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Sartain F, Viecelli AK, Veitch M, Franklin ME, Dymock BW, Wells JW, Campbell SB. Predicting Tacrolimus Concentrations in the Skin of Adult Kidney Transplant Recipients: A Feasibility Study. Transpl Int 2024; 37:12019. [PMID: 38323070 PMCID: PMC10844510 DOI: 10.3389/ti.2024.12019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/11/2024] [Indexed: 02/08/2024]
Abstract
Solid organ transplant recipients are at an increased risk of developing skin cancers due to chronic immunosuppression, particularly with calcineurin inhibitors. Tacrolimus is the most prescribed calcineurin inhibitor in this patient cohort, and understanding tacrolimus concentrations in the skin will facilitate the development of anti-cancer preventive and therapeutic strategies. Here, we show that in mice, tacrolimus blood levels peaked rapidly ∼1 h post last oral dose while skin levels rose more slowly and remained high for at least 6 h. Subsequently, tacrolimus skin and blood concentrations were assessed in 15 kidney transplant recipients. The mean age was 61 years, the average time post-transplant was 7 years (range 0-21 years) and 87% were male. The average skin sampling time post tacrolimus dosing was 6 h 32 min. Skin tacrolimus concentrations ranged from 7.1 ng/g to 71.2 ng/g and correlated with blood concentrations (r = 0.6). Mouse and human mean skin concentrations were in a similar range. Our data suggests that tacrolimus measurements in the blood may be used to approximate tacrolimus concentrations in the skin of kidney transplant recipients, and further exploited for the delivery of anti-cancer therapies designed to antagonize the immunosuppressive effects of tacrolimus in the skin.
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Affiliation(s)
| | - Andrea K. Viecelli
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Margaret Veitch
- Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Michael E. Franklin
- Department of Clinical Pharmacology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Brian W. Dymock
- Queensland Emory Drug Discovery Initiative, UniQuest, The University of Queensland, Brisbane, QLD, Australia
| | - James W. Wells
- Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Dermatology Research Centre, Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Scott B. Campbell
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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2
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King CP, Cossart AR, Isbel NM, Campbell SB, Staatz CE. The association between tacrolimus exposure and tremor, headache and insomnia in adult kidney transplant recipients: A systematic review. Transplant Rev (Orlando) 2024; 38:100815. [PMID: 38071930 DOI: 10.1016/j.trre.2023.100815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE Tremor, headache and insomnia have been linked to the immunosuppressant, tacrolimus. The aim of this systematic review was to determine if there is a correlation between tacrolimus exposure and new-onset tremor, headache and insomnia experienced by adult kidney transplant recipients. METHODS PubMed, Embase, Cochrane Library and CINAHL databases were searched up to 11 April 2023 for published studies which reported on tacrolimus exposure in adult kidney transplant recipients, alongside information on treatment-emergent neurologic manifestations, including tremor, headache and insomnia. Review articles, case studies, conference abstracts and articles not published in English in peer-reviewed journals were excluded. The Physiotherapy Evidence Database and Newcastle-Ottawa Quality Assessment Scales were used to assess risk of bias. Extracted data was analysed via a narrative synthesis. RESULTS Eighteen studies involving 4030 patients in total were included in the final analysis. These comprised five randomised control trials and thirteen observational studies. Studies failed to find significant association between tacrolimus trough concentrations in whole blood and the incidence of neurologic side effects such as tremor, headache and insomnia; however, in one study the incidence of toxicity requiring a dose reduction increased with increasing, supratherapeutic targeted levels. Females, especially Black females, and older age were positively associated with the prevalence of neurologic adverse effects. Results were conflicting regarding whether extended-release formulations were associated with fewer neurologic complications than immediate-release formulations. CONCLUSION The varied study designs and criteria for reporting tremor, headache and insomnia impacted on the quality of the data for exploring the relationship between tacrolimus exposure and the onset of neurologic manifestations experienced after kidney transplantation. Studies that examine defined neurologic complications as the primary outcome, and that consider novel markers of tacrolimus exposure while assessing the potential contribution of multiple covariate factors, are required.
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Affiliation(s)
- Catherine P King
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia.
| | - Amelia R Cossart
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | - Nicole M Isbel
- Department of Nephrology, The Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Scott B Campbell
- Department of Nephrology, The Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Christine E Staatz
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
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3
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Chan S, Wood DLA, Hawley CM, Campbell KL, Campbell SB, Cao C, Francis RS, Hale R, Isbel NM, Pascoe EM, Johnson DW, Morrison M. Characteristics of the gastrointestinal microbiota following prebiotic supplementation in acute kidney transplant recipients: Results from a randomised controlled trial. Clin Transplant 2024; 38:e15175. [PMID: 37902121 DOI: 10.1111/ctr.15175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 10/31/2023]
Affiliation(s)
- Samuel Chan
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - David LA Wood
- Microbia Life Sciences, Brisbane, Queensland, Australia
| | - Carmel M Hawley
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
| | - Katrina L Campbell
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Scott B Campbell
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Christopher Cao
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Ross S Francis
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Rachael Hale
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Nicole M Isbel
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
| | - Elaine M Pascoe
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - David W Johnson
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
| | - Mark Morrison
- Faculty of Medicine, University of Queensland Frazer Institute, Translational Research Institute, Woolloongabba, Queensland, Australia
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Aljishi M, Isbel NM, Jegatheesan D, Johnson DW, Cho Y, Campbell SB, Hawley CM, Thornton A, Gillis D, Johnstone K. Rejection and graft outcomes in kidney transplant recipients with and without angiotensin II receptor type 1 antibodies. Transpl Immunol 2023; 76:101756. [PMID: 36460263 DOI: 10.1016/j.trim.2022.101756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 11/10/2022] [Accepted: 11/22/2022] [Indexed: 12/02/2022]
Abstract
AIM Angiotensin II type 1 receptor antibody (AT1R Ab) is a non-Human Leucocyte Antigen (HLA) antibody that is maybe associated with early severe kidney transplant rejection and worse graft outcomes. This study aimed to assess the association between AT1R Ab and kidney transplant rejection and graft outcomes. METHODS We performed a retrospective analysis of all adult kidney transplant recipients in an Australian centre who had an AT1R Ab test between 1 January 2015 to 30 June 2020. AT1R Ab positive patients were compared to AT1R Ab negative patients. Primary outcomes were rejection risk, type and histopathological severity scores. Secondary outcomes were 8-week graft function and graft loss. RESULTS Of 965 kidney transplants that were performed during the study period, 73 patients had AT1R Ab tested; 16 (22%) were positive and 57(78%) were negative. Positive patients were on average younger and had higher level of donor-specific HLA antibodies. Rejection occurred in 13 (81%) positive patients and 41 (72%) negative patients (P = 0.45). No significant differences in rejection type or severity were found. HLA mismatch and peak panel reactive antibody ≥80%, but not AT1R Ab, independently predicted rejection. Average (132 vs. 177 mmol/L, P = 0.302) and graft loss were not significantly different between groups. CONCLUSION The study found no evidence that AT1R Ab is associated with rejection type, severity or worse graft function. Future studies should assess its relationship with graft outcomes to help complement immunological risk assessment and potentially provide therapeutic options to alter outcomes.
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Affiliation(s)
- Manaf Aljishi
- Nephrology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | - Nicole M Isbel
- Nephrology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Dev Jegatheesan
- Nephrology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - David W Johnson
- Nephrology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Yeoungjee Cho
- Nephrology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Scott B Campbell
- Nephrology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Carmel M Hawley
- Nephrology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | - David Gillis
- Pathology Queensland, Brisbane, Queensland, Australia
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Chan S, Hawley CM, Pascoe EM, Cao C, Campbell KL, Campbell SB, Francis RS, Hale R, Isbel NM, Morrison M, Johnson DW. PREBIOTIC: a study protocol of a randomised controlled trial to assess prebiotic supplementation in kidney transplant recipients for preventing infections and gastrointestinal upset - a feasibility study. Pilot Feasibility Stud 2023; 9:11. [PMID: 36647175 PMCID: PMC9841639 DOI: 10.1186/s40814-023-01236-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/02/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Modulating the microbiota in the large intestine of kidney transplant recipients through prebiotic supplementation may prevent infectious complications from occurring. To date, there have been no interventional trials which have investigated this novel treatment in kidney transplantation. The aim of PREBIOTIC is to assess the feasibility of performing a randomised controlled trial of prebiotics in reducing infections and gastrointestinal symptoms in kidney transplant recipients. METHODS Sixty kidney transplant patients will be recruited to a double-blind, placebo-controlled, randomised feasibility trial. Patients will be provided with prebiotic therapy or placebo for 4 to 6 weeks. Outcomes will include recruitment, adherence, tolerance, retention, laboratory parameters (including serum indoxyl sulphate, ρ-cresyl sulphate and stool collection), patients' self-assessed quality of life, gastrointestinal symptoms and clinical outcomes. DISCUSSION This trial will assess the feasibility of prebiotic supplementation in kidney transplant recipients. Prebiotics not only may alter the gut microbiota and their inherent metabolism and production of uraemic toxins but also may prevent infections from occurring in kidney transplant recipients. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry number ACTRN12618001057279p. The date of registration was 25th June 2018, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375370&isReview=true .
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Affiliation(s)
- Samuel Chan
- grid.412744.00000 0004 0380 2017Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland Australia ,grid.1003.20000 0000 9320 7537Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland Australia ,grid.489335.00000000406180938Translational Research Institute, Brisbane, Queensland Australia
| | - Carmel M. Hawley
- grid.412744.00000 0004 0380 2017Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland Australia ,grid.1003.20000 0000 9320 7537Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland Australia ,grid.489335.00000000406180938Translational Research Institute, Brisbane, Queensland Australia
| | - Elaine M. Pascoe
- grid.412744.00000 0004 0380 2017Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland Australia ,grid.1003.20000 0000 9320 7537Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland Australia ,grid.489335.00000000406180938Translational Research Institute, Brisbane, Queensland Australia
| | - Christopher Cao
- grid.412744.00000 0004 0380 2017Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland Australia
| | - Katrina L. Campbell
- grid.1003.20000 0000 9320 7537Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland Australia
| | - Scott B. Campbell
- grid.412744.00000 0004 0380 2017Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland Australia ,grid.1003.20000 0000 9320 7537Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland Australia ,grid.489335.00000000406180938Translational Research Institute, Brisbane, Queensland Australia
| | - Ross S. Francis
- grid.412744.00000 0004 0380 2017Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland Australia ,grid.1003.20000 0000 9320 7537Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland Australia ,grid.489335.00000000406180938Translational Research Institute, Brisbane, Queensland Australia
| | - Rachael Hale
- grid.412744.00000 0004 0380 2017Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland Australia
| | - Nicole M. Isbel
- grid.412744.00000 0004 0380 2017Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland Australia ,grid.1003.20000 0000 9320 7537Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland Australia ,grid.489335.00000000406180938Translational Research Institute, Brisbane, Queensland Australia
| | - Mark Morrison
- grid.1003.20000 0000 9320 7537The University of Queensland Diamantina Institute, Faculty of Medicine, University of Queensland, Woolloongabba, Queensland Australia
| | - David W. Johnson
- grid.412744.00000 0004 0380 2017Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland Australia ,grid.1003.20000 0000 9320 7537Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland Australia ,grid.489335.00000000406180938Translational Research Institute, Brisbane, Queensland Australia
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Liu C, Campbell SB, Li J, Bannerman D, Pascual-Gil S, Kieda J, Wu Q, Herman PR, Radisic M. High Throughput Omnidirectional Printing of Tubular Microstructures from Elastomeric Polymers. Adv Healthc Mater 2022; 11:e2201346. [PMID: 36165232 PMCID: PMC9742311 DOI: 10.1002/adhm.202201346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/09/2022] [Indexed: 01/28/2023]
Abstract
Bioelastomers are extensively used in biomedical applications due to their desirable mechanical strength, tunable properties, and chemical versatility; however, three-dimensional (3D) printing bioelastomers into microscale structures has proven elusive. Herein, a high throughput omnidirectional printing approach via coaxial extrusion is described that fabricates perfusable elastomeric microtubes of unprecedently small inner diameter (350-550 µm) and wall thickness (40-60 µm). The versatility of this approach is shown through the printing of two different polymeric elastomers, followed by photocrosslinking and removal of the fugitive inner phase. Designed experiments are used to tune the microtube dimensions and stiffness to match that of native ex vivo rat vasculature. This approach affords the fabrication of multiple biomimetic shapes resembling cochlea and kidney glomerulus and affords facile, high-throughput generation of perfusable structures that can be seeded with endothelial cells for biomedical applications. Post-printing laser micromachining is performed to generate micro-sized holes (520 µm) in the tube wall to tune microstructure permeability. Importantly, for organ-on-a-chip applications, the described approach takes only 3.6 min to print microtubes (without microholes) over an entire 96-well plate device, in contrast to comparable hole-free structures that take between 1.5 and 6.5 days to fabricate using a manual 3D stamping approach.
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Affiliation(s)
- Chuan Liu
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Scott B. Campbell
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Jianzhao Li
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Dawn Bannerman
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - Simon Pascual-Gil
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Jennifer Kieda
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Qinghua Wu
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Peter R. Herman
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Milica Radisic
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
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7
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Mohammadi MH, Okhovatian S, Savoji H, Campbell SB, Lai BFL, Wu J, Pascual-Gil S, Bannerman D, Rafatian N, Li RK, Radisic M. Toward Hierarchical Assembly of Aligned Cell Sheets into a Conical Cardiac Ventricle Using Microfabricated Elastomers. Adv Biol (Weinh) 2022; 6:e2101165. [PMID: 35798316 PMCID: PMC9691564 DOI: 10.1002/adbi.202101165] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 05/31/2022] [Indexed: 01/28/2023]
Abstract
Despite current efforts in organ-on-chip engineering to construct miniature cardiac models, they often lack some physiological aspects of the heart, including fiber orientation. This motivates the development of bioartificial left ventricle models that mimic the myofiber orientation of the native ventricle. Herein, an approach relying on microfabricated elastomers that enables hierarchical assembly of 2D aligned cell sheets into a functional conical cardiac ventricle is described. Soft lithography and injection molding techniques are used to fabricate micro-grooves on an elastomeric polymer scaffold with three different orientations ranging from -60° to +60°, each on a separate trapezoidal construct. The width of the micro-grooves is optimized to direct the majority of cells along the groove direction and while periodic breaks are used to promote cell-cell contact. The scaffold is wrapped around a central mandrel to obtain a conical-shaped left ventricle model inspired by the size of a human left ventricle 19 weeks post-gestation. Rectangular micro-scale holes are incorporated to alleviate oxygen diffusional limitations within the 3D scaffold. Cardiomyocytes within the 3D left ventricle constructs showed high viability in all layers after 7 days of cultivation. The hierarchically assembled left ventricle also provided functional readouts such as calcium transients and ejection fraction.
