated home dialysis model' in patients who initiate dialysis with PD.
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Affiliation(s)
- Annie-Claire Nadeau-Fredette
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Université de Montreal, Montreal, Canada
| | - Christopher T Chan
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Yeoungjee Cho
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - Carmel M Hawley
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - Elaine M Pascoe
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Philip A Clayton
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Sydney Medical School, University of Sydney, Sydney, Australia
| | - Kevan R Polkinghorne
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Department of Nephrology, Monash Medical Centre Monash Health, Clayton, Australia Departments of Medicine & Epidemiology & Preventative Medicine, Monash University, Melbourne, Australia
| | - Neil Boudville
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | | | - David W Johnson
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
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40
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Lockridge R, Cornelis T, Van Eps C. Prescriptions for home hemodialysis. Hemodial Int 2015; 19 Suppl 1:S112-27. [DOI: 10.1111/hdi.12279] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Tom Cornelis
- Department of Internal Medicine; Division of Nephrology; Maastricht University Medical Center; Maastricht The Netherlands
| | - Carolyn Van Eps
- Princess Alexandra Hospital; Brisbane New South Wales Australia
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Naso A, Scaparrotta G, Naso E, Calò LA. Intensive Home Hemodialysis: An Eye at the Past Looking for the Hemodialysis of the Future. Artif Organs 2015; 39:736-40. [DOI: 10.1111/aor.12458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Agostino Naso
- Department of Medicine, Nephrology; University of Padova-Azienda Ospedaliera di Padova; Padova Italy
| | - Giuseppe Scaparrotta
- Department of Medicine, Nephrology; University of Padova-Azienda Ospedaliera di Padova; Padova Italy
| | - Elena Naso
- Department of Medicine, Nephrology; University of Padova-Azienda Ospedaliera di Padova; Padova Italy
| | - Lorenzo A. Calò
- Department of Medicine, Nephrology; University of Padova-Azienda Ospedaliera di Padova; Padova Italy
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42
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Marshall MR, Chan CT. An open-source practical manual for home hemodialysis: a catalyst for change! Hemodial Int 2015; 18:716-9. [PMID: 25789363 DOI: 10.1111/hdi.12235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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43
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Sherman RA. Briefly Noted. Semin Dial 2015. [DOI: 10.1111/sdi.12321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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44
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Nadeau-Fredette AC, Badve SV, Johnson DW. Daily home hemodialysis: balancing cardiovascular benefits with infectious harms. Am J Kidney Dis 2014; 65:6-8. [PMID: 25523799 DOI: 10.1053/j.ajkd.2014.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 08/22/2014] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - David W Johnson
- University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia.
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Unruh M, Dew MA. Asking dialysis patients about what they were told: a new strategy for improving access to kidney transplantation? J Am Soc Nephrol 2014; 25:2683-5. [PMID: 25168027 DOI: 10.1681/asn.2014060571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Mark Unruh
- University of New Mexico School of Medicine, University of New Mexico, Albuquerque, New Mexico; and
| | - Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology, Biostatistics, and Clinical and Translational Science, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania
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46
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Golper TA, Fissell R. Mind the gap. J Am Soc Nephrol 2014; 25:1893-5. [PMID: 24854280 DOI: 10.1681/asn.2014030274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Rachel Fissell
- Vanderbilt University Medical Center, Nashville, Tennessee
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