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Sever MS, Mueller TF, Oniscu GC, Schena P, Vanholder R. Facts and myths about altruistic organ donation. Nephrol Dial Transplant 2024:gfae039. [PMID: 38366137 DOI: 10.1093/ndt/gfae039] [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: 02/18/2024] Open
Affiliation(s)
| | - Thomas F Mueller
- Swisstransplant, Bern, Switzerland; Co-Chair of the Declaration of Istanbul Custodian Group
| | - Gabriel C Oniscu
- Transplant Division, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Schena
- Regional Centre of Organ Transplantation, University of Bari, Policlinico, Bari, Italy
| | - Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium; Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
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Sever MS, Luyckx V, Tonelli M, Kazancioglu R, Rodgers D, Gallego D, Tuglular S, Vanholder R. Disasters and kidney care: pitfalls and solutions. Nat Rev Nephrol 2023; 19:672-686. [PMID: 37479903 DOI: 10.1038/s41581-023-00743-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 07/23/2023]
Abstract
Patients with kidney disease, especially those with kidney failure, are particularly susceptible to the adverse effects of disasters because their survival depends on functional infrastructure, advanced technology, the availability of specific drugs and well-trained medical personnel. The risk of poor outcomes across the entire spectrum of patients with kidney diseases (acute kidney injury, chronic kidney disease and kidney failure on dialysis or with a functioning transplant) increases as a result of disaster-related logistical challenges. Patients who are displaced face even more complex problems owing to additional threats that arise during travel and after reaching their new location. Overall, risks may be mitigated by pre-disaster preparedness and training. Emergency kidney disaster responses depend on the type and severity of the disaster and include medical and/or surgical treatment of injuries, treatment of mental health conditions, appropriate diet and logistical interventions. After a disaster, patients should be evaluated for problems that were not detected during the event, including those that may have developed as a result of the disaster. A retrospective review of the disaster response is vital to prevent future mistakes. Important ethical concerns include fair distribution of limited resources and limiting harm. Patients with kidney disease, their care-givers, health-care providers and authorities should be trained to respond to the medical and logistical problems that occur during disasters to improve outcomes.
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Affiliation(s)
- Mehmet Sukru Sever
- Istanbul University, Istanbul School of Medicine, Department of Nephrology, Istanbul, Turkey.
| | - Valerie Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Renal Division, Brigham and Women's Hospital, Harvard, Medical School, Boston, MA, USA
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Rumeyza Kazancioglu
- Division of Nephrology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Darlene Rodgers
- Independent Nurse Consultant, American Society of Nephrology, Washington, DC, USA
| | - Dani Gallego
- European Kidney Health Alliance, Brussels, Belgium
- European Kidney Patient Federation, Wien, Austria
| | - Serhan Tuglular
- Marmara University, School of Medicine, Department of Nephrology, Istanbul, Turkey
| | - Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium
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Hruba P, Klema J, Le AV, Girmanova E, Mrazova P, Massart A, Maixnerova D, Voska L, Piredda GB, Biancone L, Puga AR, Seyahi N, Sever MS, Weekers L, Muhfeld A, Budde K, Watschinger B, Miglinas M, Zahradka I, Abramowicz M, Abramowicz D, Viklicky O. Novel transcriptomic signatures associated with premature kidney allograft failure. EBioMedicine 2023; 96:104782. [PMID: 37660534 PMCID: PMC10480056 DOI: 10.1016/j.ebiom.2023.104782] [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: 04/25/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND The power to predict kidney allograft outcomes based on non-invasive assays is limited. Assessment of operational tolerance (OT) patients allows us to identify transcriptomic signatures of true non-responders for construction of predictive models. METHODS In this observational retrospective study, RNA sequencing of peripheral blood was used in a derivation cohort to identify a protective set of transcripts by comparing 15 OT patients (40% females), from the TOMOGRAM Study (NCT05124444), 14 chronic active antibody-mediated rejection (CABMR) and 23 stable graft function patients ≥15 years (STA). The selected differentially expressed transcripts between OT and CABMR were used in a validation cohort (n = 396) to predict 3-year kidney allograft loss at 3 time-points using RT-qPCR. FINDINGS Archetypal analysis and classifier performance of RNA sequencing data showed that OT is clearly distinguishable from CABMR, but similar to STA. Based on significant transcripts from the validation cohort in univariable analysis, 2 multivariable Cox models were created. A 3-transcript (ADGRG3, ATG2A, and GNLY) model from POD 7 predicted graft loss with C-statistics (C) 0.727 (95% CI, 0.638-0.820). Another 3-transcript (IGHM, CD5, GNLY) model from M3 predicted graft loss with C 0.786 (95% CI, 0.785-0.865). Combining 3-transcripts models with eGFR at POD 7 and M3 improved C-statistics to 0.860 (95% CI, 0.778-0.944) and 0.868 (95% CI, 0.790-0.944), respectively. INTERPRETATION Identification of transcripts distinguishing OT from CABMR allowed us to construct models predicting premature graft loss. Identified transcripts reflect mechanisms of injury/repair and alloimmune response when assessed at day 7 or with a loss of protective phenotype when assessed at month 3. FUNDING Supported by the Ministry of Health of the Czech Republic under grant NV19-06-00031.