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Affiliation(s)
| | - Sargol Okhovatian
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - Houman Savoji
- Institute of Biomedical Engineering, Department of Pharmacology and Physiology, Faculty of Medicine, University of Montreal, Sainte Justine University Hospital Research Center, Montreal TransMedTech Institute, Montreal, Quebec, Canada
| | - Scott B. Campbell
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Benjamin Fook Lun Lai
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Jun Wu
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Simon Pascual-Gil
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Dawn Bannerman
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - Naimeh Rafatian
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Ren-Ke Li
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Division of Cardiovascular Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Milica Radisic
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
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Mohammadi MH, Okhovatian S, Savoji H, Campbell SB, Lai BFL, Wu J, Pascual‐Gil S, Bannerman D, Rafatian N, Li R, Radisic M. Toward Hierarchical Assembly of Aligned Cell Sheets into a Conical Cardiac Ventricle Using Microfabricated Elastomers (Adv. Biology 11/2022). Adv Biol (Weinh) 2022. [DOI: 10.1002/adbi.202270111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cossart AR, Staatz CE, Isbel NM, Campbell SB, Cottrell WN. Exploring Transplant Medication-Taking Behaviours in Older Adult Kidney Transplant Recipients: A Qualitative Study of Semi-Structured Interviews. Drugs Aging 2022; 39:887-898. [PMID: 36175739 PMCID: PMC9626420 DOI: 10.1007/s40266-022-00975-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 01/05/2023]
Abstract
Background Today, older adult patients routinely undergo kidney transplantation. To support graft survival, patients must take immunosuppressant medicines for the rest of their lives. The post-transplant medication regimen is complex, and barriers to medication taking are likely confounded by both functional and intrinsic changes associated with advancing age. To develop diverse and innovative approaches to support best health outcomes in this vulnerable age group, it is imperative that the degree to which patients’ needs are currently being met, be identified. Aim The aim of this study was to examine medication-taking behaviours of kidney transplant recipients transplanted at 60 years of age or older. Methods This qualitative study used semi-structured patient interviews to explore how kidney transplant recipients currently manage their immunosuppressant regimen and how they cope after transplantation with the complex routine. Data were themed using the principles of Grounded Theory methodology; with interviews conducted until data saturation was reached. Results Quantitative information was collected from 14 participants who ranged in age from 66 to 77 years (at time of interview), and were prescribed a median of 13 (min: 10, max: 26) medicines. The main themes that emerged from the interview were variability in health literacy toward medicines, the importance of support networks, the need to adjust health expectations, factors that were motivators for self-care, different approaches to medication management, and different approaches to medication taking. Overall, it was found that patients prioritised medication taking above all else, and gratitude to their donor was a powerful motivator to adhere. However, strategies to support medication taking were sometimes ineffective when patients’ routine changed. Conclusions Future interventions should consider approaches to foster adaptable medication taking behaviours that stand up to changes in the day-to-day routine. Medication taking is complicated in transplant recipients, due to the number of medicines that need to be taken and the complex nature of the treatment regimen. Challenges in older transplant recipients may be more pronounced and varied compared with younger adults. There are multiple factors that may impact medication taking in older adults and each requires consideration, including level of dependence, living arrangements, level of mobility and manual dexterity, vision and memory, and social situation. To better identify the gaps in support, patients’ current perspectives around medication taking and how they cope after transplantation must be explored. Therefore, this study aimed to identify how older adult transplant recipients currently manage their anti-rejection medicine regimen. Participants described several strategies around how they manage a complex medication regimen. These included cues such as an alarm and linking the time they should take their medication to already established habits such as eating meals. Most participants discussed at length their relationships, and it seems that these relationships are often crucial to post-transplant positivity. Additionally, extreme gratitude to the donor, relative improvement in their life quality (compared with the rapid deterioration in their health when on dialysis), and fear of consequences (particularly graft failure) were important facilitators of self-care and served as timely reminders to prioritise one’s own health. To foster more robust medication-taking habits, future education needs to be tailored to each individual patient and include details about how to link medication taking to already established routines (coined ‘habit stacking’).
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Affiliation(s)
- Amelia R Cossart
- School of Pharmacy, University of Queensland, Woolloongabba, 20 Cornwall Street, QLD, 4102, Australia.
| | - Christine E Staatz
- School of Pharmacy, University of Queensland, Woolloongabba, 20 Cornwall Street, QLD, 4102, Australia
| | - Nicole M Isbel
- Department of Nephrology, University of Queensland at the Princess Alexandra Hospital, Brisbane, Australia
| | - Scott B Campbell
- Department of Nephrology, University of Queensland at the Princess Alexandra Hospital, Brisbane, Australia
| | - W Neil Cottrell
- School of Pharmacy, University of Queensland, Woolloongabba, 20 Cornwall Street, QLD, 4102, Australia
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10
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Gately R, Chong CH, Scholes-Robertson N, Teixeira-Pinto A, Isbel NM, Johnson DW, Hawley CM, Campbell SB, Wong G. Predictive factors for BK polyomavirus infection in solid organ transplant recipients. Hippokratia 2022. [DOI: 10.1002/14651858.cd015174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Ryan Gately
- Department of Nephrology; Princess Alexandra Hospital; Woolloongabba Australia
| | - Chanel H Chong
- Sydney School of Public Health; The University of Sydney; Sydney Australia
| | | | | | - Nicole M Isbel
- Department of Nephrology; Princess Alexandra Hospital; Woolloongabba Australia
| | - David W Johnson
- Department of Nephrology; Princess Alexandra Hospital; Woolloongabba Australia
| | - Carmel M Hawley
- Department of Nephrology; Princess Alexandra Hospital; Woolloongabba Australia
| | - Scott B Campbell
- Department of Nephrology; Princess Alexandra Hospital; Woolloongabba Australia
| | - Germaine Wong
- Sydney School of Public Health; The University of Sydney; Sydney Australia
- Centre for Kidney Research; The Children's Hospital at Westmead; Westmead Australia
- Centre for Transplant and Renal Research; Westmead Hospital; Westmead Australia
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11
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Ethier I, Campbell SB, Cho Y, Hawley CM, Isbel NM, Krishnasamy R, Roberts MA, Semple D, Sypek M, Viecelli AK, Johnson DW. Dialysis modality utilization patterns and mortality in older persons initiating dialysis in Australia and New Zealand. Nephrology (Carlton) 2022; 27:663-672. [PMID: 35678544 DOI: 10.1111/nep.14073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/27/2022] [Accepted: 05/28/2022] [Indexed: 11/28/2022]
Abstract
AIM The benefits of dialysis in the older population remain highly debated, particularly for certain dialysis modalities. This study aimed to explore the dialysis modality utilization patterns between in-centre haemodialysis (ICHD), peritoneal dialysis (PD) and home haemodialysis (HHD) and their association with outcomes in older persons. METHODS Older persons (≥75 years) initiating dialysis in Australia and New Zealand from 1999 to 2018 reported to the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry were included. The main aim of the study was to characterize dialysis modality utilization patterns and describe individual characteristics of each pattern. Relationships between identified patterns and survival, causes of death and withdrawal were examined as secondary analyses, where the pattern was considered as the exposure. RESULTS A total of 10 306 older persons initiated dialysis over the study period. Of these, 6776 (66%) and 1535 (15%) were exclusively treated by ICHD and PD, respectively, while 136 (1%) ever received HHD during their dialysis treatment course. The remainder received both ICHD and PD: 906 (9%) started dialysis on ICHD and 953 (9%) on PD. Different individual characteristics were seen across dialysis modality utilization patterns. Median survival time was 3.0 (95%CI 2.9-3.1) years. Differences in survival were seen across groups and varied depending on the time period following dialysis initiation. Dialysis withdrawal was an important cause of death and varied according to individual characteristics and utilization patterns. CONCLUSION This study showed that dialysis modality utilization patterns in older persons are associated with mortality, independent of individual characteristics.
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Affiliation(s)
- Isabelle Ethier
- Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Scott B Campbell
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
| | - Nicole M Isbel
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia
| | - Rathika Krishnasamy
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.,Department of Nephrology, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Matthew A Roberts
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - David Semple
- Department of Renal Medicine, Auckland District Health Board, Auckland, New Zealand.,School of Medicine, University of Auckland, Auckland, New Zealand
| | - Matthew Sypek
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
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12
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Chan S, Howell M, Johnson DW, Hawley CM, Tong A, Craig JC, Cao C, Blumberg E, Brennan D, Campbell SB, Francis RS, Huuskes BM, Isbel NM, Knoll G, Kotton C, Mamode N, Muller E, Biostat EMPM, An HPH, Tedesco-Silva H, White DM, Viecelli AK. Critically important outcomes for infection in trials in kidney transplantation: An international survey of patients, caregivers and health professionals. Clin Transplant 2022; 36:e14660. [PMID: 35362617 DOI: 10.1111/ctr.14660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/07/2022] [Accepted: 03/29/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Infections are a common complication following kidney transplantation, but are reported inconsistently in clinical trials. This study aimed to identify the infection outcomes of highest priority for patients/caregivers and health professionals to inform a core outcome set to be reported in all kidney transplant clinical trials. METHODS In an international online survey, participants rated the absolute importance of 16 infections and 8 severity dimensions on 9-point Likert Scales, with 7-9 being critically important. Relative importance was determined using a best-worst scale. Means and proportions of the Likert-scale ratings and best-worst preference scores were calculated. RESULTS 353 healthcare professionals (19 who identified as both patients/caregiver and healthcare professionals) and 220 patients/caregivers (190 patients, 22 caregivers, 8 who identified as both) from 55 countries completed the survey. Both healthcare professionals and patients/caregivers rated bloodstream (mean 8.4 and 8.5 respectively; aggregate 8.5), kidney/bladder (mean 7.9 and 8.4; aggregate 8.1) and BK virus (mean 8.1 and 8.6; aggregate 8.3) as the top 3 most critically important infection outcomes, whilst infectious death (mean 8.8 and 8.6; aggregate 8.7), impaired graft function (mean 8.4 and 8.7; aggregate 8.5) and admission to the intensive care unit (mean 8.2 and 8.3; aggregate 8.2) were the top 3 severity dimensions. Relative importance (best-worst) scores were consistent. CONCLUSIONS Healthcare professionals and patients/caregivers consistently identified bloodstream infection, kidney/bladder infections and BK virus as the three most important infection outcomes, and infectious death, admission to intensive care unit and infection impairing graft function as the three most important infection severity outcomes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Samuel Chan
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
| | - Martin Howell
- Sydney School of Public Health, Faculty of Medicine and Health.,Centre for Kidney Research, The Children's Hospital at Westmead, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
| | - Allison Tong
- Sydney School of Public Health, Faculty of Medicine and Health.,Centre for Kidney Research, The Children's Hospital at Westmead, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Christopher Cao
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Emily Blumberg
- Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel Brennan
- Division of Nephrology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Scott B Campbell
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Ross S Francis
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Brooke M Huuskes
- Centre for Cardiovascular Biology and Disease Research, La Trobe University, Melbourne, Victoria, Australia
| | - Nicole M Isbel
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Greg Knoll
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa
| | - Camille Kotton
- Transplant and Immunocompromised Host Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nizam Mamode
- Department of Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, United Kingdom
| | - Elmi Muller
- Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Elaine M Pascoe M Biostat
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Ha Phan Hai An
- Department of Internal Medicine, Division of Nephrology, Viet Duc Hospital, Hanoi Medical University, Vietnam
| | - Helio Tedesco-Silva
- Division of Nephrology, Hospital do Rim, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
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13
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Lu RXZ, Lai BFL, Rafatian N, Gustafson D, Campbell SB, Banerjee A, Kozak R, Mossman K, Mubareka S, Howe KL, Fish JE, Radisic M. Vasculature-on-a-chip platform with innate immunity enables identification of angiopoietin-1 derived peptide as a therapeutic for SARS-CoV-2 induced inflammation. Lab Chip 2022; 22:1171-1186. [PMID: 35142777 PMCID: PMC9207819 DOI: 10.1039/d1lc00817j] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Coronavirus disease 2019 (COVID-19) was primarily identified as a novel disease causing acute respiratory syndrome. However, as the pandemic progressed various cases of secondary organ infection and damage by severe respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported, including a breakdown of the vascular barrier. As SARS-CoV-2 gains access to blood circulation through the lungs, the virus is first encountered by the layer of endothelial cells and immune cells that participate in host defense. Here, we developed an approach to study SARS-CoV-2 infection using vasculature-on-a-chip. We first modeled the interaction of virus alone with the endothelialized vasculature-on-a-chip, followed by the studies of the interaction of the virus exposed-endothelial cells with peripheral blood mononuclear cells (PBMCs). In an endothelial model grown on a permeable microfluidic bioscaffold under flow conditions, both human coronavirus (HCoV)-NL63 and SARS-CoV-2 presence diminished endothelial barrier function by disrupting VE-cadherin junctions and elevating the level of pro-inflammatory cytokines such as interleukin (IL)-6, IL-8, and angiopoietin-2. Inflammatory cytokine markers were markedly more elevated upon SARS-CoV-2 infection compared to HCoV-NL63 infection. Introduction of PBMCs with monocytes into the vasculature-on-a-chip upon SARS-CoV-2 infection further exacerbated cytokine-induced endothelial dysfunction, demonstrating the compounding effects of inter-cellular crosstalk between endothelial cells and monocytes in facilitating the hyperinflammatory state. Considering the harmful effects of SARS-CoV-2 on endothelial cells, even without active virus proliferation inside the cells, a potential therapeutic approach is critical. We identified angiopoietin-1 derived peptide, QHREDGS, as a potential therapeutic capable of profoundly attenuating the inflammatory state of the cells consistent with the levels in non-infected controls, thereby improving the barrier function and endothelial cell survival against SARS-CoV-2 infection in the presence of PBMC.
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Affiliation(s)
- Rick Xing Ze Lu
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, M5S 3G9, Canada.
| | - Benjamin Fook Lun Lai
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, M5S 3G9, Canada.
| | - Naimeh Rafatian
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, M5S 3G9, Canada.
| | - Dakota Gustafson
- Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, M5G 2C4, Canada
| | - Scott B Campbell
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, M5S 3G9, Canada.