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Affiliation(s)
- Petra Hruba
- Transplant Laboratory, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jiri Klema
- Department of Computer Science, Czech Technical University, Prague, Czech Republic
| | - Anh Vu Le
- Department of Computer Science, Czech Technical University, Prague, Czech Republic
| | - Eva Girmanova
- Transplant Laboratory, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petra Mrazova
- Transplant Laboratory, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Annick Massart
- Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Dita Maixnerova
- Department of Nephrology, 1st Faculty of Medicine and General Faculty Hospital, Prague, Czech Republic
| | - Ludek Voska
- Department of Clinical and Transplant Pathology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Gian Benedetto Piredda
- Department of Kidney Disease Medicine of Renal Transplantation, G.Brotzu Hospital Cagliari, Italy
| | - Luigi Biancone
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - Ana Ramirez Puga
- Hospital Universitario Insular de Gran Canaria, Servicio de nefrología, Spain
| | - Nurhan Seyahi
- Istanbul University, Cerrahpasa Medical Faculty, Nephrology, Istanbul, Turkey
| | - Mehmet Sukru Sever
- Istanbul University, Istanbul School of Medicine, Internal Medicine, Nephrology, Istanbul, Turkey
| | | | - Anja Muhfeld
- Department of Nephrology, Uniklinik RWTH Aachen, Aachen, Germany
| | - Klemens Budde
- Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Berlin, Germany
| | - Bruno Watschinger
- Department of Internal Medicine III, Nephrology, Medical University Vienna / AKH Wien, Vienna, Austria
| | - Marius Miglinas
- Faculty of Medicine, Nephrology Center, Vilnius University Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania
| | - Ivan Zahradka
- Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Marc Abramowicz
- Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Rue Michel Servet 1, 1206 Geneva, Switzerland
| | - Daniel Abramowicz
- Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Ondrej Viklicky
- Transplant Laboratory, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
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Massart A, Danger R, Olsen C, Emond MJ, Viklicky O, Jacquemin V, Soblet J, Duerinckx S, Croes D, Perazzolo C, Hruba P, Daneels D, Caljon B, Sever MS, Pascual J, Miglinas M, Pirson I, Ghisdal L, Smits G, Giral M, Abramowicz D, Abramowicz M, Brouard S. An exome-wide study of renal operational tolerance. Front Med (Lausanne) 2023; 9:976248. [PMID: 37265662 PMCID: PMC10230038 DOI: 10.3389/fmed.2022.976248] [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: 06/23/2022] [Accepted: 10/31/2022] [Indexed: 06/03/2023] Open
Abstract
Background Renal operational tolerance is a rare and beneficial state of prolonged renal allograft function in the absence of immunosuppression. The underlying mechanisms are unknown. We hypothesized that tolerance might be driven by inherited protein coding genetic variants with large effect, at least in some patients. Methods We set up a European survey of over 218,000 renal transplant recipients and collected DNAs from 40 transplant recipients who maintained good allograft function without immunosuppression for at least 1 year. We performed an exome-wide association study comparing the distribution of moderate to high impact variants in 36 tolerant patients, selected for genetic homogeneity using principal component analysis, and 192 controls, using an optimal sequence-kernel association test adjusted for small samples. Results We identified rare variants of HOMER2 (3/36, FDR 0.0387), IQCH (5/36, FDR 0.0362), and LCN2 (3/36, FDR 0.102) in 10 tolerant patients vs. 0 controls. One patient carried a variant in both HOMER2 and LCN2. Furthermore, the three genes showed an identical variant in two patients each. The three genes are expressed at the primary cilium, a key structure in immune responses. Conclusion Rare protein coding variants are associated with operational tolerance in a sizable portion of patients. Our findings have important implications for a better understanding of immune tolerance in transplantation and other fields of medicine.ClinicalTrials.gov, identifier: NCT05124444.
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Affiliation(s)
- Annick Massart
- Human Genetics Unit, Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (IRIBHM), Université Libre de Bruxelles (ULB), Brussels, Belgium
- Interuniversity Institute of Bioinformatics in Brussels (IB2), Université Libre de Bruxelles - Vrije Universiteit Brussel (ULB-VUB), Brussels, Belgium
- Department of Nephrology, Antwerp University Hospital and Laboratory of Experimental Medicine, University of Antwerp, Antwerp, Belgium
| | - Richard Danger
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, CR2TI, UMR 1064, ITUN, Nantes, France
| | - Catharina Olsen
- Interuniversity Institute of Bioinformatics in Brussels (IB2), Université Libre de Bruxelles - Vrije Universiteit Brussel (ULB-VUB), Brussels, Belgium
- Brussels Interuniversity Genomics High Throughput Core (BRIGHTcore), VUB-ULB, Brussels, Belgium
- Center for Medical Genetics, Reproduction and Genetics, Reproduction Genetics and Regenerative Medicine, Vrije Universiteit Brussel, UZ Brussel, Brussels, Belgium
| | - Mary J. Emond
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Ondrej Viklicky
- Transplant Laboratory, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Valérie Jacquemin
- Human Genetics Unit, Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (IRIBHM), Université Libre de Bruxelles (ULB), Brussels, Belgium
- Interuniversity Institute of Bioinformatics in Brussels (IB2), Université Libre de Bruxelles - Vrije Universiteit Brussel (ULB-VUB), Brussels, Belgium
| | - Julie Soblet
- Interuniversity Institute of Bioinformatics in Brussels (IB2), Université Libre de Bruxelles - Vrije Universiteit Brussel (ULB-VUB), Brussels, Belgium
- Department of Genetics, Hôpital Erasme, ULB Center of Human Genetics, Université Libre de Bruxelles, Brussels, Belgium
- Department of Genetics, Hôpital Universitaire des Enfants Reine Fabiola, ULB Center of Human Genetics, Université Libre de Bruxelles, Brussels, Belgium
| | - Sarah Duerinckx
- Human Genetics Unit, Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (IRIBHM), Université Libre de Bruxelles (ULB), Brussels, Belgium
- Interuniversity Institute of Bioinformatics in Brussels (IB2), Université Libre de Bruxelles - Vrije Universiteit Brussel (ULB-VUB), Brussels, Belgium
| | - Didier Croes
- Interuniversity Institute of Bioinformatics in Brussels (IB2), Université Libre de Bruxelles - Vrije Universiteit Brussel (ULB-VUB), Brussels, Belgium
- Brussels Interuniversity Genomics High Throughput Core (BRIGHTcore), VUB-ULB, Brussels, Belgium
- Center for Medical Genetics, Reproduction and Genetics, Reproduction Genetics and Regenerative Medicine, Vrije Universiteit Brussel, UZ Brussel, Brussels, Belgium
- Center for Human Genetics, Clinique Universitaires Saint Luc, Brussels, Belgium
| | - Camille Perazzolo
- Human Genetics Unit, Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (IRIBHM), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Petra Hruba
- Transplant Laboratory, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Dorien Daneels
- Interuniversity Institute of Bioinformatics in Brussels (IB2), Université Libre de Bruxelles - Vrije Universiteit Brussel (ULB-VUB), Brussels, Belgium
- Brussels Interuniversity Genomics High Throughput Core (BRIGHTcore), VUB-ULB, Brussels, Belgium
- Center for Medical Genetics, Reproduction and Genetics, Reproduction Genetics and Regenerative Medicine, Vrije Universiteit Brussel, UZ Brussel, Brussels, Belgium
| | - Ben Caljon
- Brussels Interuniversity Genomics High Throughput Core (BRIGHTcore), VUB-ULB, Brussels, Belgium
- Center for Medical Genetics, Reproduction and Genetics, Reproduction Genetics and Regenerative Medicine, Vrije Universiteit Brussel, UZ Brussel, Brussels, Belgium
| | - Mehmet Sukru Sever
- Istanbul Tip Fakültesi, Istanbul School of Medicine, Internal Medicine, Nephrology, Istanbul, Türkiye
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Institute Mar for Medical Research, Barcelona, Spain
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Marius Miglinas
- Nephrology Center, Santaros Klinikos, Medical Faculty, Vilnius University, Vilnius, Lithuania
| | | | - Isabelle Pirson
- Human Genetics Unit, Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (IRIBHM), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Lidia Ghisdal
- Department of Nephrology, Hospital Centre EpiCURA, Baudour, Belgium
| | - Guillaume Smits
- Interuniversity Institute of Bioinformatics in Brussels (IB2), Université Libre de Bruxelles - Vrije Universiteit Brussel (ULB-VUB), Brussels, Belgium
- Department of Genetics, Hôpital Erasme, ULB Center of Human Genetics, Université Libre de Bruxelles, Brussels, Belgium
| | - Magali Giral
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, CR2TI, UMR 1064, ITUN, Nantes, France
- CHU Nantes, Centre d'Investigation Clinique en Biothérapie, Centre de Ressources Biologiques (CRB), Nantes, France
- LabEx IGO “Immunotherapy, Graft, Oncology”, Nantes, France
| | - Daniel Abramowicz
- Department of Nephrology, Antwerp University Hospital and Laboratory of Experimental Medicine, University of Antwerp, Antwerp, Belgium
| | - Marc Abramowicz
- Human Genetics Unit, Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (IRIBHM), Université Libre de Bruxelles (ULB), Brussels, Belgium
- Interuniversity Institute of Bioinformatics in Brussels (IB2), Université Libre de Bruxelles - Vrije Universiteit Brussel (ULB-VUB), Brussels, Belgium
- Department of Genetic Medicine and Development, Faculty of Medicine, Université de Geneve, Geneva, Switzerland
| | - Sophie Brouard
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, CR2TI, UMR 1064, ITUN, Nantes, France
- CHU Nantes, Centre d'Investigation Clinique en Biothérapie, Centre de Ressources Biologiques (CRB), Nantes, France
- LabEx IGO “Immunotherapy, Graft, Oncology”, Nantes, France
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Sever MS, Vanholder R, Oniscu G, Abramowicz D, Van Biesen W, Maggiore U, Watschinger B, Mariat C, Buturovic-Ponikvar J, Crespo M, Mjoen G, Heering P, Peruzzi L, Gandolfini I, Hellemans R, Hilbrands L. Kidney transplantation during mass disasters - from COVID-19 to other catastrophes A Consensus Statement by the DESCARTES Working Group and Ethics Committee of the ERA. Nephrol Dial Transplant 2023; 38:300–308. [PMID: 36066915 PMCID: PMC9923698 DOI: 10.1093/ndt/gfac251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/20/2022] [Indexed: 07/23/2023] Open
Abstract
Mass disasters are characterized by a disparity between health care demand and supply, which hampers complex therapies like kidney transplantation. Considering scarcity of publications on previous disasters, we reviewed transplantation practice during the recent COVID-19 pandemic, and dwelled upon this experience for guiding transplantation strategies in the future pandemic and non-pandemic catastrophes. We strongly suggest continuing transplantation programs during mass disasters, if medical and logistic operational circumstances are appropriate. Postponing transplantations from living donors and referral of urgent cases to safe regions or hospitals are justified. Specific preventative measures in anticipated disasters (such as vaccination programs during pandemics or evacuation in case of hurricanes or wars) may be useful to minimize risks. Immunosuppressive therapies should consider stratifying risk status and avoiding heavy immune suppression in patients with a low probability of therapeutic success. Discharging patients at the earliest convenience is justified during pandemics, whereas delaying discharge is reasonable in other disasters, if infrastructural damage results in unhygienic living environments for the patients. In the outpatient setting, telemedicine is a useful approach to reduce the patient load to hospitals, to minimize the risk of nosocomial transmission in pandemics and the need for transport in destructive disasters. If it comes down to save as many lives as possible, some ethical principles may vary in function of disaster circumstances, but elementary ethical rules are non-negotiable. Patient education is essential to minimize disaster-related complications and to allow for an efficient use of health care resources.
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Affiliation(s)
| | - Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium; Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | | | | | - Wim Van Biesen
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Umberto Maggiore
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Bruno Watschinger
- Medical University of Vienna, Department of Medicine III, Division of Nephrology and Dialysis, Vienna, Austria
| | - Christophe Mariat
- Service de Néphrologie, Dialyse et Transplantation rénale, Centre Hospitalier Universitaire de Saint Etienne, Hôpital NORD, Université de Lyon, Université Jean Monnet, Saint Etienne, France
| | | | - Marta Crespo
- Hospital del Mar, Department of Nephrology, Barcelona, Spain
| | - Geir Mjoen
- Section of Nephrology, Department of Transplant Medicine, Oslo University Hospital, Oslo, Norway
| | - Peter Heering
- Klinik für Nephrologie und Allgemeine Innere Medizin, Städtisches Klinikum Solingen, Solingen, Germany
| | | | | | - Rachel Hellemans
- Department of Nephrology and Hypertension, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Luuk Hilbrands
- Radboud university medical center, Department of Nephrology, Nijmegen, The Netherlands
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Grossi AA, Sever MS, Hellemans R, Mariat C, Crespo M, Watschinger B, Peruzzi L, Demir E, Velioglu A, Gandolfini I, Oniscu GC, Hilbrands L, Mjoen G. The 3-Step Model of informed consent for living kidney donation: a proposal on behalf of the DESCaRTES Working Group of the European Renal Association. Nephrol Dial Transplant 2023:7005240. [PMID: 36702535 DOI: 10.1093/ndt/gfad022] [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] [Indexed: 01/28/2023] Open
Abstract
Living donation challenges the ethical principle of non-maleficence in that it exposes healthy persons to risks for the benefit of someone else. This makes safety, informed consent (IC) and education a priority. Living kidney donation has multiple benefits for the potential donor, but there are also several known short- and long-term risks. Although complete standardization of IC is likely to be unattainable, studies have emphasized the need for a standardized IC process to enable equitable educational and decision-making prospects for the prevention of inequities across transplant centers. Based on the Three-Talk Model of shared decision making by Elwyn et al., we propose a model, named 3-Step (S) Model, where each step coincides with the three ideal timings of the process leading the living donor to the decision to pursue living donation: prior to the need for kidney replacement therapy (team talk); at the local nephrology unit or transplant center, with transplant clinicians and surgeons prior to evaluations start (option talk); and throughout evaluation, after having learned about the different aspects of donation, especially if there are second thoughts or doubts (decision talk). Based on the 3-S Model, to deliver conceptual and practical guidance to nephrologists and transplant clinicians, we provide recommendations for standardization of the timing, content, modalities for communicating risks, and assessment of understanding prior to donation. The 3-S Model successfully allows an integration between standardization and individualization of IC, enabling a person-centered approach to potential donors. Studies will assess the effectiveness of the 3-S Model in kidney transplant clinical practice.