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, M5G 2C4, Canada
| | - Arinjay Banerjee
- McMaster Immunology Research Centre, McMaster University, Hamilton, Ontario, L8S 4L8, Canada
- Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, Saskatchewan, S7N5E3, Canada
| | - Robert Kozak
- McMaster Immunology Research Centre, McMaster University, Hamilton, Ontario, L8S 4L8, Canada
| | - Karen Mossman
- McMaster Immunology Research Centre, McMaster University, Hamilton, Ontario, L8S 4L8, Canada
| | - Samira Mubareka
- Sunnybrook Health Sciences Center, Toronto, Ontario, M4N 3M5, Canada
| | - Kathryn L Howe
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, M5G 2C4, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Jason E Fish
- Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, M5G 2C4, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Milica Radisic
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, M5S 3G9, Canada.
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, M5G 2C4, Canada
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, M5S 3E5, Canada
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14
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Cossart AR, Cottrell WN, Mcstea M, Isbel NM, Campbell SB, Staatz CE. Immunosuppressant prescribing patterns in elderly kidney transplant recipients using registry data from Australia and New Zealand. Pharmacy Practice and Res 2022. [DOI: 10.1002/jppr.1788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - Megan Mcstea
- Centre for Health Services Research University of Queensland Brisbane Australia
| | - Nicole M. Isbel
- Department of Nephrology University of Queensland at the Princess Alexandra Hospital Brisbane Australia
| | - Scott B. Campbell
- Department of Nephrology University of Queensland at the Princess Alexandra Hospital Brisbane Australia
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15
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Chan S, Hawley CM, Pascoe EM, Cao C, Campbell SB, Campbell KL, Francis RS, Hale R, Isbel NM, Morrison M, Johnson DW. Journal of Renal Nutrition Prebiotic supplementation in kidney transplant recipients for preventing infections and gastrointestinal upset: a randomized controlled feasibility study. J Ren Nutr 2022; 32:718-725. [DOI: 10.1053/j.jrn.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/10/2022] [Accepted: 02/20/2022] [Indexed: 11/11/2022] Open
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16
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Pysar R, Wallingford CK, Boyle J, Campbell SB, Eckstein L, McWhirter R, Terrill B, Jacobs C, McInerney-Leo AM. Australian human research ethics committee members' confidence in reviewing genomic research applications. Eur J Hum Genet 2021; 29:1811-1818. [PMID: 34446835 PMCID: PMC8633339 DOI: 10.1038/s41431-021-00951-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/06/2021] [Accepted: 08/12/2021] [Indexed: 02/07/2023] Open
Abstract
Human research ethics committees (HRECs) are evaluating increasing quantities of genomic research applications with complex ethical considerations. Genomic confidence is reportedly low amongst many non-genetics-experts; however, no studies have evaluated genomic confidence levels in HREC members specifically. This study used online surveys to explore genomic confidence levels, predictors of confidence, and genomics resource needs of members from 185 HRECs across Australia. Surveys were fully or partially completed by 145 members. All reported having postgraduate 94 (86%) and/or bachelor 15 (14%) degrees. Participants consisted mainly of researchers (n = 45, 33%) and lay members (n = 41, 30%), affiliated with either public health services (n = 73, 51%) or public universities (n = 31, 22%). Over half had served their HREC [Formula: see text]3 years. Fifty (44%) reviewed genomic studies [Formula: see text]3 times annually. Seventy (60%) had undertaken some form of genomic education. While most (94/103, 91%) had high genomic literacy based on familiarity with genomic terms, average genomic confidence scores (GCS) were moderate (5.7/10, n = 119). Simple linear regression showed that GCS was positively associated with years of HREC service, frequency of reviewing genomic applications, undertaking self-reported genomic education, and familiarity with genomic terms (p < 0.05 for all). Conversely, lay members and/or those relying on others when reviewing genomic studies had lower GCSs (p < 0.05 for both). Most members (n = 83, 76%) agreed further resources would be valuable when reviewing genomic research applications, and online courses and printed materials were preferred. In conclusion, even well-educated HREC members familiar with genomic terms lack genomic confidence, which could be enhanced with additional genomic education and/or resources.
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Affiliation(s)
- Ryan Pysar
- grid.117476.20000 0004 1936 7611Genetic Counseling, Graduate School of Health, University of Technology Sydney, Sydney, NSW Australia ,grid.414009.80000 0001 1282 788XCentre for Clinical Genetics, Sydney Children’s Hospital, Randwick, NSW Australia
| | - Courtney K. Wallingford
- grid.1003.20000 0000 9320 7537University of Queensland Diamantina Institute, University of Queensland, Dermatology Research Centre, Woolloongabba, QLD Australia
| | - Jackie Boyle
- grid.511220.50000 0005 0259 3580NSW Genetics of Learning Disability (GOLD) Service, Hunter Genetics, Waratah, NSW Australia
| | - Scott B. Campbell
- grid.412744.00000 0004 0380 2017Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, QLD Australia
| | - Lisa Eckstein
- grid.1009.80000 0004 1936 826XFaculty of Law University of Tasmania, Hobart, TAS Australia
| | - Rebekah McWhirter
- grid.1021.20000 0001 0526 7079School of Medicine, Faculty of Health, Deakin University, Geelong, VIC Australia
| | - Bronwyn Terrill
- grid.415306.50000 0000 9983 6924Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, NSW Australia ,grid.1005.40000 0004 4902 0432St Vincent’s Clinical School, UNSW Sydney, Sydney, NSW Australia
| | - Chris Jacobs
- grid.117476.20000 0004 1936 7611Genetic Counseling, Graduate School of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Aideen M. McInerney-Leo
- grid.1003.20000 0000 9320 7537University of Queensland Diamantina Institute, University of Queensland, Dermatology Research Centre, Woolloongabba, QLD Australia
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17
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Yaxley J, Campbell SB, Gray NA, Viecelli AK. A Survey Study of Trends in Adult Nephrology Advanced Training in Australia and New Zealand. Intern Med J 2021; 52:206-213. [PMID: 34528751 DOI: 10.1111/imj.15535] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/06/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There has been considerable growth in nephrology advanced trainee numbers in Australia and New Zealand, with uncertain effects on clinical experience, competence and employment outcomes. AIM To review the perceived adequacy and temporal trends of advanced training in nephrology in Australia and New Zealand by evaluating training experiences, personal views on important aspects of training and nephrology, career paths and early employment outcomes. METHODS An online survey was distributed to members of the Australian and New Zealand Society of Nephrology via email in December 2020. Responses were sought from current trainees and from nephrologists qualifying since 2014. Likert scale proportions were calculated and group comparisons made using the Chi-square test. RESULTS A total of 88 participants returned the survey yielding a response rate of 32%, with a representative sample of trainees and consultants from across Australia and New Zealand. Training was reported as adequate in most aspects of clinical nephrology, although 88% of respondents felt poorly prepared for entering private practice and 61% reported inadequate training in kidney histopathology. Exposure to clinical procedures was variable, with adequate training in percutaneous kidney biopsy but mostly inadequate training in dialysis access insertion. Sixty-nine percent of nephrologists completed their advanced training entirely in large urban centres and 85% worked in an urban area after training. Only 23% of consultants were engaged in full-time clinical employment in their first year post-training and 78% were undertaking at least one of dual specialty training or a higher degree by research. Demand for subspecialty fellowships was high. CONCLUSION Trainees and nephrologists in Australia and New Zealand are currently satisfied with their training in most aspects of nephrology, however some clinical experiences are perceived as inadequate and early career paths after advanced training are increasingly diverse. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Julian Yaxley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Scott B Campbell
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Nicholas A Gray
- Department of Renal Medicine, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia
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18
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Cossart AR, Isbel NM, Scuderi C, Campbell SB, Staatz CE. Pharmacokinetic and Pharmacodynamic Considerations in Relation to Calcineurin Usage in Elderly Kidney Transplant Recipients. Front Pharmacol 2021; 12:635165. [PMID: 33912051 PMCID: PMC8072471 DOI: 10.3389/fphar.2021.635165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/12/2021] [Indexed: 12/28/2022] Open
Abstract
This review summarizes how possible age-related changes in tacrolimus and cyclosporine pharmacokinetics and pharmacodynamics may influence drug dosing and monitoring in the elderly, and highlights how micro-sampling may be useful in this cohort in the future. Advancing biological age leads to physiological changes that can affect drug absorption, distribution, metabolism and excretion, as well as immune system responsiveness. Some studies have shown that elderly recipients may have higher dose-adjusted exposure and/or lower clearance of the calcineurin inhibitors, suggesting that doses may need to be lowered in elderly recipients. Only one study has examined how aging effects drug target enzyme activity and demonstrated that age does not correlate with the calcineurin inhibitor half-maximal inhibitory concentration. Several studies have shown elderly kidney transplant recipients have increased risk of both morbidity and mortality, compared to younger adults due to increased susceptibility to immunosuppressant side effects, particularly cardiovascular disease, infection and malignancy. Current immunosuppressant dosing and monitoring protocols often make no adjustments for age. Lower maintenance immunosuppressant targets in elderly recipients may decrease patient susceptibility to drug side effects, however, further studies are required and appropriate targets need to be established. Blood draw by micro-sampling may be useful for drug monitoring in this cohort in the future, as blood collection is minimally invasive and less painful than venepuncture. Micro-sampling could also make further pharmacokinetic, pharmacodynamics and outcome studies in the elderly more feasible.
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Affiliation(s)
- Amelia R Cossart
- School of Pharmacy, University of Queensland, Brisbane, QLD, Australia
| | - Nicole M Isbel
- Department of Nephrology, University of Queensland at the Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Carla Scuderi
- School of Pharmacy, University of Queensland, Brisbane, QLD, Australia.,Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Scott B Campbell
- Department of Nephrology, University of Queensland at the Princess Alexandra Hospital, Brisbane, QLD, Australia
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19
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Ethier I, Campbell SB, Cho Y, Hawley CM, Isbel NM, Krishnasamy R, Roberts MA, Semple D, Sypek M, Viecelli AK, Johnson DW. Dialysis initiation in older persons across centres and over time in Australia and New Zealand. Nephrology (Carlton) 2021; 26:613-622. [PMID: 33715269 DOI: 10.1111/nep.13873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/06/2021] [Accepted: 03/07/2021] [Indexed: 11/28/2022]
Abstract
AIM With improved life expectancy over time, the burden of kidney failure resulting in kidney replacement therapy (KRT) in older persons is increasing. This study aimed to describe the age distribution at dialysis initiation in Australia and New Zealand (ANZ) across centres and over time. METHODS Adults initiating dialysis as first KRT in ANZ from 1999 to 2018 reported to the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry were included. The primary outcomes were the age distribution and the proportion of older persons (75 years and older) initiating dialysis across centres and over time. Secondary outcomes were characterization of the older population compared with younger people and differences in dialysis modality and treatment trajectories between groups. RESULTS Over the study period, 55 382 people initiated dialysis as first KRT, including 10 306 older persons, in 100 centres. Wide variation in age distribution across states/countries was noted, although the proportion of older persons at dialysis initiation did not significantly change over time (from 13% in 1999 to 19% in 2003, then remaining stable thereafter). Older persons were less likely to be treated with home therapies compared with younger people. Older persons were mostly Caucasians; had higher socioeconomic position, more cardiovascular comorbidities and higher eGFR at baseline; and resided in major cities. Higher proportions of older persons per centre were noted in privately funded facilities. CONCLUSION Wide variations were noted in the proportions of older persons initiating dialysis across centres and states/country, which were associated with different case-mix across regions, particularly in terms of ethnicity, remoteness and socioeconomic advantage.
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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
| | - Scott B Campbell
- 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, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - Nicole M Isbel
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Rathika Krishnasamy
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Department of Nephrology, Sunshine Coast University Hospital, Sunshine Coast, 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
| | - Matthew Sypek
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Andrea K Viecelli
- 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, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
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20
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Chan S, Morrison M, Hawley CM, Campbell SB, Francis RS, Isbel NM, Pascoe EM, Johnson DW. Characteristics of the gastrointestinal microbiota in paired live kidney donors and recipients. Nephrology (Carlton) 2021; 26:471-478. [PMID: 33501716 DOI: 10.1111/nep.13853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND There are few studies that have examined whether dysbiosis occurs in kidney donors and transplant recipients following kidney transplant surgery. AIM To ascertain whether changes occur in the gastrointestinal microbiota of the kidney donor and recipient following kidney transplantation. METHODS Kidney transplant recipients and their donors were prospectively enrolled in a pilot study to collect one faecal sample prior to, and another faecal sample between four to eight weeks following surgery. Gastrointestinal microbiota richness, Shannon diversity measures and functional assessments of kidney donors and recipients were analysed via metagenomic sequencing. RESULTS The study included 12 donors (median age 56 years, 6 females) and 12 recipients (median age 51 years, 3 females). Donor microbiota showed no significant changes in gastrointestinal microbiota richness, Shannon diversity, or functional assessments before and after nephrectomy. Recipient microbiota was altered post-transplant, reflected in reductions of the mean (±SD) richness values (156 ± 46.5 to 116 ± 38.6, p = 0.002), and Shannon diversity (3.57 ± 0.49 to 3.14 ± 0.52, p = 0.007), and a dramatic increase in Roseburia spp. abundance post-transplant (26-fold increase from 0.16 ± 0.0091 to 4.6 ± 0.3; p = 0.006; FDR = 0.12). Functionally, the post-transplant microbial community shifted towards those taxa using the glycolysis pathway (1.2-fold increase; p = 0.02; FDR = 0.26) for energy metabolism, while those functions involved with reactive oxygen species degradation decreased (2.6-fold; p = 0.006; FDR = 0.14). CONCLUSION Live donor kidney transplantation and standard care post-transplant result in significant alterations in gut microbiota richness, diversity, composition and functional parameters in kidney transplant recipients but not in their kidney donors.