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Affiliation(s)
- Alessandra Agnese Grossi
- Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy.,Department of Human Sciences, Innovation, and Territory, University of Insubria, Como, Italy
| | | | - Rachel Hellemans
- Department of Nephrology-Hypertension, University Hospital, Edegem, Belgium.,Faculty of Medicine & Health Sciences, Laboratory of Experimental Medicine and Paediatrics (LEMP), University of Antwerp,Wilrijk, Belgium
| | - Christophe Mariat
- Nephrology Dialysis and Renal Transplantation Dpt, Chu de Saint-Etienne, Université Jean Monnet, Saint-Etienne, France
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar Medical Research Institute (IMIM), Hospital del Mar, Barcelona, Spain. Partially supported by INT21/00003 (Spanish Ministry of Health ISCIII FIS-FEDER)
| | - Bruno Watschinger
- Medical University of Vienna, Department of Medicine III, Division of Nephrology and Dialysis, Vienna, Austria
| | - Licia Peruzzi
- Pediatric Nephrology Dialysis and Transplantation Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Erol Demir
- Transplant Immunology Research Centre of Excellence, Koç University Hospital, Istanbul, Turkey
| | - Arzu Velioglu
- Marmara University, School of Medicine, Department of Nephrology, Istanbul, Turkey
| | | | - Gabriel C Oniscu
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, United Kingdom
| | - Luuk Hilbrands
- Department of Nephrology, Radboud university medical center, Nijmegen, The Netherlands
| | - Geir Mjoen
- Department of Transplant Medicine, Oslo University Hospital, Oslo, Norway
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7
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Mirioglu S, Dirim AB, Bektas M, Demir E, Tor YB, Ozluk Y, Kilicaslan I, Oto OA, Yalcinkaya Y, Caliskan Y, Artim-Esen B, Yazici H, Inanc M, Turkmen A, Gul A, Sever MS. Efficacy and safety of interleukin-1 blockers in kidney transplant recipients with familial Mediterranean fever: a propensity score-matched cohort study. Nephrol Dial Transplant 2022; 38:1327-1336. [PMID: 36542475 DOI: 10.1093/ndt/gfac335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background
Data on use of IL-1 blockers in kidney transplant recipients (KTRs) with familial Mediterranean fever (FMF) are very limited. We aimed to evaluate the efficacy and safety of anakinra and canakinumab in the transplantation setting.
Methods
In this retrospective cohort study, we included KTRs suffered from AA amyloidosis caused by FMF and treated with anakinra or canakinumab (study group, n = 36). Using propensity score matching, we selected 36 patients without FMF or amyloidosis from our database of 696 KTRs as the control group. Primary outcomes were patient and graft survival. Biopsy-confirmed graft rejection, changes in eGFR, hsCRP, erythrocyte sedimentation rate (ESR), proteinuria, and number of monthly attacks were secondary outcomes.
Results
All KTRs with FMF began IL-1 blocker therapy with anakinra and nine (25%) were switched to canakinumab. Overall death was more frequent in study group (19.4% vs 0%) (p = 0.005); however, overall graft loss was comparable between study (27.8%) and control groups (36.1%) (p = 0.448). Five- and 10-year graft survival rates were significantly higher in study group (94.4% and 83.3%, respectively) than control group (77.8% and 63.9%, respectively) (p = 0.014 and p<0.001, respectively). Rejections were numerically lower in study group (8.3% vs 25%), but it did not reach to statistical significance (p = 0.058). When compared to pre-treatment period, with IL-1 blockers, number of attacks per month (p<0.001), eGFR (p = 0.004), hsCRP (p<0.001) and ESR (p = 0.026) levels were lower throughout the follow-up; whereas proteinuria levels were not.
Conclusions
Anakinra and canakinumab are effective in KTRs suffering from FMF; however, mortality rate may be of concern.
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Affiliation(s)
- Safak Mirioglu
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
- Division of Nephrology, Department of Internal Medicine, Bezmialem Vakif University School of Medicine , Istanbul , Turkey
| | - Ahmet Burak Dirim
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Murat Bektas
- Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Erol Demir
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Yavuz Burak Tor
- Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Isin Kilicaslan
- Department of Pathology, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Ozgur Akin Oto
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Yasemin Yalcinkaya
- Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Yasar Caliskan
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
- Center for Abdominal Transplantation, Saint Louis University School of Medicine , Saint Louis , MO, USA
| | - Bahar Artim-Esen
- Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Halil Yazici
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Murat Inanc
- Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Aydin Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Ahmet Gul
- Division of Rheumatology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Mehmet Sukru Sever
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine , Istanbul , Turkey
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8
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Noordzij M, Meijers B, Gansevoort RT, Covic A, Duivenvoorden R, Hilbrands LB, Hemmelder MH, Jager KJ, Mjoen G, Nistor I, Parshina E, Pessolano G, Tuglular S, Vart P, Zanoli L, Franssen CFM, van der Net JB, Essig M, du Buf-Vereijken PWG, van Ginneken B, Maas N, van Jaarsveld BC, Bemelman FJ, Klingenberg-Salahova F, Vervloet MG, Nurmohamed A, Vogt L, Abramowicz D, Verhofstede S, Maoujoud O, Malfait T, Fialova J, Lips J, Hengst M, Konings C, Rydzewski A, Oliveira J, Zakharova EV, Lepeytre F, Rabaté C, Rostoker G, Marques S, Azasevac T, Majstorovic GS, Fricke L, Slebe JJP, ElHafeez SA, El-Wakil HS, Verhoeven M, Logan I, Panagoutsos S, Mallamaci F, Postorino A, Cambareri F, Matceac I, Groeneveld JHM, Jousma J, van Buren M, Pereira TA, Arias-Cabrales C, Crespo M, Llinàs-Mallol L, Buxeda A, Tàrrega CB, Redondo-Pachon D, Jimenez MDA, Mendoza-Valderrey A, Martins AC, Mateus C, Alvila G, Laranjinha I, Arroyo D, Castellano S, Rodríguez-Ferrero ML, Lemahieu W, Dirim AB, Demir E, Sever MS, Turkmen A, Şafak S, Hollander DAMJ, Büttner S, Sridharan S, van der Sande FM, Christiaans MHL, Luca MD, Beerenhout C, Adema AY, Stepanov VA, Zulkarnaev AB, Turkmen K, Fliedner A, Åsberg A, Pini S, de Biase C, Kerckhoffs A, van de Logt AE, Maas R, Lebedeva O, Reichert LJM, Verhave J, Marcantoni C, van Gils-Verrij LEA, Battaglia Y, Lentini P, Cabezas-Reina CJ, Roca AM, Nauta F, Goffin E, Kanaan N, Labriola L, Devresse A, Coca A, Naesens M, Kuypers D, Desschans B, Dedinska I, Malik S, Berger SP, Sanders JSF, Özyilmaz A, Ponikvar JB, Pernat AM, Kovac D, Arnol M, Abrahams AC, Molenaar FM, van Zuilen AD, Meijvis SCA, Dolmans H, Esposito P, Krzesinski JM, Barahira JD, Gallieni M, Guglielmetti G, Guzzo G, Luik AJ, van Kuijk WHM, Stikkelbroeck LWH, Hermans MMH, Rimsevicius L, Righetti M, Islam M, Heitink-ter Braak N. Strategies to prevent SARS-CoV-2 transmission in hemodialysis centres across Europe - Lessons for the future. Clin Kidney J 2022; 16:662-675. [PMID: 37007687 PMCID: PMC10061429 DOI: 10.1093/ckj/sfac253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Indexed: 12/04/2022] Open
Abstract
Abstract
Background
Early reports on the pandemic nature of COVID-19 directed the nephrology community to develop infection prevention and control guidance. We aimed to make an inventory of strategies that dialysis centres followed to prevent infection with COVID-19 in the first pandemic wave.
Methods
We analyzed IPC measures taken by hemodialysis centres treating patients presenting with COVID-19 between March 1, 2020 and July 31, 2020 and that completed the European Renal Association COVID-19 Database centre questionnaire. Additionally, we made an inventory of guidelines published in European countries to prevent spread of SARS-CoV-2 in dialysis centres.
Results
Data from 73 dialysis units located in and bordering Europe were analyzed. All participating centres implemented IPC measures to mitigate the impact of SARS-CoV-2 during the first pandemic wave. Measures mentioned most often included triage with questions before entering the dialysis ward, measuring body temperature, hand disinfection, masking for all patients and staff, and personal protective equipment for staff members. These measures were also recommended in most of the 14 guidelines that were identified in the inventory of national guidelines and were also scored as being among the most important measures by the authors of this paper. Heterogeneity existed between centres and national guidelines regarding the minimal distance between dialysis chairs and recommendations regarding isolation and cohorting.
Conclusions
Although variation existed, measures to prevent transmission of SARS-CoV-2 were relatively similar across centres and national guidelines. Further research is needed to assess causal relationships between measures taken and spread of SARS-CoV-2.
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Affiliation(s)
- Marlies Noordzij
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Björn Meijers
- Department of Nephrology , UZ Leuven, Leuven , , Immunology and Transplantation, KU Leuven, Leuven , Belgium
- Belgium and Department of Microbiology , UZ Leuven, Leuven , , Immunology and Transplantation, KU Leuven, Leuven , Belgium
| | - Ron T Gansevoort
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Adrian Covic
- Grigore T Popa University of Medicine and Pharmacy , Iasi , , Iasi , Romania
- Romania / Dr Ci Parhon Hospital , Iasi , , Iasi , Romania
| | - Raphaël Duivenvoorden
- Department of Nephrology, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Marc H Hemmelder
- Dept. of Internal Medicine, Div. of Nephrology, Maastricht University Medical Center / CARIM school for cardiovascular disease, University of Maastricht , Maastricht , The Netherlands
| | - Kitty J Jager
- ERA Registry, Amsterdam UMC location University of Amsterdam , Medical Informatics, Amsterdam , The Netherlands
- Amsterdam Public Health Research Institute , Quality of Care, Amsterdam , The Netherlands
| | - Geir Mjoen
- Department of Transplantation, Oslo University Hospital , Norway
| | - Ionut Nistor
- Grigore T Popa University of Medicine and Pharmacy , Iasi , , Iasi , Romania
- Romania / Dr Ci Parhon Hospital , Iasi , , Iasi , Romania
| | - Ekaterina Parshina
- Nephrology and Dialysis Department, Saint Petersburg State University Hospital , Saint-Petersburg, Russia
| | - Giuseppina Pessolano
- Division of Nephrology , Azienda Ospedaliera Universitaria Integrata Verona, Italy
| | - Serhan Tuglular
- Medical Faculty, Department of Internal Medicine, Marmara University , Istanbul , Turkey
| | - Priya Vart
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen , The Netherlands
| | - Luca Zanoli
- Nephrology and dialysis, San Marco Hospital, University of Catania , Catania , Italy
| | - Casper F M Franssen
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
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Oniscu GC, Abramowicz D, Bolignano D, Gandolfini I, Hellemans R, Maggiore U, Nistor I, O'Neill S, Sever MS, Koobasi M, Nagler EV. Management of obesity in kidney transplant candidates and recipients: A clinical practice guideline by the Descartes working group of ERA. Nephrol Dial Transplant 2021; 37:i1-i15. [PMID: 34788854 PMCID: PMC8712154 DOI: 10.1093/ndt/gfab310] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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] [Indexed: 11/13/2022] Open
Abstract
The clinical practice guideline Management of Obesity in Kidney Transplant Candidates and Recipients was developed to guide decision-making in caring for people with end-stage kidney disease (ESKD) living with obesity. The document considers the challenges in defining obesity, weighs interventions for treating obesity in kidney transplant candidates as well as recipients and reflects on the impact of obesity on the likelihood of wait-listing as well as its effect on transplant outcomes. It was designed to inform management decisions related to this topic and provide the backdrop for shared decision-making. This guideline was developed by the European Renal Association’s Developing Education Science and Care for Renal Transplantation in European States working group. The group was supplemented with selected methodologists to supervise the project and provide methodological expertise in guideline development throughout the process. The guideline targets any healthcare professional treating or caring for people with ESKD being considered for kidney transplantation or having received a donor kidney. This includes nephrologists, transplant physicians, transplant surgeons, general practitioners, dialysis and transplant nurses. Development of this guideline followed an explicit process of evidence review. Treatment approaches and guideline recommendations are based on systematic reviews of relevant studies and appraisal of the quality of the evidence and the strength of recommendations followed the Grading of Recommendations Assessment, Development and Evaluation approach. Limitations of the evidence are discussed and areas of future research are presented.
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Affiliation(s)
| | | | - Davide Bolignano
- Department of Medical and Surgical Sciences. Nephrology and Dialysis Unit. Magna Graecia University of Catanzaro, Italy
| | - Ilaria Gandolfini
- Dipartimento di Medicina e Chirurgia Università di Parma, UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Parma Italy
| | | | - Umberto Maggiore
- Dipartimento di Medicina e Chirurgia Università di Parma, UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Parma Italy
| | - Ionut Nistor
- Methodological Center for Medical Research and Evidence-Based Medicine, University of Medicine and Pharmacy "Grigore T. Popa", Iași, Romania
| | | | | | - Muguet Koobasi
- Knowledge Centre for Health Ghent, Ghent University Hospital, Belgium
| | - Evi V Nagler
- Department of Nephrology, Ghent University Hospital, Belgium
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Mariat C, Mjøen G, Watschinger B, Sever MS, Crespo M, Peruzzi L, Oniscu GC, Abramowicz D, Hilbrands L, Maggiore U. Assessment of Pre-Donation Glomerular Filtration Rate: Going Back To Basics A Position Paper from the DESCARTES Working Group of the ERA-EDTA. Nephrol Dial Transplant 2021; 37:430-437. [PMID: 34519827 DOI: 10.1093/ndt/gfab259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/25/2021] [Indexed: 12/24/2022] Open
Abstract
The 2017 version of the KDIGO (Kidney Disease: Improving Global Outcomes) guidelines is the most recent international framework for the evaluation and care of living kidneys donors. Along with the call for an integrative approach evaluating the long-term end-stage kidney disease risk for the future potential donor, several recommendations are formulated regarding the predonation glomerular filtration rate (GFR) adequacy with no or little consideration for the donor candidate's age and for the importance of using reference methods of GFR measurements. Herein, we question the position of the KDIGO guidelines and discuss the rationale and modalities for a more basic, but not less demanding GFR evaluation susceptible to enable a more efficient selection of the potential kidney donor.