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Affiliation(s)
- Samuel Chan
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
| | - Mark Morrison
- The University of Queensland Diamantina Institute, Faculty of Medicine, University of Queensland, Woolloongabba, Queensland, Australia
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
| | - Scott B Campbell
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Ross S Francis
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Nicole M Isbel
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
| | - Elaine M Pascoe
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
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21
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Pei J, Ethier I, Hudson RE, Hawley CM, Johnson DW, Campbell SB, Francis RS, Wong G, Craig JC, Viecelli AK, Cho Y. Peritoneal dialysis versus haemodialysis for people commencing dialysis. Hippokratia 2020. [DOI: 10.1002/14651858.cd013800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Juan Pei
- Department of Nephrology; The First Affiliated Hospital of Xiamen University; Xiamen China
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Australia
| | - Isabelle Ethier
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Australia
- Department of Nephrology; Centre hospitalier de l’Université de Montréal; Montréal Canada
| | - Rebecca E Hudson
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Australia
| | - Carmel M Hawley
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Australia
- Australasian Kidney Trials Network; The University of Queensland; Brisbane Australia
- Translational Research Institute; Brisbane Australia
| | - David W Johnson
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Australia
- Australasian Kidney Trials Network; The University of Queensland; Brisbane Australia
- Translational Research Institute; Brisbane Australia
| | - Scott B Campbell
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Australia
| | - Ross S Francis
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Australia
| | - Germaine Wong
- School of Public Health; The University of Sydney; Sydney Australia
| | - Jonathan C Craig
- Cochrane Kidney and Transplant, Centre for Kidney Research; The Children's Hospital at Westmead; Westmead Australia
- College of Medicine and Public Health; Flinders University; Adelaide Australia
| | - Andrea K Viecelli
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Australia
- Australasian Kidney Trials Network; The University of Queensland; Brisbane Australia
- Translational Research Institute; Brisbane Australia
| | - Yeoungjee Cho
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Australia
- Australasian Kidney Trials Network; The University of Queensland; Brisbane Australia
- Translational Research Institute; Brisbane Australia
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22
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Ethier I, Cho Y, Hawley C, Pascoe EM, Viecelli AK, Campbell SB, van Eps C, Isbel NM, Cooper BA, Harris DC, Pollock CA, Wong MG, Johnson DW. Rate of decline in residual kidney function pre and post peritoneal dialysis initiation: A post hoc analysis of the IDEAL study. PLoS One 2020; 15:e0242254. [PMID: 33196667 PMCID: PMC7668577 DOI: 10.1371/journal.pone.0242254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/30/2020] [Indexed: 11/19/2022] Open
Abstract
Background Residual kidney function (RKF) is associated with improved survival and quality of life in dialysis patients. Previous studies have suggested that initiation of peritoneal dialysis (PD) may slow RKF decline compared to the pre-dialysis period. We sought to evaluate the association between PD initiation and RKF decline in the Initiating Dialysis Early And Late (IDEAL) trial. Methods In this post hoc analysis of the IDEAL randomized controlled trial, PD participants were included if results from 24-hour urine collections had been recorded within 30 days of dialysis initiation, and at least one value pre- and one value post-dialysis commencement were available. The primary outcome was slope of RKF decline, calculated as mean of urinary creatinine and urea clearances. Secondary outcomes included slope of urine volume decline and time from PD initiation to anuria. Results The study included 151 participants (79 early start, 72 late start). The slope of RKF decline was slower after PD initiation (-2.69±0.18mL/min/1.73m2/yr) compared to before PD (-4.09±0.33mL/min/1.73m2/yr; change in slope +1.19 mL/min/1.73m2/yr, 95%CI 0.48–1.90, p<0.001). In contrast, urine volume decline was faster after PD commencement (-0.74±0.05 L/yr) compared to beforehand (-0.57±0.06L/yr; change in slope -0.18L/yr, 95%CI -0.34—-0.01, p = 0.04). No differences were observed between the early- and late-start groups with respect to RKF decline, urine volume decline or time to anuria. Conclusions Initiation of PD was associated with a slower decline of RKF compared to the pre-dialysis period.
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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
- * E-mail:
| | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Carmel Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Elaine M. Pascoe
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Andrea K. Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Scott B. Campbell
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Carolyn van Eps
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Nicole M. Isbel
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Bruce A. Cooper
- Department of Renal Medicine, Royal North Shore Hospital, St Leonards, Australia
| | - David C. Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Carol A. Pollock
- Department of Renal Medicine, Royal North Shore Hospital, St Leonards, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Muh Geot Wong
- Department of Renal Medicine, Royal North Shore Hospital, St Leonards, Australia
- The George Institute for Global Health, Newtown, Australia
| | - David W. Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
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23
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Ethier I, Cho Y, Davies CE, Hawley CM, Campbell SB, Isbel NM, Pascoe EM, Polkinghorne KR, Roberts M, See EJ, Semple D, van Eps C, Viecelli AK, Johnson DW. Variability and trends over time and across centres in haemodialysis weekly duration in Australia and New Zealand. Nephrology (Carlton) 2020; 26:153-163. [PMID: 33094549 DOI: 10.1111/nep.13782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/27/2020] [Accepted: 08/28/2020] [Indexed: 11/28/2022]
Abstract
AIM Haemodialysis treatment prescription varies widely internationally. This study explored patient- and centre-level characteristics associated with weekly haemodialysis hours. METHODS Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data were analysed. Characteristics associated with weekly duration were evaluated using mixed-effects linear regression models with patient- and centre-level covariates as fixed effects, and dialysis centre and state as random effects using the 2017 prevalent in-centre haemodialysis (ICHD) and home haemodialysis (HHD) cohorts. Evaluation of patterns of weekly duration over time analysed the 2000 to 2017 incident ICHD and HHD cohorts. RESULTS Overall, 12 494 ICHD and 1493 HHD prevalent patients in 2017 were included. Median weekly treatment duration was 13.5 (interquartile range [IQR] 12-15) hours for ICHD and 16 (IQR 15-20) hours for HHD. Male sex, younger age, higher body mass index, arteriovenous fistula/graft use, Aboriginal and Torres Strait Islander ethnicity and longer dialysis vintage were associated with longer weekly duration for both ICHD and HHD. No centre characteristics were associated with duration. Variability in duration across centres was very limited in ICHD compared with HHD, with variation in HHD being associated with state. Duration did not vary significantly over time for ICHD, whereas longer weekly HHD treatments were reported between 2006 and 2012 compared with before and after this period. CONCLUSION This study in the Australian and New Zealand haemodialysis population showed that weekly duration was primarily associated with patient characteristics. No centre effect was demonstrated. Practice patterns seemed to differ across states/countries, with more variability in HHD than ICHD.
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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, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Christopher E Davies
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Scott B Campbell
- 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
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Kevan R Polkinghorne
- Department of Nephrology, Monash Medical Centre, Melbourne, Australia.,Department of Medicine, Monash University, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Matthew Roberts
- Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Emily J See
- School of Medicine, University of Melbourne, Melbourne, Australia.,Department of Intensive Care, Austin Health, Melbourne, Australia
| | - David Semple
- Department of Renal Medicine, Auckland District Health Board, Auckland, New Zealand.,School of Medicine, University of Auckland, Auckland, New Zealand
| | - Carolyn van Eps
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Andrea K Viecelli
- 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, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
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24
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Campbell SB, Wu Q, Yazbeck J, Liu C, Okhovatian S, Radisic M. Beyond Polydimethylsiloxane: Alternative Materials for Fabrication of Organ-on-a-Chip Devices and Microphysiological Systems. ACS Biomater Sci Eng 2020; 7:2880-2899. [PMID: 34275293 DOI: 10.1021/acsbiomaterials.0c00640] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Polydimethylsiloxane (PDMS) is the predominant material used for organ-on-a-chip devices and microphysiological systems (MPSs) due to its ease-of-use, elasticity, optical transparency, and inexpensive microfabrication. However, the absorption of small hydrophobic molecules by PDMS and the limited capacity for high-throughput manufacturing of PDMS-laden devices severely limit the application of these systems in personalized medicine, drug discovery, in vitro pharmacokinetic/pharmacodynamic (PK/PD) modeling, and the investigation of cellular responses to drugs. Consequently, the relatively young field of organ-on-a-chip devices and MPSs is gradually beginning to make the transition to alternative, nonabsorptive materials for these crucial applications. This review examines some of the first steps that have been made in the development of organ-on-a-chip devices and MPSs composed of such alternative materials, including elastomers, hydrogels, thermoplastic polymers, and inorganic materials. It also provides an outlook on where PDMS-alternative devices are trending and the obstacles that must be overcome in the development of versatile devices based on alternative materials to PDMS.
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Affiliation(s)
- Scott B Campbell
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario M5S 3G9, Canada
| | - Qinghua Wu
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario M5S 3G9, Canada
| | - Joshua Yazbeck
- Department of Chemical Engineering & Applied Chemistry, University of Toronto, Toronto, Ontario M5S 3E5, Canada
| | - Chuan Liu
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario M5S 3G9, Canada
| | - Sargol Okhovatian
- Department of Chemical Engineering & Applied Chemistry, University of Toronto, Toronto, Ontario M5S 3E5, Canada
| | - Milica Radisic
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario M5S 3G9, Canada.,Department of Chemical Engineering & Applied Chemistry, University of Toronto, Toronto, Ontario M5S 3E5, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario M5G 2C4, Canada
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25
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Chan S, Ng S, Chan HP, Pascoe EM, Playford EG, Wong G, Chapman JR, Lim WH, Francis RS, Isbel NM, Campbell SB, Hawley CM, Johnson DW. Perioperative antibiotics for preventing post-surgical site infections in solid organ transplant recipients. Cochrane Database Syst Rev 2020; 8:CD013209. [PMID: 32799356 PMCID: PMC7437398 DOI: 10.1002/14651858.cd013209.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Solid organ transplant recipients are at high risk for infections due to the complexity of surgical procedures combined with the impact of immunosuppression. No consensus exists on the role of antibiotics for surgical site infections in solid organ transplant recipients. OBJECTIVES To assess the benefits and harms of prophylactic antimicrobial agents for preventing surgical site infections in solid organ transplant recipients. SEARCH METHODS The Cochrane Kidney and Transplant Register of Studies was searched up to 21 April 2020 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal, and ClinicalTrials.gov. SELECTION CRITERIA All randomised controlled trials (RCTs) and quasi-RCTs in any language assessing prophylactic antibiotics in preventing surgical site infections in solid organ transplant recipients at any time point after transplantation. DATA COLLECTION AND ANALYSIS Two authors independently determined study eligibility, assessed quality, and extracted data. Primary outcomes were surgical site infections and antimicrobial resistance. Other outcomes included urinary tract infections, pneumonias and septicaemia, death (any cause), graft loss, graft rejection, graft function, adverse reactions to antimicrobial agents, and outcomes identified by the Standardised Outcomes of Nephrology Group (SONG), specifically graft health, cardiovascular disease, cancer and life participation. Summary effect estimates were obtained using a random-effects model and results were expressed as risk ratios (RR) and 95% confidence intervals (CI). The quality of the evidence was assessed using the risk of bias and the GRADE approach. MAIN RESULTS We identified eight eligible studies (718 randomised participants). Overall, five studies (248 randomised participants) compared antibiotics versus no antibiotics, and three studies (470 randomised participants) compared extended duration versus short duration antibiotics. Risk of bias was assessed as high for performance bias (eight studies), detection bias (eight studies) and attrition bias (two studies). It is uncertain whether antibiotics reduce the incidence of surgical site infections as the certainty of the evidence has been assessed as very low (RR 0.42, 95% CI 0.21 to 0.85; 5 studies, 226 participants; I2 = 25%). The certainty of the evidence was very low for all other reported outcomes (death, graft loss, and other infections). It is uncertain whether extended duration antibiotics reduces the incidence of surgical site infections in either solid organ transplant recipients (RR 1.19, 95% CI 0.58 to 2.48; 2 studies, 302 participants; I2 = 0%) or kidney-only transplant recipients (RR 0.50, 95% CI 0.05 to 5.48; 1 study, 205 participants) as the certainty of the evidence has been assessed as very low. The certainty of the evidence was very low for all other reported outcomes (death, graft loss, and other infections). None of the eight included studies evaluated antimicrobial agent adverse reactions, graft health, cardiovascular disease, cancer, life participation, biochemical and haematological parameters, intervention cost, hospitalisation length, or overall hospitalisation costs. AUTHORS' CONCLUSIONS Due to methodological limitations, risk of bias and significant heterogeneity, the current evidence for the use of prophylactic perioperative antibiotics in transplantation is of very low quality. Further high quality, adequately powered RCTs would help better inform clinical practice.
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Affiliation(s)
- Samuel Chan
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Samantha Ng
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Hooi P Chan
- General Practice Queensland, Brisbane, Australia
| | - Elaine M Pascoe
- Department of Biostatistics, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | | | - Germaine Wong
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Jeremy R Chapman
- Department of Nephrology, Westmead Clinical School, Sydney, Australia
| | - Wai H Lim
- Department of Nephrology, Sir Charles Gardiner Hospital, Perth, Australia
| | - Ross S Francis
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Nicole M Isbel
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Scott B Campbell
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
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26
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Htay H, Pascoe EM, Hawley CM, Campbell SB, Chapman J, Cho Y, Clayton PA, Collins MG, Francis RS, Isbel NM, Lim WH, Putrino S, Johnson DW. Patient and center characteristics associated with kidney transplant outcomes: a binational registry analysis. Transpl Int 2020; 33:1667-1680. [PMID: 32589787 DOI: 10.1111/tri.13681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/14/2020] [Accepted: 06/22/2020] [Indexed: 11/29/2022]
Abstract
This registry-based study evaluated the contribution of center characteristics to kidney transplant outcomes in adult first kidney transplant recipients in Australia and New Zealand between 2004 and 2014. Primary outcomes were mortality and graft failure, and secondary outcomes were transplant complications. Overall, 6970 transplants from 17 centers were included. For deceased donor transplants, 5-year patient and graft survival rates varied considerably (81.0-93.9% and 72.2-88.3%, respectively). Variations in mortality and graft failure were partially reduced after adjustment for patient characteristics (1% and 20% reductions) and more markedly reduced after adjustment for center characteristics (41% and 55% reductions). For living donor transplants, 5-year patient and graft survival rates varied (89.7-100% and 79.2-96.9%, respectively). Centers with high average total ischemic times (>14 h) were associated with higher mortality for both deceased (adjusted hazard ratio [(AHR] 2.24, 95% CI 1.21-4.13) and living donor transplants (AHR 1.76, 95% CI 1.02-3.04). Small center size (<35 new kidney transplants/year) was associated with a lower hazard of mortality for living donor kidney transplants (AHR 0.48, 95% CI 0.28-0.81). No center characteristic was associated with graft failure. The appreciable variations in deceased donor kidney transplant recipient and graft survival outcomes across centers were attributable to center effects.