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Affiliation(s)
- Christophe Mariat
- Service de Néphrologie, Dialyse et Transplantation rénale, Centre Hospitalier Universitaire de Saint Etienne, Hôpital NORD, Université de LYON, Université Jean MONNET, Saint Etienne, France
| | | | - Bruno Watschinger
- Medical University of Vienna, Department of Medicine III, Division of Nephrology and Dialysis, Vienna, Austria
| | | | - Marta Crespo
- Hospital del Mar, Nephrology Department, Barcelona, Spain
| | | | | | | | - Luuk Hilbrands
- Radboud university medical center, Department of Nephrology, Nijmegen, The Netherlands
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11
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Candellier A, Goffin EJ, Vart P, Noordzij M, Arnol M, Covic A, Lentini P, Malik S, Reichert L, Sever MS, Watschinger B, Jager KJ, Gansevoort R. FC 028COVID-19 RELATED MORTALITY IN KIDNEY TRANSPLANT AND DIALYSIS PATIENTS: A COMPARATIVE, PROSPECTIVE REGISTRY BASED STUDY. Nephrol Dial Transplant 2021. [PMCID: PMC8195177 DOI: 10.1093/ndt/gfab145.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background and Aims Studies examining kidney failure patients with COVID-19 reported higher mortality in hemodialysis patients than in kidney transplant recipients. However, hemodialysis patients are often older and have more comorbidities. This study investigated the association of type of kidney replacement therapy with COVID-19 severity adjusting for differences in characteristics. Method Data were retrieved from the European Renal Association COVID-19 Database (ERACODA), which includes kidney replacement therapy patients diagnosed with COVID-19 from all over Europe. We included all kidney transplant recipients and hemodialysis patients who presented between February 1st and December 1st 2020 and had complete information reason for COVID-19 screening and vital status at day 28. The diagnosis of COVID-19 was made based on a PCR of a nasal or pharyngeal swab specimens and/or COVID-19 compatible findings on a lung CT scan. The association of kidney transplantation or hemodialysis with 28-day mortality was examined using Cox proportional-hazards regression models adjusted for age, sex, frailty and comorbidities. Additionally, this association was investigated in the subsets of patients that were screened because of symptoms or have had routine screening. Results A total of 1,670 patients (496 functional kidney transplant recipients and 1,174 hemodialysis patients) were examined. 16.9% of kidney transplant recipients and 23.9% of hemodialysis patients died within 28 days of presentation. In an unadjusted model, the risk of 28-day mortality was 33% lower in kidney transplant recipients compared with hemodialysis patients (hazard ratio (HR): 0.67, 95% CI: 0.52, 0.85). However, in an age, sex and frailty adjusted model, the risk of 28-day mortality was 29% higher in kidney transplant recipients (HR=1.29, 95% CI: 1.00, 1.68), whereas in a fully adjusted model the risk was even 43% higher (HR=1.43, 95% CI: 1.06, 1.93). This association in patients who were screened because of symptoms (n=1,145) was similar (fully adjusted model HR=1.46, 95% CI: 1.05, 2.04). Results were similar when other endpoints were studied (e.g. risk for hospitalization, ICU admission or mortality beyond 28 days) as well as across subgroups. Only age was found to interact significantly, suggesting that the increased mortality risk associated with kidney transplantation was especially present in elderly subjects. Conclusion In this study, kidney transplant recipients had a greater risk of a more severe course of COVID-19 compared with hemodialysis patients when adjusted for age, sex and comorbidities.
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Affiliation(s)
- Alexandre Candellier
- Cliniques Universitaires Saint-Luc, Institute of Experimental and Clinical Research, Université catholique de Louvain, Department of Nephrology, Brussels, Belgium
- Centre Hospitalier Universitaire Amiens-Picardie, Department of Nephrology, Amiens, France
| | - Eric Jean Goffin
- Cliniques Universitaires Saint-Luc, Institute of Experimental and Clinical Research, Université catholique de Louvain, Department of Nephrology, Brussels, Belgium
| | - Priya Vart
- University Medical Center Groningen, University of Groningen, Department of Internal Medicine, Groningen, Netherlands
- University Medical Center Groningen, University of Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, Netherlands
| | - Marlies Noordzij
- University Medical Center Groningen, University of Groningen, Department of Internal Medicine, Groningen, Netherlands
| | - Miha Arnol
- University Medical Centre Ljubljana, Department of Nephrology, Ljubljana, Slovenia
| | - Adrian Covic
- University Hospital, ‘Grigore T. Popa' University of Medicine, Nephrology Clinic, Dialysis and Renal Transplant Center, 'C.I. PARHON’ , Iasi, Romania
| | - Paolo Lentini
- San Bassiano Hospital, Bassano del Grappa, Nephrology and Dialysis Unit, Vicenza, Italy
| | - Shafi Malik
- University Hospital of Coventry and Warwickshire and University of Leicester., Department of Renal and Transplant, Leicester, United Kingdom
| | - Louis Reichert
- Rijnstate Hospital, Department of Nephrology, Arnhem, Netherlands
| | - Mehmet Sukru Sever
- Istanbul School of Medicine, Istanbul University, Department of Nephrology, Istanbul, Turkey
| | - Bruno Watschinger
- Medical University of Vienna, Department of Nephrology, Vienna, Austria
| | - Kitty J Jager
- Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health research institute, ERA-EDTA Registry, Department of Medical Informatics, Amsterdam, Netherlands
| | - Ronald Gansevoort
- University Medical Center Groningen, University of Groningen, Department of Internal Medicine, Groningen, Netherlands
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12
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Demir E, Turkmen A, Sever MS. Risk factors, pathogenesis, presentation and management of BK virus infection in kidney transplantation. Nephrol Dial Transplant 2021; 36:985-987. [PMID: 34047340 DOI: 10.1093/ndt/gfz214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 09/11/2019] [Indexed: 12/21/2022] Open
Affiliation(s)
- Erol Demir
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Sukru Sever
- Department of Internal Medicine, Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Sever MS, Ortiz A, Maggiore U, Bac-García E, Vanholder R. Mass Disasters and Burnout in Nephrology Personnel: From Earthquakes and Hurricanes to COVID-19 Pandemic. Clin J Am Soc Nephrol 2021; 16:829-837. [PMID: 33414153 PMCID: PMC8259469 DOI: 10.2215/cjn.08400520] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Mass disasters result in extensive health problems and make health care delivery problematic, as has been the case during the COVID-19 pandemic. Although COVID-19 was initially considered a pulmonary problem, it soon became clear that various other organs were involved. Thus, many care providers, including kidney health personnel, were overwhelmed or developed burnout. This review aims to describe the spectrum of burnout in mass disasters and suggests solutions specifically for nephrology personnel by extending previous experience to the COVID-19 pandemic. Burnout (a psychologic response to work-related stress) is already a frequent part of routine nephrology practice and, not surprisingly, is even more common during mass disasters due to increased workload and specific conditions, in addition to individual factors. Avoiding burnout is essential to prevent psychologic and somatic health problems in personnel as well as malpractice, understaffing, and inadequate health care delivery, all of which increase the health care burden of disasters. Burnout may be prevented by predisaster organizational measures, which include developing an overarching plan and optimizing health care infrastructure, and ad hoc disaster-specific measures that encompass both organizational and individual measures. Organizational measures include increasing safety, decreasing workload and fear of malpractice, optimizing medical staffing and material supplies, motivating personnel, providing mental health support, and enabling flexibility in working circumstances. Individual measures include training on coping with stress and problematic conditions, minimizing the stigma of emotional distress, and maintaining physical health. If these measures fall short, asking for external help is mandatory to avoid an inefficient disaster health care response. Minimizing burnout by applying these measures will improve health care provision, thus saving as many lives as possible.