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Affiliation(s)
- Htay Htay
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.,Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore.,Australasian Kidney Trial Network, University of Queensland, Brisbane, Qld, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trial Network, University of Queensland, Brisbane, Qld, Australia
| | - Carmel M Hawley
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.,Australasian Kidney Trial Network, University of Queensland, Brisbane, Qld, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Qld, Australia.,Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia
| | - Scott B Campbell
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Jeremy Chapman
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia
| | - Yeoungjee Cho
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.,Australasian Kidney Trial Network, University of Queensland, Brisbane, Qld, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Qld, Australia.,Translational Research Institute, Brisbane, Qld, Australia
| | - Philip A Clayton
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.,Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Michael G Collins
- Department of Renal Medicine, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand.,University of Auckland, Auckland, New Zealand
| | - Ross S Francis
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Nicole M Isbel
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Wai H Lim
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.,Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.,School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Samantha Putrino
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Qld, Australia.,University of Queensland, Brisbane, Qld, Australia
| | - David W Johnson
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.,Australasian Kidney Trial Network, University of Queensland, Brisbane, Qld, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Qld, Australia.,Translational Research Institute, Brisbane, Qld, Australia
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27
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Johnson DW, Herzig KA, Gissane R, Campbell SB, Hawley CM, Isbel NM. Oral versus Intravenous Iron Supplementation in Peritoneal Dialysis Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080102103s41] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The vast majority of erythropoietin (EPO)–treated peritoneal dialysis (PD) patients require iron supplementation. Most authors and clinical practice guidelines recommend primary oral iron supplementation in PD patients because it is more practical and less expensive. However, numerous studies have clearly demonstrated that oral iron therapy is unable to maintain EPO-treated PD patients in positive iron balance. Once patients become iron-deficient, intravenous iron administration has been found to more effectively augment iron stores and hematologic response than does oral therapy. We recently performed a prospective, cross-over trial in 28 iron-replete PD patients and showed that twice-monthly outpatient iron polymaltose infusions (200 mg) were a practical and safe alternative to oral iron. That treatment produced significant increases in hemoglobin concentration and body iron stores. The additional expense of intravenous iron therapy was completely offset by reductions in EPO dosage. Careful monitoring of iron stores is important in patients receiving intravenous iron supplementation in view of epidemiologic links with infection and cardiovascular disease. Nevertheless, a growing body of evidence suggests that, as has been found for hemodialysis patients, intravenous iron therapy is superior to oral iron supplementation in EPO-treated PD patients.
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Affiliation(s)
- David W. Johnson
- Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | - Karen A. Herzig
- Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | - Ruth Gissane
- Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | - Scott B. Campbell
- Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | - Carmel M. Hawley
- Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | - Nicole M. Isbel
- Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia
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28
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Johnson DW, Mudge DW, Sturtevant JM, Hawley CM, Campbell SB, Isbel NM, Hollett P. Predictors of Decline of Residual Renal Function in New Peritoneal Dialysis Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080302300311] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
♦ Objective The aim of this study was to prospectively evaluate the risk factors for decline of residual renal function (RRF) in an incident peritoneal dialysis (PD) population. ♦ Design Prospective observational study of an incident PD cohort at a single center. ♦ Setting Tertiary-care institutional dialysis center. ♦ Participants The study included 146 consecutive patients commencing PD at the Princess Alexandra Hospital between 1 August 1995 and 1 July 2001 (mean age 54.8 ± 1.4 years, 42% male, 34% diabetic). Patients with failed renal transplants ( n = 26) were excluded. ♦ Main Measurements Timed urine collections ( n = 642) were performed initially and at 6-month intervals thereafter to measure RRF. The development of anuria was also prospectively recorded. ♦ Results The mean (±SD) follow-up period was 20.5 ± 14.8 months. The median slope of RRF decline was –0.05 mL/minute/month/1.73 m2. Using binary logistic regression, it was shown that the 50% of patients with more rapid RRF loss (< –0.05 mL/min/month/1.73 m2) were more likely to have had a higher initial RRF at commencement of PD [adjusted odds ratio (AOR) 1.83, 95% confidence interval (CI) 1.39 – 2.40] and a higher baseline dialysate/plasma creatinine ratio at 4 hours (D/P creat; AOR 44.6, 95% CI 1.05 – 1900). On multivariate Cox proportional hazards model analysis, time from commencement of PD to development of anuria was independently predicted by baseline RRF [adjusted hazard ratio (HR) 0.81, 95% CI 0.60 – 0.81], D/P creat (HR 2.87, 95% CI 2.06 – 82.3), body surface area (HR 6.23, 95% CI 1.53 – 25.5), dietary protein intake (HR 2.87, 95% CI 1.06 – 7.78), and diabetes mellitus (HR 1.65, 95% CI 1.00 – 2.72). Decline of RRF was independent of age, gender, dialysis modality, urgency of initiation of dialysis, smoking, vascular disease, blood pressure, medications (including angiotensin-converting enzyme inhibitors), duration of follow-up, and peritonitis rate. ♦ Conclusions The results of this study suggest that high baseline RRF and high D/P creat ratio are risk factors for rapid loss of RRF. Moreover, a shorter time to the onset of anuria is independently predicted by low baseline RRF, increased body surface area, high dietary protein intake, and diabetes mellitus. Such at-risk patients should be closely monitored for early signs of inadequate dialysis.
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Affiliation(s)
- David W. Johnson
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - David W. Mudge
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Joanna M. Sturtevant
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Carmel M. Hawley
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Scott B. Campbell
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Nicole M. Isbel
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Peter Hollett
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Johnson DW, Herzig KA, Purdie DM, Chang W, Brown AM, Rigby RJ, Campbell SB, Nicol DL, Hawley CM. Is Obesity a Favorable Prognostic Factor in Peritoneal Dialysis Patients? Perit Dial Int 2020. [DOI: 10.1177/089686080002000623] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
ObjectiveTo determine the influence of an elevated body mass index (BMI) on cardiovascular outcomes and survival in peritoneal dialysis (PD) patients.DesignProspective, observational study of a prevalent PD cohort at a single center.SettingTertiary care institutional dialysis center.PatientsThe study included all patients with a BMI of at least 20 who had been receiving PD for at least 1 month as of 31 January 1996 ( n = 43). Patients were classified as overweight [BMI > 27.5; mean ± standard error of mean (SEM): 32.1 ± 1.1; n = 14] or normal weight (BMI 20 – 27.5; mean ± SEM: 23.8 ± 0.4; n = 29).Outcome MeasuresPatient survival and adverse cardiovascular events (myocardial infarction, congestive cardiac failure, cerebrovascular accident, and symptomatic peripheral vascular disease) were recorded over a 3-year period.ResultsAt baseline, no significant differences were seen between the groups in clinical, biochemical, nutritional, or echocardiographic parameters, except for a lower dietary protein intake (0.97 ± 0.10 g/kg/day vs 1.44 ± 0.10 g/ kg/day, p = 0.004) and a higher proportion of well-nourished patients by subjective global assessment (100% vs 72%, p < 0.05) in the overweight group. After 3 years of follow-up, 29% of overweight patients and 69% of normal-weight patients had died ( p < 0.05). Using a Cox proportional hazards model, a BMI greater than 27.5 was shown to be an independent positive predictor of patient survival, with an adjusted hazard ratio (HR) of 0.09 [95% confidence interval (CI): 0.01 – 0.85; p < 0.05]. However, being overweight did not significantly influence myocardial infarction-free survival (adjusted HR: 0.33; 95% CI: 0.07 – 1.48; p = 0.15) or combined adverse cardiovascular event-free survival (adjusted HR: 0.67; 95% CI: 0.23 – 1.93; p = 0.46).ConclusionsObesity conferred a significant survival advantage in our PD population. Obese patients should therefore not be discouraged from receiving PD purely on the basis of BMI. Moreover, maintaining a higher-than-average BMI to preserve “nutritional reserve” may help to reduce the mortality and morbidity rates associated with PD.
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Affiliation(s)
| | | | - David M. Purdie
- Department of Renal Medicine, Princess Alexandra Hospital, Epidemiology and Population Health Unit, Queensland Institute of Medical Research
| | | | | | | | | | - David L. Nicol
- Renal Transplant Unit, Princess Alexandra Hospital, Brisbane, Australia
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Johnson DW, Kay TD, Vesey DA, Isbel N, Campbell SB, Hawley CM. Peritoneal Homocysteine Clearance is Inefficient in Peritoneal Dialysis Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080002000630] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ObjectivesTo investigate the degree and the determinants of peritoneal homocysteine (Hcy) clearance and to compare measured Hcy clearance with the Hcy clearance predicted based on molecular weight (MW).DesignCross-sectional observational analysis.SettingTertiary care institutional dialysis center.PatientsSixty-five stable peritoneal dialysis (PD) patients.Outcome MeasuresFasting blood and 24-hour pooled dialysate effluents were collected for determination of peritoneal clearances of Hcy (CpHcy), urea (CpUr), and creatinine (CpCr). The dialysate-to-plasma creatinine ratio at 4 hours (D/P Cr 4 h) and levels of red cell folate, B12, ferritin, and C-reactive protein (CRP) were measured concurrently. Observed CpHcy was compared with predicted clearance, based on Hcy plasma protein binding and the relative molecular weights of Hcy, urea, and creatinine.ResultsPlasma concentrations of Hcy averaged 24.6 ± 1.1 μmol/L and were elevated above the upper limit of normal in 59 (91%) patients. The mean dialysate concentration of Hcy was 2.9 ± 0.3 μmol/L, equating to a daily peritoneal elimination of 34.6 ± 3.6 μmol. Observed CpHcy was closely approximated by predicted CpHcy (8.7 ± 0.6 L/week/1.73 m2vs 9.0 ± 0.3 L/week/1.73 m2respectively, p = 0.55). Patients maintained on automated PD ( n = 5) had a CpHcy similar to that of patients treated with continuous ambulatory peritoneal dialysis (8.9 ± 1.0 L/week/1.73 m2vs 8.7 ± 0.6 L/week/1.73 m2, p = 0.92). The CpHcy was significantly correlated with C-reactive protein (CRP), D/P creatinine, CpUr, CpCr, and peritoneal protein loss, but not with plasma Hcy, albumin, B12, ferritin, age, dialysis duration, peritonitis episodes, or daily dialysate effluent volume. By multivariate analysis, the only variables that remained significant independent predictors of CpHcy were CRP and D/P Cr 4 h. High and high-average transporters had a higher CpHcy than low and low-average transporters (9.7 ± 0.8 L/week/1.73 m2vs 7.0 ± 0.7 L/week/1.73 m2, p < 0.05), despite comparably elevated plasma Hcy concentrations [25.2 ± 1.5 μmol/L vs 23.4 ± 1.6 μmol/L, p = nonsignificant (NS)].ConclusionsElevated plasma concentrations of Hcy are not efficiently reduced by PD. The relatively low peritoneal clearance of Hcy is largely accounted for by a high degree of plasma protein binding and is significantly influenced by peritoneal membrane permeability.
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Affiliation(s)
- David W. Johnson
- Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | - Troy D. Kay
- Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | - David A. Vesey
- Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | - Nicole Isbel
- Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | - Scott B. Campbell
- Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | - Carmel M. Hawley
- Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia
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Chan S, Hawley CM, Campbell KL, Morrison M, Campbell SB, Isbel NM, Francis RS, Playford EG, Johnson DW. Transplant associated infections-The role of the gastrointestinal microbiota and potential therapeutic options. Nephrology (Carlton) 2019; 25:5-13. [PMID: 31587409 DOI: 10.1111/nep.13670] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/26/2019] [Accepted: 09/14/2019] [Indexed: 02/06/2023]
Abstract
Infectious complications are common following kidney transplantation and rank in the top five causes of death in patients with allograft function. Over the last 5 years, there has been emerging evidence that changes in the gastrointestinal microbiota following kidney transplantation may play a key role in the pathogenesis of transplant-associated infections. Different factors have emerged which may disrupt the interaction between the gastrointestinal microbiota and the immune system, which may lead to infective complications in kidney transplant recipients. Over the last 5 years, there has been emerging evidence that changes in the gastrointestinal microbiota following kidney transplantation may play a key role in the pathogenesis of transplant-associated infections. This review will discuss the structure and function of the gastrointestinal microbiota, the changes that occur in the gastrointestinal microbiota following kidney transplantation and the factors underpinning these changes, how these changes may lead to transplant-associated infectious complications and potential treatments which may be instituted to mitigate this risk.
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Affiliation(s)
- Samuel Chan
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
| | - Katrina L Campbell
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia.,Centre for Applied Health Economics, Menzies Research Institute, Griffith University, Brisbane, Queensland, Australia
| | - Mark Morrison
- The University of Queensland Diamantina Institute, Faculty of Medicine, University of Queensland, Woolloongabba, Queensland, Australia
| | - Scott B Campbell
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
| | - Nicole M Isbel
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
| | - Ross S Francis
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
| | - Elliot G Playford
- Infection Management Services, Department of Microbiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
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Chan S, Isbel NM, Hawley CM, Campbell SB, Campbell KL, Morrison M, Francis RS, Playford EG, Johnson DW. Infectious Complications Following Kidney Transplantation-A Focus on Hepatitis C Infection, Cytomegalovirus Infection and Novel Developments in the Gut Microbiota. ACTA ACUST UNITED AC 2019; 55:medicina55100672. [PMID: 31590269 PMCID: PMC6843315 DOI: 10.3390/medicina55100672] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/24/2019] [Accepted: 09/30/2019] [Indexed: 12/19/2022]
Abstract
The incidence of infectious complications, compared with the general population and the pre-transplant status of the recipient, increases substantially following kidney transplantation, causing significant morbidity and mortality. The potent immunosuppressive therapy given to prevent graft rejection in kidney transplant recipients results in an increased susceptibility to a wide range of opportunistic infections including bacterial, viral and fungal infections. Over the last five years, several advances have occurred that may have changed the burden of infectious complications in kidney transplant recipients. Due to the availability of direct-acting antivirals to manage donor-derived hepatitis C infection, this has opened the way for donors with hepatitis C infection to be considered in the donation process. In addition, there have been the development of medications targeting the growing burden of resistant cytomegalovirus, as well as the discovery of the potentially important role of the gastrointestinal microbiota in the pathogenesis of post-transplant infection. In this narrative review, we will discuss these three advances and their potential implications for clinical practice.
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Affiliation(s)
- Samuel Chan
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia; (N.M.I.); (C.M.H.); (S.B.C.); (R.S.F.); (D.W.J.)
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, QLD 4102, Australia; (K.L.C.); (E.G.P.)
- Translational Research Institute, Brisbane, QLD 4102, Australia
- Correspondence: ; Tel.: +61-7-3176-5080
| | - Nicole M Isbel
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia; (N.M.I.); (C.M.H.); (S.B.C.); (R.S.F.); (D.W.J.)
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, QLD 4102, Australia; (K.L.C.); (E.G.P.)
- Translational Research Institute, Brisbane, QLD 4102, Australia
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia; (N.M.I.); (C.M.H.); (S.B.C.); (R.S.F.); (D.W.J.)
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, QLD 4102, Australia; (K.L.C.); (E.G.P.)
| | - Scott B Campbell
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia; (N.M.I.); (C.M.H.); (S.B.C.); (R.S.F.); (D.W.J.)