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Affiliation(s)
- Mehmet Sukru Sever
- Department of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
| | - Umberto Maggiore
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy,UO Nefrologia, Azienda-Ospedaliero Universitaria di Parma, Parma, Italy
| | - Enrique Bac-García
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain,Department of Psychiatry, Universidad Autonoma de Madrid, Madrid, Spain
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium,European Kidney Health Alliance, Brussels, Belgium
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Mjøen G, Maggiore U, Kessaris N, Kimenai D, Watschinger B, Mariat C, Sever MS, Crespo M, Peruzzi L, Spasovski G, Sørensen SS, Heemann U, Pascual J, Viklicky O, Courtney AE, Hadaya K, Wagner L, Nistor I, Hadjianastassiou V, Durlik M, Helanterä I, Oberbauer R, Oniscu G, Hilbrands L, Abramowicz D. Long-term risks after kidney donation: how do we inform potential donors? A survey from DESCARTES and EKITA transplantation working groups. Nephrol Dial Transplant 2021; 36:1742-1753. [PMID: 33585931 PMCID: PMC8397510 DOI: 10.1093/ndt/gfab035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Indexed: 11/29/2022] Open
Abstract
Background Publications from the last decade have increased knowledge regarding long-term risks after kidney donation. We wanted to perform a survey to assess how transplant professionals in Europe inform potential kidney donors regarding long-term risks. The objectives of the survey were to determine how they inform donors and to what extent, and to evaluate the degree of variation. Methods All transplant professionals involved in the evaluation process were considered eligible, regardless of the type of profession. The survey was dispatched as a link to a web-based survey. The subjects included questions on demographics, the information policy of the respondent and the use of risk calculators, including the difference of relative and absolute risks and how the respondents themselves understood these risks. Results The main finding was a large variation in how often different long-term risks were discussed with the potential donors, i.e. from always to never. Eighty percent of respondents stated that they always discuss the risk of end-stage renal disease, while 56% of respondents stated that they always discuss the risk of preeclampsia. Twenty percent of respondents answered correctly regarding the relationship between absolute and relative risks for rare outcomes. Conclusions The use of written information and checklists should be encouraged. This may improve standardization regarding the information provided to potential living kidney donors in Europe. There is a need for information and education among European transplant professionals regarding long-term risks after kidney donation and how to interpret and present these risks.
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Affiliation(s)
- Geir Mjøen
- Section of Nephrology, Department of Transplant Medicine, Oslo University Hospital, Oslo, Norway
| | - Umberto Maggiore
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Diederik Kimenai
- Erasmus University Hospital Rotterdam, Rotterdam, The Netherlands
| | - Bruno Watschinger
- Medical University of Vienna, Department of Medicine III, Division of Nephrology and Dialysis, Vienna, Austria
| | - Cristophe Mariat
- Centre Hospitalier Universitaire de Saint Etienne, Saint Etienne, France
| | | | - Marta Crespo
- Hospital del Mar, Department of Nephrology, Barcelona, Spain
| | | | - Goce Spasovski
- University Clinic of Nephrology, Skopje, North Macedonia
| | | | - Uwe Heemann
- Technische Universität München, München, Germany
| | - Julio Pascual
- Hospital del Mar, Department of Nephrology, Barcelona, Spain
| | - Ondrej Viklicky
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | | | | | - Ionut Nistor
- Methodological Center for Medical Research and Evidence-Based Medicine, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
| | - Vassilis Hadjianastassiou
- Renal Unit, Royal London Hospital, Whitechapel, Bart's Health, NHS Trust, London, UK.,University of Nicosia, Nicosia, Cyprus
| | | | | | - Rainer Oberbauer
- Medical University of Vienna, Department of Medicine III, Division of Nephrology and Dialysis, Vienna, Austria
| | | | - Luuk Hilbrands
- Radboud University Medical Center, Nijmegen, The Netherlands
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Oto OA, Yazici H, Caliskan Y, Artan AS, Sever MS, Cebeci E, Ozturk S, Turkmen A. Presence of M-type Phospholipase A2 Receptor Antibody in Membranous Nephropathy. Turk J Nephrol 2020. [DOI: 10.5152/turkjnephrol.2020.3733] [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: 11/22/2022]
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Abstract
Following disasters, children are physically, psychologically and socially more vulnerable than adults; consequently, their morbidity and mortality are higher. The risks are especially high for orphans and unaccompanied children who are separated from their families, making them frequently victims of human trafficking, slavery, drug addiction, crime or sexual exploitation. Education of children and families about disaster-related risks and providing special protection in disaster preparedness plans may mitigate these threats. Kidney disease patients, both paediatric and adult, are extra vulnerable during disasters, because their treatment is dependent on technology and functioning infrastructure. Acute kidney injury, chronic kidney disease patients not on dialysis and dialysis and transplant patients are faced with extensive problems. Overall, similar treatment principles apply both for adults and paediatric kidney patients, but management of children is more problematic, because of substantial medical and logistic difficulties. To minimize drawbacks, it is vital to be prepared for renal disasters. Preparedness plans should address not only medical professionals, but also patients and their families. If problems cannot be coped with locally, calling for national and/or international help is mandatory. This paper describes the spectrum of disaster-related problems in children and the specific features in treating acute and chronic kidney disease in disasters.