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, QLD 4102, Australia; (K.L.C.); (E.G.P.)
- Translational Research Institute, Brisbane, QLD 4102, Australia
| | - Katrina L Campbell
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, QLD 4102, Australia; (K.L.C.); (E.G.P.)
- Centre for Applied Health Economics, Menzies Research Institute, Griffith University, Brisbane, QLD 4102, Australia
| | - Mark Morrison
- The University of Queensland Diamantina Institute, Faculty of Medicine, University of Queensland, Woolloongabba, QLD 4102, Australia;
| | - Ross S Francis
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia; (N.M.I.); (C.M.H.); (S.B.C.); (R.S.F.); (D.W.J.)
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, QLD 4102, Australia; (K.L.C.); (E.G.P.)
- Translational Research Institute, Brisbane, QLD 4102, Australia
| | - E Geoffrey Playford
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, QLD 4102, Australia; (K.L.C.); (E.G.P.)
- Infection Management Services, Department of Microbiology, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia; (N.M.I.); (C.M.H.); (S.B.C.); (R.S.F.); (D.W.J.)
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, QLD 4102, Australia; (K.L.C.); (E.G.P.)
- Translational Research Institute, Brisbane, QLD 4102, Australia
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Chan S, Pascoe EM, Clayton PA, McDonald SP, Lim WH, Sypek MP, Palmer SC, Isbel NM, Francis RS, Campbell SB, Hawley CM, Johnson DW. Infection-Related Mortality in Recipients of a Kidney Transplant in Australia and New Zealand. Clin J Am Soc Nephrol 2019; 14:1484-1492. [PMID: 31455690 PMCID: PMC6777595 DOI: 10.2215/cjn.03200319] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/24/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES The burden of infectious disease is high among kidney transplant recipients because of concomitant immunosuppression. In this study the incidence of infectious-related mortality and associated factors were evaluated. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In this registry-based retrospective, longitudinal cohort study, recipients of a first kidney transplant in Australia and New Zealand between 1997 and 2015 were included. Cumulative incidence of infectious-related mortality was estimated using competing risk regression (using noninfectious mortality as a competing risk event), and compared with age-matched, populated-based data using standardized incidence ratios. RESULTS Among 12,519 patients, (median age 46 years, 63% men, 15% diabetic, 6% Indigenous ethnicity), 2197 (18%) died, of whom 416 (19%) died from infection. The incidence of infection-related mortality during the study period (1997-2015) was 45.8 (95% confidence interval [95% CI], 41.6 to 50.4) per 10,000 patient-years. The incidence of infection-related mortality reduced from 53.1 (95% CI, 45.0 to 62.5) per 10,000 person-years in 1997-2000 to 43.9 (95% CI, 32.5 to 59.1) per 10,000 person-years in 2011-2015 (P<0.001) Compared with the age-matched general population, kidney transplant recipients had a markedly higher risk of infectious-related death (standardized incidence ratio, 7.8; 95% CI, 7.1 to 8.6). Infectious mortality was associated with older age (≥60 years adjusted subdistribution hazard ratio [SHR], 4.16; 95% CI, 2.15 to 8.05; reference 20-30 years), female sex (SHR, 1.62; 95% CI, 1.19 to 2.29), Indigenous ethnicity (SHR, 2.87; 95% CI, 1.84 to 4.46; reference white), earlier transplant era (2011-2015: SHR, 0.39; 95% CI, 0.20 to 0.76; reference 1997-2000), and use of T cell-depleting therapy (SHR, 2.43; 95% CI, 1.36 to 4.33). Live donor transplantation was associated with lower risk of infection-related mortality (SHR, 0.53; 95% CI, 0.37 to 0.76). CONCLUSIONS Infection-related mortality in kidney transplant recipients is significantly higher than the general population, but has reduced over time. Risk factors include older age, female sex, Indigenous ethnicity, T cell-depleting therapy, and deceased donor transplantation. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_08_27_CJN03200319.mp3.
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Affiliation(s)
- Samuel Chan
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, South Australia, Australia; .,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
| | - Elaine M Pascoe
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
| | - Philip A Clayton
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, South Australia, Australia.,Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen P McDonald
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, South Australia, Australia.,Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Wai H Lim
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, South Australia, Australia.,Sir Charles Gairdner Hospital Unit, The University of Western Australia, Perth, Western Australia, Australia; and
| | - Matthew P Sypek
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, South Australia, Australia.,Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Suetonia C Palmer
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Nicole M Isbel
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Ross S Francis
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Scott B Campbell
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, South Australia, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Carmel M Hawley
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, South Australia, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
| | - David W Johnson
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, South Australia, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
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Cossart AR, Cottrell WN, Campbell SB, Isbel NM, Staatz CE. Characterizing the pharmacokinetics and pharmacodynamics of immunosuppressant medicines and patient outcomes in elderly renal transplant patients. Transl Androl Urol 2019; 8:S198-S213. [PMID: 31236338 DOI: 10.21037/tau.2018.10.16] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This review examines what is currently known about the pharmacokinetics and pharmacodynamics of commonly prescribed immunosuppressant medicines, tacrolimus, cyclosporine, mycophenolate and prednisolone, in elderly renal transplant recipients, and reported patient outcomes in this cohort. Renal transplantation is increasing rapidly in the elderly, however, currently, long-term patient outcomes are relatively poor compared to younger adults. Some studies have suggested that elderly recipients may have higher dose-adjusted exposure and/or lower clearance of the calcineurin inhibitors tacrolimus and cyclosporine; with one study reporting up to 50% reduction in tacrolimus exposure in the elderly. Elderly transplant recipients do not appear to have higher dosage-adjusted exposure to mycophenolic acid (MPA). The effects of ageing on the pharmacokinetics of prednisolone are unknown. Only one study has examined how aging effects drug target enzymes, reporting no difference in baseline inosine 5'-monophosphate dehydrogenase (IMPDH) activity and MPA-induced IMPDH activity in elderly compared to younger adult renal transplant recipients. In elderly transplant recipients, immunosenescence likely lowers the risk of acute rejection, but increases the risk of drug-related adverse effects. Currently, the three main causes of death in elderly renal transplant recipients are cardiovascular disease, infection and malignancy. One study has showed that renal transplant recipients aged over 65 years are seven times more likely to die with a functioning graft compared with young adults (aged 18-29 years). This suggests that an optimal balance between immunosuppressant medicine efficacy and toxicity is not achieved in elderly recipients, and further studies are needed to foster long-term graft and patient survival. Lower maintenance immunosuppressant targets in elderly recipients may decrease patient susceptibility to drug side effects, however, further studies are required and appropriate targets need to be established.
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Affiliation(s)
- Amelia R Cossart
- School of Pharmacy, University of Queensland, Brisbane, Australia
| | - W Neil Cottrell
- School of Pharmacy, University of Queensland, Brisbane, Australia
| | - Scott B Campbell
- Department of Nephrology, University of Queensland at the Princess Alexandra Hospital, Brisbane, Australia
| | - Nicole M Isbel
- Department of Nephrology, University of Queensland at the Princess Alexandra Hospital, Brisbane, Australia
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Chan S, Ng S, Chan HP, Pascoe E, Playford EG, Wong G, Chapman JR, Lim WH, Francis RS, Isbel NM, Campbell SB, Hawley CM, Johnson DW. Perioperative antibiotics for preventing post-surgical site infections in solid organ transplant recipients. Hippokratia 2018. [DOI: 10.1002/14651858.cd013209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Samuel Chan
- Princess Alexandra Hospital; Department of Nephrology; Ipswich Road, Woolloongabba Brisbane Queensland Australia 4102
| | - Samantha Ng
- Princess Alexandra Hospital; Department of Nephrology; Ipswich Road, Woolloongabba Brisbane Queensland Australia 4102
| | - Hooi P Chan
- General Practice Queensland; Brisbane Queensland Australia 4102
| | - Elaine Pascoe
- The University of Queensland; Department of Biostatistics, Faculty of Medicine; Brisbane Queensland Australia 4102
| | - Elliott Geoffrey Playford
- Princess Alexandra Hospital; Department of Infection Control Management; 199 Ipswich Road Woolloongabba Queensland Australia 4102
| | - Germaine Wong
- The University of Sydney; School of Public Health; Sydney NSW Australia 2006
| | - Jeremy R Chapman
- Westmead Clinical School; Department of Nephrology; Sydney NSW Australia 2006
| | - Wai H Lim
- Sir Charles Gardiner Hospital; Department of Nephrology; Perth Western Australia Australia 6009
| | - Ross S Francis
- Princess Alexandra Hospital; Department of Nephrology; Ipswich Road, Woolloongabba Brisbane Queensland Australia 4102
| | - Nicole M Isbel
- Princess Alexandra Hospital; Department of Nephrology; Ipswich Road, Woolloongabba Brisbane Queensland Australia 4102
| | - Scott B Campbell
- Princess Alexandra Hospital; Department of Nephrology; Ipswich Road, Woolloongabba Brisbane Queensland Australia 4102
| | - Carmel M Hawley
- Princess Alexandra Hospital; Department of Nephrology; Ipswich Road, Woolloongabba Brisbane Queensland Australia 4102
| | - David W Johnson
- Princess Alexandra Hospital; Department of Nephrology; Ipswich Road, Woolloongabba Brisbane Queensland Australia 4102
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Ellis RJ, Edey DP, Del Vecchio SJ, McStea M, Campbell SB, Hawley CM, Johnson DW, Morais C, Jordan SJ, Francis RS, Wood ST, Gobe GC. End-Stage Kidney Disease following Surgical Management of Kidney Cancer. Clin J Am Soc Nephrol 2018; 13:1641-1648. [PMID: 30266837 PMCID: PMC6237064 DOI: 10.2215/cjn.06560518] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/20/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVES We investigated the incidence of ESKD after surgical management of kidney cancer in the Australian state of Queensland, and described patterns in the initiation of kidney replacement therapy resulting from kidney cancer across Australia. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS All newly diagnosed cases of kidney cancer in the Australian state of Queensland between January of 2009 and December of 2014 were ascertained through the Queensland Cancer Registry. There were 2739 patients included in our analysis. Patients who developed ESKD were identified using international classification of disease-10-coded hospital administrative data. Incidence rate and 3-year cumulative incidence were calculated, and multivariable Cox proportional hazards models were used to identify factors associated with ESKD. Additional descriptive analysis was undertaken of Australian population data. RESULTS The incidence rate of ESKD in all patients was 4.9 (95% confidence interval [95% CI], 3.9 to 6.2) per 1000 patient-years. The 3-year cumulative incidence was 1.7%, 1.9%, and 1.0% for all patients, and patients managed with radical or partial nephrectomy, respectively. Apart from preoperative kidney disease, exposures associated with increased ESKD risk were age≥65 years (adjusted hazard ratio [aHR], 2.0; 95% CI, 1.2 to 3.2), male sex (aHR, 2.3; 95% CI, 1.3 to 4.3), preoperative diabetes (aHR, 1.8; 95% CI, 1.0 to 3.3), American Society of Anesthesiologists classification ≥3 (aHR, 4.0; 95% CI, 2.2 to 7.4), socioeconomic disadvantage (aHR, 1.6; 95% CI, 0.9 to 2.7), and postoperative length of hospitalization ≥6 days (aHR, 2.1; 95% CI, 1.4 to 3.0). Australia-wide trends indicate that the rate of kidney replacement therapy after oncologic nephrectomy doubled between 1995 and 2015, from 0.3 to 0.6 per 100,000 per year. CONCLUSIONS In Queensland between 2009 and 2014, one in 53 patients managed with radical nephrectomy and one in 100 patients managed with partial nephrectomy developed ESKD within 3 years of surgery. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_09_28_CJASNPodcast_18_1_.mp3.
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Affiliation(s)
- Robert J. Ellis
- Departments of Nephrology and
- Centre for Kidney Disease Research, Faculty of Medicine
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Australia
- Cancer Causes and Care Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia; and
| | - Daniel P. Edey
- Centre for Kidney Disease Research, Faculty of Medicine
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Australia
| | - Sharon J. Del Vecchio
- Urology, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Kidney Disease Research, Faculty of Medicine
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Australia
| | - Megan McStea
- Australasian Kidney Trials Network
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Australia
| | | | - Carmel M. Hawley
- Departments of Nephrology and
- Centre for Kidney Disease Research, Faculty of Medicine
- Australasian Kidney Trials Network
- Australian and New Zealand Dialysis and Transplant Registry, Adelaide, Australia
| | - David W. Johnson
- Departments of Nephrology and
- Centre for Kidney Disease Research, Faculty of Medicine
- Australasian Kidney Trials Network
- Australian and New Zealand Dialysis and Transplant Registry, Adelaide, Australia
| | - Christudas Morais
- Urology, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Kidney Disease Research, Faculty of Medicine
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Australia
| | - Susan J. Jordan
- Schools of Public Health and
- Cancer Causes and Care Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia; and
| | - Ross S. Francis
- Departments of Nephrology and
- Centre for Kidney Disease Research, Faculty of Medicine
- Australasian Kidney Trials Network
- Australian and New Zealand Dialysis and Transplant Registry, Adelaide, Australia
| | - Simon T. Wood
- Urology, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Kidney Disease Research, Faculty of Medicine
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Australia
| | - Glenda C. Gobe
- Centre for Kidney Disease Research, Faculty of Medicine
- Biomedical Sciences, and
- NHMRC Chronic Kidney Disease Centre for Research Excellence, University of Queensland, Brisbane, Australia
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Australia
| | - Cancer Alliance Queensland
- Departments of Nephrology and
- Urology, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Kidney Disease Research, Faculty of Medicine
- Australasian Kidney Trials Network
- Schools of Public Health and
- Biomedical Sciences, and
- NHMRC Chronic Kidney Disease Centre for Research Excellence, University of Queensland, Brisbane, Australia
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Australia
- Cancer Causes and Care Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia; and
- Australian and New Zealand Dialysis and Transplant Registry, Adelaide, Australia
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Sivakumaran D, Bakaic E, Campbell SB, Xu F, Mueller E, Hoare T. Fabricating Degradable Thermoresponsive Hydrogels on Multiple Length Scales via Reactive Extrusion, Microfluidics, Self-assembly, and Electrospinning. J Vis Exp 2018. [PMID: 29708523 PMCID: PMC5933509 DOI: 10.3791/54502] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
While various smart materials have been explored for a variety of biomedical applications (e.g., drug delivery, tissue engineering, bioimaging, etc.), their ultimate clinical use has been hampered by the lack of biologically-relevant degradation observed for most smart materials. This is particularly true for temperature-responsive hydrogels, which are almost uniformly based on polymers that are functionally non-degradable (e.g., poly(N-isopropylacrylamide) (PNIPAM) or poly(oligoethylene glycol methacrylate) (POEGMA)). As such, to effectively translate the potential of thermoresponsive hydrogels to the challenges of remote-controlled or metabolism-regulated drug delivery, cell scaffolds with tunable cell-material interactions, theranostic materials with the potential for both imaging and drug delivery, and other such applications, a method is required to render the hydrogels (if not fully degradable) at least capable of renal clearance following the required lifetime of the material. To that end, this protocol describes the preparation of hydrolytically-degradable hydrazone-crosslinked hydrogels on multiple length scales based on the reaction between hydrazide and aldehyde-functionalized PNIPAM or POEGMA oligomers with molecular weights below the renal filtration limit. Specifically, methods to fabricate degradable thermoresponsive bulk hydrogels (using a double barrel syringe technique), hydrogel particles (on both the microscale through the use of a microfluidics platform facilitating simultaneous mixing and emulsification of the precursor polymers and the nanoscale through the use of a thermally-driven self-assembly and cross-linking method), and hydrogel nanofibers (using a reactive electrospinning strategy) are described. In each case, hydrogels with temperature-responsive properties similar to those achieved via conventional free radical cross-linking processes can be achieved, but the hydrazone cross-linked network can be degraded over time to re-form the oligomeric precursor polymers and enable clearance. As such, we anticipate these methods (which may be generically applied to any synthetic water-soluble polymer, not just smart materials) will enable easier translation of synthetic smart materials to clinical applications.
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Affiliation(s)
| | - Emilia Bakaic
- Department of Chemical Engineering, McMaster University
| | | | - Fei Xu
- Department of Chemical Engineering, McMaster University
| | - Eva Mueller
- Department of Chemical Engineering, McMaster University
| | - Todd Hoare
- Department of Chemical Engineering, McMaster University;
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Chan S, Campbell SB, Clayton PA, Mudge DW, Hawley CM, Johnson DW, Francis FS. Temporal changes in deceased kidney donor characteristics in Australia. Intern Med J 2017. [DOI: 10.1111/imj.2_13457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- S Chan
- Australian and New Zealand Dialysis and Transplant Registry; Adelaide Australia
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Queensland Australia
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - SB Campbell
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Queensland Australia
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - PA Clayton
- Australian and New Zealand Dialysis and Transplant Registry; Adelaide Australia
- Central Northern Adelaide Renal and Transplantation Service; Royal Adelaide Hospital; Adelaide Australia
- School of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - DW Mudge
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Queensland Australia
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - CM Hawley
- Australian and New Zealand Dialysis and Transplant Registry; Adelaide Australia
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Queensland Australia
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - DW Johnson
- Australian and New Zealand Dialysis and Transplant Registry; Adelaide Australia
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Queensland Australia
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - FS Francis
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Queensland Australia
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
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Badve SV, Pascoe EM, Burke M, Clayton PA, Campbell SB, Hawley CM, Lim WH, McDonald SP, Wong G, Johnson DW. Mammalian Target of Rapamycin Inhibitors and Clinical Outcomes in Adult Kidney Transplant Recipients. Clin J Am Soc Nephrol 2016; 11:1845-1855. [PMID: 27445164 PMCID: PMC5053777 DOI: 10.2215/cjn.00190116] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 06/06/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Emerging evidence from recently published observational studies and an individual patient data meta-analysis shows that mammalian target of rapamycin inhibitor use in kidney transplantation is associated with increased mortality. Therefore, all-cause mortality and allograft loss were compared between use and nonuse of mammalian target of rapamycin inhibitors in patients from Australia and New Zealand, where mammalian target of rapamycin inhibitor use has been greater because of heightened skin cancer risk. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Our longitudinal cohort study included 9353 adult patients who underwent 9558 kidney transplants between January 1, 1996 and December 31, 2012 and had allograft survival ≥1 year. Risk factors for all-cause death and all-cause and death-censored allograft loss were analyzed by multivariable Cox regression using mammalian target of rapamycin inhibitor as a time-varying covariate. Additional analyses evaluated mammalian target of rapamycin inhibitor use at fixed time points of baseline and 1 year. RESULTS Patients using mammalian target of rapamycin inhibitors were more likely to be white and have a history of pretransplant cancer. Over a median follow-up of 7 years, 1416 (15%) patients died, and 2268 (24%) allografts were lost. There was a higher risk of all-cause mortality with time-varying mammalian target of rapamycin inhibitor use (hazard ratio, 1.47; 95% confidence interval, 1.23 to 1.76) as well as in the fixed time model analyses comparing mammalian target of rapamycin inhibitor use at baseline (hazard ratio, 1.54; 95% confidence interval, 1.22 to 1.93) and 1 year (hazard ratio, 1.63; 95% confidence interval, 1.32 to 2.01). Time-varying mammalian target of rapamycin inhibitor use was associated with higher risk of death because of malignancy (hazard ratio, 1.37; 95% confidence interval, 1.09 to 1.71). There were no statistically significant differences in the risk of all-cause (hazard ratio, 0.98; 95% confidence interval, 0.85 to 1.12) and death-censored (hazard ratio, 0.85; 95% confidence interval, 0.69 to 1.03) allograft loss between the mammalian target of rapamycin inhibitor use and nonuse groups in the time-varying model as well as the fixed time models. CONCLUSIONS Mammalian target of rapamycin inhibitor use was associated with a higher risk of all-cause mortality but not allograft loss.
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Affiliation(s)
- Sunil V. Badve
- Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia
- Department of Nephrology, St. George Hospital, Sydney, Australia
- Renal and Metabolic Division, The George Institute for Global Health, Sydney, Australia
| | - Elaine M. Pascoe
- Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia
| | - Michael Burke
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Philip A. Clayton
- The Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia
- Central Northern Adelaide Renal and Transplantation Service, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Scott B. Campbell
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Carmel M. Hawley
- Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Wai H. Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia; and
| | - Stephen P. McDonald
- The Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia
- Central Northern Adelaide Renal and Transplantation Service, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Germaine Wong
- Center for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia
| | - David W. Johnson
- Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
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Bergmann TK, Isbel NM, Ostini R, Barraclough KA, Campbell SB, McWhinney BC, Inder WJ, Russell A, Staatz CE. Exploratory study of total and free prednisolone plasma exposure and cushingoid appearance, quality of life and biochemical toxicity in adult male kidney transplant recipients. Clin Drug Investig 2016; 35:743-50. [PMID: 26403249 DOI: 10.1007/s40261-015-0334-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Long-term adverse effects of oral glucocorticoids are frequent and serious. Large between-patient variability in the pharmacokinetics of prednisolone might explain why drug dose is a poor predictor of drug-related toxicity. The aim of the study was to investigate relationships between prednisolone exposure and adverse effects. METHODS Male kidney transplant recipients were recruited for serial blood sampling and assessment of glucocorticoid-related adverse effects including dyslipidaemia, abnormal body fat distribution, Cushingoid appearance and impaired quality of life. Total and free prednisolone plasma concentrations were determined using ultra-high-performance liquid chromatography with tandem mass spectrometric detection. Prednisolone exposure was estimated using a limited sampling strategy. RESULTS Fifty-six patients were recruited. Patients had a mean age of 54 years and median time post-transplantation of 75 months. Median prednisolone dose was 5 mg. Mean area under the plasma concentration-time curve was 2390 nmol h/L (±580) (SD) and 175 nmol h/L (±78) for total and free prednisolone, respectively. Waist to upper arm circumference ratio was positively associated with free prednisolone plasma exposure with a Spearman correlation coefficient of 0.30 (p value 0.02). The correlation coefficient was 0.24 (p value 0.08) for neck to upper arm circumference ratio and free prednisolone plasma exposure. The clinical Cushingoid phenotype as determined by the Visual Assessment of Cushing's Severity (VACS) score was associated with a reduced score relating to physical functioning on the SF-12, but there was no significant relationship between free prednisolone plasma exposure and quality-of-life scores. Lipid levels and haemoglobin A1c (HbA1c) were not associated with total or free prednisolone exposure. CONCLUSIONS There is a positive correlation between free prednisolone plasma exposure and waist to upper arm circumference ratio in adult male kidney transplant recipients on low maintenance prednisolone doses. There is no significant association between total or free prednisolone plasma exposure and plasma glucose and lipid levels in the low prednisolone dose range.
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Affiliation(s)
- Troels K Bergmann
- School of Pharmacy, University of Queensland, Brisbane, Australia. .,Department of Clinical Chemistry and Pharmacology, Odense University Hospital, J.B. Winsloews Vej 19, 5000, Odense C, Denmark.
| | - Nicole M Isbel
- Department of Nephrology, University of Queensland at the Princess Alexandra Hospital, Brisbane, Australia
| | - Remo Ostini
- Rural Clinical School Research Centre, University of Queensland, Toowoomba, Australia
| | | | - Scott B Campbell
- Department of Nephrology, University of Queensland at the Princess Alexandra Hospital, Brisbane, Australia
| | - Brett C McWhinney
- Department of Chemical Pathology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Warrick J Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
| | - Anthony Russell
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
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Maitland D, Campbell SB, Chen J, Hoare T. Controlling the resolution and duration of pulsatile release from injectable magnetic ‘plum-pudding’ nanocomposite hydrogels. RSC Adv 2016. [DOI: 10.1039/c6ra01665k] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Injectable hydrogel nanocomposites with entrapped SPIONs, thermosensitive microgels, and model drugs generate heat when an alternating magnetic field is applied, causing the microgels to deswell and create pore space to promote enhanced drug release.
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Affiliation(s)
- Danielle Maitland
- Department of Chemical Engineering
- McMaster University
- Hamilton
- Canada L8S 4L7
| | - Scott B. Campbell
- Department of Chemical Engineering
- McMaster University
- Hamilton
- Canada L8S 4L7
| | - Jenny Chen
- Department of Chemical Engineering
- McMaster University
- Hamilton
- Canada L8S 4L7
| | - Todd Hoare
- Department of Chemical Engineering
- McMaster University
- Hamilton
- Canada L8S 4L7
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Fahim MA, Hayen AD, Horvath AR, Dimeski G, Coburn A, Tan KS, Johnson DW, Craig JC, Campbell SB, Hawley CM. Biological variation of high sensitivity cardiac troponin-T in stable dialysis patients: implications for clinical practice. Clin Chem Lab Med 2015; 54:e149-50. [PMID: 26562041 DOI: 10.1515/cclm-2015-0998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 11/15/2022]
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Mallett A, Tang W, Hart G, McDonald SP, Hawley CM, Badve SV, Boudville N, Brown FG, Campbell SB, Clayton PA, Johnson DW. End-Stage Kidney Disease Due to Fibrillary Glomerulonephritis and Immunotactoid Glomerulopathy - Outcomes in 66 Consecutive ANZDATA Registry Cases. Am J Nephrol 2015; 42:177-84. [PMID: 26418732 DOI: 10.1159/000440815] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 08/27/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fibrillary glomerulonephritis (FGN) and immunotactoid glomerulopathy (IG) are uncommon and characterised by non-amyloid fibrillary glomerular deposits. The aim of this study was to investigate characteristics and outcomes of patients undergoing renal replacement therapy (RRT) for end-stage kidney disease (ESKD) secondary to FGN and IG. METHODS All ESKD patients who commenced RRT in Australia and New Zealand 1 January 1990 to 31 December 2010 were included. Outcomes were assessed by Kaplan-Meier, multivariate logistic-regression analysis and multivariable Cox proportional-hazards survival analysis. RESULTS Of 45,216 individuals with ESKD, 55 (0.12%) had FGN and 11 (0.02%) had IG. The median survival of FGN patients on dialysis (5.63 years, 95% CI 3.31-7.96) was not significantly different from patients with other ESKD causes (median 4.01 years, 95% CI 4.34-4.47; log-rank 1.32, p = 0.25), but was significantly longer than that of IG patients (median 2.93 years, 95% CI 0.00-6.17; log-rank 4.8, p = 0.03). Thirteen (24%) FGN patients received 13 renal-allografts, 4 (36%) IG patients received 4 renal-allografts and 11,528 (26%) other ESKD patients received 12,278 renal-allografts. FGN patients experienced comparable outcomes to other ESKD patients for both 10-year patient survival (100 vs. 84%, p = 0.93) and renal-allograft survival (67 vs. 76%, p = 0.06). For IG, the median follow-up was 3.66 years with 75% patient survival and 100% renal-allograft survival. One (8%) FGN patient and 1 (25%) IG patient experienced recurrent FGN and IG respectively in their allograft. CONCLUSION Patients with FGN have comparable dialysis and renal transplant outcomes to patients with other causes of ESKD. IG patients have inferior survival on dialysis, although renal transplant outcomes are acceptable. Disease recurrence in renal-allografts was low for both FGN and IG.
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Affiliation(s)
- Andrew Mallett
- Division of Nephrology, Peking University Third Hospital, Beijing, China
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Taylor E, Jones M, Hourigan MJ, Johnson DW, Gill DS, Isbel N, Hawley CM, Marlton P, Gandhi MK, Campbell SB, Mollee P. Cessation of immunosuppression during chemotherapy for post-transplant lymphoproliferative disorders in renal transplant patients. Nephrol Dial Transplant 2015; 30:1774-9. [PMID: 26188340 DOI: 10.1093/ndt/gfv260] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 05/15/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The optimal reduction of immunosuppressive therapy (IST) in renal transplant patients with post-transplant lymphoproliferative disorders (PTLDs) is uncertain. As chemotherapy is immunosuppressive, IST may be stopped during this time without compromising graft function. Subsequent long-term reduction of IST reduces relapse risk, but may increase risk of graft rejection. METHODS We performed a retrospective, matched cohort study of adult renal transplant patients in whom IST was ceased during chemotherapy and resumed at lower dose (calcineurin inhibitor at 50%, prednisolone ≤10 mg daily, no third agent) approximately 6 weeks after chemotherapy. Outcomes were compared with those of renal transplant patients without PTLD, matched for creatinine at equivalent time post-transplant that PTLD was diagnosed in cases, as well as for age, gender and year of transplant. RESULTS Twenty-four cases of PTLD occurring at a median of 9.2 years post-transplant were compared with 83 matched controls. PTLD cases were followed for a median of 11.9 years. Using competing risks analysis, time to 25% increase in serum creatinine was not significantly different between the two groups [adjusted hazard ratio (HR) 1.8, 95% confidence interval (CI) 0.89-3.6]. Similar results were obtained using multivariable Cox regression analysis (HR 1.19, 95% CI 0.44-3.23). Only one PTLD case experienced a ≥25% increase in creatinine <6 months after IST cessation in the setting of progressive PTLD and death. Three cases recommenced dialysis, compared with three controls (HR 2.5, 95% CI 0.47-13.00). Five-year patient survival rates for cases and controls were 70 and 94%, respectively (P = 0.01). CONCLUSIONS IST can be safely ceased during chemotherapy for PTLD in renal transplant patients. Furthermore, long-term reduction in IST is not associated with a significant difference in renal function deterioration. Prospective trials are needed to address the optimal reduction of IST in PTLDs.
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Affiliation(s)
- Emma Taylor
- Department of Haematology, Pathology Queensland and Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Mark Jones
- School of Population Health, University of Queensland, Brisbane, Australia
| | - Matthew J Hourigan
- Department of Haematology, Pathology Queensland and Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
| | - David W Johnson
- Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia School of Medicine, University of Queensland, Brisbane, Australia Translational Research Institute, University of Queensland, Brisbane, Australia
| | - Devinder S Gill
- Department of Haematology, Pathology Queensland and Cancer Services, Princess Alexandra Hospital, Brisbane, Australia School of Medicine, University of Queensland, Brisbane, Australia
| | - Nicole Isbel
- Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia School of Medicine, University of Queensland, Brisbane, Australia
| | - Carmel M Hawley
- Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia School of Medicine, University of Queensland, Brisbane, Australia
| | - Paula Marlton
- Department of Haematology, Pathology Queensland and Cancer Services, Princess Alexandra Hospital, Brisbane, Australia School of Medicine, University of Queensland, Brisbane, Australia
| | - Maher K Gandhi
- Department of Haematology, Pathology Queensland and Cancer Services, Princess Alexandra Hospital, Brisbane, Australia Diamantina Institute, University of Queensland, Brisbane, Australia
| | - Scott B Campbell
- Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia School of Medicine, University of Queensland, Brisbane, Australia
| | - Peter Mollee
- Department of Haematology, Pathology Queensland and Cancer Services, Princess Alexandra Hospital, Brisbane, Australia School of Medicine, University of Queensland, Brisbane, Australia
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Burke MT, Morais C, Oliver KA, Lambie DLJ, Gobe GC, Carroll RP, Staatz CE, Sinnya S, Soyer HP, Winterford C, Haass NK, Campbell SB, Isbel NM. Expression of Bcl-xL and Mcl-1 in the nonmelanoma skin cancers of renal transplant recipients. Am J Clin Pathol 2015; 143:514-26. [PMID: 25780003 DOI: 10.1309/ajcpqnb5wa3plqbk] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES This study aims to investigate how immunosuppression influences the protein expression of antiapoptotic members of the Bcl-2 family-namely, Bcl-xL and Mcl-1-in nonmelanoma skin cancer (NMSC) and the peritumoral epidermis of renal transplant recipients. METHODS NMSC and peritumoral epidermis protein expression of Bcl-xL and Mcl-1 were assessed by immunohistochemistry in renal transplant recipients receiving tacrolimus or sirolimus and the general population not receiving immunosuppression. RESULTS NMSC from renal transplant recipients compared with patients not receiving immunosuppressant medications had a reduced Bcl-xL expression intensity (P = .042). Mcl-1 expression intensity in NMSC was decreased in tacrolimus-treated patients compared with sirolimus-treated patients and the nonimmunosuppressed population (P = .024). Bcl-xL expression intensity was increased in peritumoral epidermis compared with NMSC (P = .002). CONCLUSIONS It was shown for the first time that Bcl-xL and Mcl-1 expression are widespread in the peritumoral epidermis and NMSC of renal transplant recipients. Importantly in NMSC, Bcl-xL expression was reduced with immunosuppression exposure, and Mcl-1 expression was reduced in tacrolimus-treated compared with sirolimus-treated patients.
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Affiliation(s)
- Michael T. Burke
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Christudas Morais
- Centre for Kidney Disease Research, School of Medicine, University of Queensland, Translational Research Institute, Brisbane, Australia
| | - Kimberley A. Oliver
- Department of Pathology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Duncan L. J. Lambie
- IQ Pathology, Brisbane, Australia
- The University of Queensland, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia
| | - Glenda C. Gobe
- Centre for Kidney Disease Research, School of Medicine, University of Queensland, Translational Research Institute, Brisbane, Australia
| | - Robert P. Carroll
- Central Northern Adelaide Renal and Transplantation Services, Adelaide, Australia
- Department of Medicine, The University of Adelaide, Adelaide, Australia
| | | | - Sudipta Sinnya
- Dermatology Research Centre, The University of Queensland, School of Medicine, Translational Research Institute, Brisbane, Australia
| | - H. Peter Soyer
- Dermatology Research Centre, The University of Queensland, School of Medicine, Translational Research Institute, Brisbane, Australia
| | - Clay Winterford
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Nikolas K. Haass
- The University of Queensland, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia
| | - Scott B. Campbell
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Nicole M. Isbel
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
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Fahim MA, Hayen A, Horvath AR, Dimeski G, Coburn A, Johnson DW, Hawley CM, Campbell SB, Craig JC. N-terminal pro-B-type natriuretic peptide variability in stable dialysis patients. Clin J Am Soc Nephrol 2015; 10:620-9. [PMID: 25714960 DOI: 10.2215/cjn.09060914] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 01/07/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Monitoring N-terminal pro-B-type natriuretic peptide (NT-proBNP) may be useful for assessing cardiovascular risk in dialysis patients. However, its biologic variation is unknown, hindering the accurate interpretation of serial concentrations. The aims of this prospective cohort study were to estimate the within- and between-person coefficients of variation of NT-proBNP in stable dialysis patients, and derive the critical difference between measurements needed to exclude biologic and analytic variation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Fifty-five prevalent hemodialysis and peritoneal dialysis patients attending two hospitals were assessed weekly for 5 weeks and then monthly for 4 months between October 2010 and April 2012. Assessments were conducted at the same time in the dialysis cycle and entailed NT-proBNP testing, clinical review, electrocardiography, and bioimpedance spectroscopy. Patients were excluded if they became unstable. RESULTS This study analyzed 136 weekly and 113 monthly NT-proBNP measurements from 40 and 41 stable patients, respectively. Results showed that 22% had ischemic heart disease; 9% and 87% had left ventricular systolic and diastolic dysfunction, respectively. Respective between- and within-person coefficients of variation were 153% and 27% for weekly measurements, and 148% and 35% for monthly measurements. Within-person variation was unaffected by dialysis modality, hydration status, inflammation, or cardiac comorbidity. NT-proBNP concentrations measured at weekly intervals needed to increase by at least 46% or decrease by 84% to exclude change due to biologic and analytic variation alone with 90% certainty, whereas monthly measurements needed to increase by at least 119% or decrease by 54%. CONCLUSIONS The between-person variation of NT-proBNP was large and markedly greater than within-person variation, indicating that NT-proBNP testing might better be applied in the dialysis population using a relative-change strategy. Serial NT-proBNP concentrations need to double or halve to confidently exclude change due to analytic and biologic variation alone.
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Affiliation(s)
- Magid A Fahim
- Departments of Nephrology and School of Medicine and Translational Research Institute, University of Queensland, Brisbane, Queensland, Australia;
| | - Andrew Hayen
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Andrea R Horvath
- School of Public Health, University of Sydney, Sydney, Australia; Department of Clinical Chemistry, Prince of Wales Hospital, South Eastern Area Laboratory Services, Sydney, Australia; and School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Goce Dimeski
- School of Medicine and Chemical Pathology, Pathology Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | - David W Johnson
- Departments of Nephrology and School of Medicine and Translational Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Carmel M Hawley
- Departments of Nephrology and School of Medicine and Translational Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | | | - Jonathan C Craig
- School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
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Fahim MA, Hayen AD, Horvath AR, Dimeski G, Coburn A, Tan KS, Johnson DW, Craig JC, Campbell SB, Hawley CM. Biological variation of high sensitivity cardiac troponin-T in stable dialysis patients: implications for clinical practice. ACTA ACUST UNITED AC 2015; 53:715-22. [DOI: 10.1515/cclm-2014-0838] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 11/13/2014] [Indexed: 11/15/2022]
Abstract
AbstractChanges in high sensitivity cardiac troponin-T (hs-cTnT) concentrations may reflect either acute myocardial injury or biological variation. Distinguishing between these entities is essential to accurate diagnosis, however, the biological variation of hs-cTnT in dialysis population is currently unknown. We sought to estimate the within- and between-person coefficients of variation of hs-cTnT in stable dialysis patients, and derive the critical difference between measurements needed to exclude biological variation with 99% confidence.Fifty-five prevalent haemo- and peritoneal-dialysis patients attending two metropolitan hospitals were assessed on 10 consecutive occasions; weekly for 5 weeks then monthly for 4 months. Assessments were conducted at the same dialysis cycle time-point and entailed hs-cTnT testing, clinical review, electrocardiography, and bioimpedance spectroscopy. Patients were excluded if they developed clinical or physiological instability.In total 137 weekly and 114 monthly hs-cTnT measurements from 42 stable patients were analysed. Respective between- and within-person coefficients of variation were 83% and 7.9% for weekly measurements, and 79% and 12.6% for monthly measurements. Within-person variation was unaffected by dialysis modality or cardiac co-morbidity. The bidirectional 99% reference change value was –25% and +33% for weekly measurements, and –37% and +58% for monthly measurements.The between-person variation of hs-cTnT in the dialysis population is markedly greater than within-person variation indicating that hs-cTnT testing is best applied in this population using a relative change strategy. An increase of 33% or a reduction of 25% in serial hs-cTnT concentrations measured at weekly intervals excludes change due to analytical and biological variation alone with 99% confidence.
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Bergmann TK, Isbel NM, Barraclough KA, Campbell SB, McWhinney BC, Staatz CE. Comparison of the influence of cyclosporine and tacrolimus on the pharmacokinetics of prednisolone in adult male kidney transplant recipients. Clin Drug Investig 2014; 34:183-8. [PMID: 24385281 DOI: 10.1007/s40261-013-0162-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Cyclosporine has been observed to precipitate cushingoid features in kidney transplant recipients already on prednisolone. Some pharmacokinetic studies have demonstrated increased prednisolone exposure in patients on cyclosporine therapy compared with azathioprine, whereas other studies have found no difference. The objective of this study was to determine whether cyclosporine impacts on prednisolone exposure as compared with tacrolimus. METHODS Adult male kidney transplant recipients treated with prednisolone and either cyclosporine or tacrolimus were recruited for pharmacokinetic blood sampling at the outpatient clinic at the Princess Alexandra Hospital, Brisbane, Australia. Prednisolone plasma concentrations were determined using ultra-high-performance liquid chromatography. Dose-adjusted area under the plasma concentration-time curve (AUC) of free and total prednisolone was estimated using a previously developed limited sampling strategy and non-compartmental analysis. RESULTS A total of 55 patients were eligible for analysis; 38 % received cyclosporine and 62 % received tacrolimus co-therapy. No significant difference in mean dose-adjusted total prednisolone AUC from 0 to 6 h post-dose or mean dose-adjusted free prednisolone AUC from 0 to 12 h was observed between the cyclosporine and tacrolimus groups (449 versus 428 nmol·h/L/mg, p = 0.43, and 32 versus 30 nmol·h/L/mg, p = 0.51, respectively). CONCLUSION Cyclosporine does not change the dose-adjusted exposure of prednisolone compared with tacrolimus. Adult kidney transplant recipients can therefore continue on their usual prednisolone dose when changing therapy between cyclosporine and tacrolimus.
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Campbell SB, Patenaude M, Hoare T. Injectable Superparamagnets: Highly Elastic and Degradable Poly(N-isopropylacrylamide)–Superparamagnetic Iron Oxide Nanoparticle (SPION) Composite Hydrogels. Biomacromolecules 2013; 14:644-53. [PMID: 23410094 DOI: 10.1021/bm301703x] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Scott B. Campbell
- Department of Chemical Engineering, McMaster University, 1280 Main Street West, Hamilton, Ontario,
Canada L8S 4L7
| | - Mathew Patenaude
- Department of Chemical Engineering, McMaster University, 1280 Main Street West, Hamilton, Ontario,
Canada L8S 4L7
| | - Todd Hoare
- Department of Chemical Engineering, McMaster University, 1280 Main Street West, Hamilton, Ontario,
Canada L8S 4L7
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Tang W, Bose B, McDonald SP, Hawley CM, Badve SV, Boudville N, Brown FG, Clayton PA, Campbell SB, Peh CA, Johnson DW. The outcomes of patients with ESRD and ANCA-associated vasculitis in Australia and New Zealand. Clin J Am Soc Nephrol 2013; 8:773-80. [PMID: 23349331 DOI: 10.2215/cjn.08770812] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES This study aimed to evaluate dialysis and transplant outcomes of patients with ESRD secondary to ANCA-associated vasculitis (AAV). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS All ESRD patients who commenced renal replacement therapy in Australia and New Zealand between 1996 and 2010 were included. Outcomes were assessed by Kaplan-Meier, multivariable Cox regression, and competing-risks regression survival analyses. RESULTS Of 36,884 ESRD patients, 228 had microscopic polyangiitis (MPA) and 221 had granulomatosis with polyangiitis (GPA). Using competing-risks regression, compared with other causes of ESRD, MPA patients (hazard ratio [HR], 0.89; 95% confidence interval [95% CI], 0.73-1.08; P=0.24) and GPA patients (HR, 0.94; 95% CI, 0.74-1.19; P=0.62) experienced comparable survival on dialysis. Forty-six MPA patients (21%) and 47 GPA (20%) patients received 98 renal allografts. Respective 10-year first graft survival rates in MPA, GPA, and non-AAV patients were 50%, 62%, 70%, whereas patient survival rates were 68%, 85% and 83%, respectively. Compared with non-AAV patients, MPA transplant recipients had higher risks of graft failure (HR, 1.87; 95% CI, 1.07-3.25; P=0.03) and death (HR, 1.94; 95% CI, 1.02-3.69; P=0.04), whereas GPA transplant recipients experienced comparable renal allograft survival (HR, 0.91; 95% CI, 0.43-1.93; P=0.81) and patient survival (HR, 0.58; 95% CI, 0.23-2.27; P=0.58). AAV recurrence was observed in two renal allografts (2%). CONCLUSIONS Compared with ESRD patients without AAV, those with GPA have comparable renal replacement therapy outcomes, whereas MPA patients have comparable dialysis survival but poorer renal transplant allograft and patient survival rates.
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Affiliation(s)
- Wen Tang
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia
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