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Affiliation(s)
- Mehmet Sukru Sever
- Department of Nephrology, Istanbul School of Medicine, Istanbul University, Millet Caddesi, 34093, Capa Istanbul, Turkey.
| | - Lale Sever
- Department of Paediatric Nephrology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
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17
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Sarihan I, Caliskan Y, Mirioglu S, Ozluk Y, Senates B, Seyahi N, Basturk T, Yildiz A, Kilicaslan I, Sever MS. Amyloid A Amyloidosis After Renal Transplantation: An Important Cause of Mortality. Transplantation 2020; 104:1703-1711. [PMID: 32732850 DOI: 10.1097/tp.0000000000003043] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND There are limited data on the outcome of transplant recipients with familial Mediterranean fever (FMF)-associated AA amyloidosis. The aim of the present study is to evaluate demographic, clinical, laboratory, and prognostic characteristics and outcome measures of these patients. METHODS Eighty-one renal transplant recipients with FMF-associated AA amyloidosis (group 1) and propensity score-matched transplant recipients (group 2, n = 81) with nonamyloidosis etiologies were evaluated in this retrospective, multicenter study. Recurrence of AA amyloidosis was diagnosed in 21 patients (group 1a), and their features were compared with 21 propensity score-matched recipients with FMF amyloidosis with no laboratory signs of recurrence (group 1b). RESULTS The risk of overall allograft loss was higher in group 1 compared with group 2 (25 [30.9%] versus 12 [14.8%]; P = 0.015 [hazard ratio, 2.083; 95% confidence interval, 1.126-3.856]). Patients in group 1 were characterized by an increased risk of mortality compared with group 2 (11 [13.6%] versus 0%; P = 0.001 [hazard ratio, 1.136; 95% confidence interval, 1.058-1.207]). Kaplan-Meier analysis revealed that 5- and 10-year patient survival rates in group 1 (92.5% and 70.4%) were significantly lower than in group 2 (100% and 100%; P = 0.026 and P = 0.023, respectively). Although not reaching significance, overall, 5- and 10-year graft survival rates (57.1%, 94.7%, and 53.8%, respectively) in group 1a were worse than in group 1b (76.2%, 95%, and 77.8%, respectively; P = 0.19, P = 0.95, and P = 0.27, respectively). CONCLUSIONS AA amyloidosis is associated with higher risk of mortality after kidney transplantation. Inflammatory indicators should be monitored closely, and persistent high levels of acute-phase reactants should raise concerns about amyloid recurrence in allograft.
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Affiliation(s)
- Irem Sarihan
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasar Caliskan
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Division of Nephrology and Hypertension, Saint Louis University School of Medicine, Saint Louis, MO
| | - Safak Mirioglu
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Banu Senates
- Division of Nephrology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nurhan Seyahi
- Division of Nephrology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Taner Basturk
- Division of Nephrology, Sisli Hamidiye Etfal Training and Education Hospital, Istanbul, Turkey
| | - Abdulmecit Yildiz
- Division of Nephrology, Department of Internal Medicine, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Isin Kilicaslan
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Sukru Sever
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Abstract
Acute kidney injury (AKI) is frequent during wars and other man-made disasters, and contributes significantly to the overall death toll. War-related AKI may develop as a result of polytrauma, traumatic bleeding and hypovolemia, chemical and airborne toxin exposure, and crush syndrome. Thus, prerenal, intrinsic renal, or postrenal AKI may develop at the battlefield, in field hospitals, or tertiary care centers, resulting not only from traumatic, but also nontraumatic, etiologies. The prognosis usually is unfavorable because of systemic and polytrauma-related complications and suboptimal therapeutic interventions. Measures for decreasing the risk of AKI include making preparations for foreseeable disasters, and early management of polytrauma-related complications, hypovolemia, and other pathogenetic mechanisms. Transporting casualties initially to field hospitals, and afterward to higher-level health care facilities at the earliest convenience, is critical. Other man-made disasters also may cause AKI; however, the number of patients is mostly lower and treatment possibilities are broader than in war. If there is no alternative other than prolonged field care, the medical community must be prepared to offer health care and even perform dialysis in austere conditions, which in that case, is the only option to decrease the death toll resulting from AKI.
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Affiliation(s)
- Mehmet Sukru Sever
- Department of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Norbert Lameire
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
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Lameire N, Sever MS, Van Biesen W, Vanholder R. Role of the International and National Renal Organizations in Natural Disasters: Strategies for Renal Rescue. Semin Nephrol 2020; 40:393-407. [DOI: 10.1016/j.semnephrol.2020.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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20
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Demir E, Kayaş K, Erel C, Caparali B, Ozler TE, Dirim AB, Catikkas NM, Guller N, Safak S, Ucar AR, Oto OA, Yazici H, Caliskan YK, Akgul SU, Temurhan S, Ozluk Y, Kilicaslan I, Yildiz A, Turkmen A, Sever MS. P1743IMPORTANCE OF KIDNEY ALLOGRAFT REJECTİON IN BK VIRUS NEPHROPATHY. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
Allograft rejection following BK virus nephropathy (BKVN) is an important cause of allograft loss in kidney transplant recipients. However, the effect of rejection type on allograft survival in patients with BKVN has not been described previously. This study aimed to investigate the relationship between allograft rejection type and graft survival in patients with BKVN.
Method
We retrospectively analyzed the data of 159 kidney transplant recipients diagnosed BKVN and followed-up in our center between January 2009 and December 2019. BKVN was diagnosed by persistent viremia of more than 10000 copies/mL for four weeks or allograft biopsy. Vascular, obstructive or other non-parenchymal etiologies for allograft dysfunction were excluded. All patients were investigated for the presence of anti-HLA antibody at 6 and 12 months after BKVN diagnosis. Luminex solid-phase assay was used to investigate Class I and Class II PRA and MFI values greater than 1000 were accepted as positive. Allograft biopsy was performed in patients with progressive graft dysfunction or the presence of donor-specific antibodies (DSA) and analyzed according to the Banff Classification. The primary outcomes were defined as allograft loss or the allograft dysfunction which defined as was doubling serum creatinine levels.
Results
Patients were followed-up median 70 (IQR 13-198) months after kidney transplantation. Demographic data and clinical characteristics are provided in the table. 28 kidney transplant recipients suffered from allograft rejection after BKVN. Median rejection time to rejection after BKVN was 9 (IQR 5-164) months. 3 patients (18,8%) in the AMR group and 1 patient (8,3%) in the TCMR group experienced graft loss during follow-up. The mean serum creatinine levels at the last clinical visit were significantly higher in the AMR group compared to the TCMR group (1,9±0,8 vs 1,3±1,2 mg/dl; p=0,002). In multivariate analysis, AMR was an independent risk factor for allograft dysfunction (HR, 1,735; 95% CI 1,060 to 2,839; p=0,028).
Conclusion
The occurrence of AMR after BKVN is an important indicator of allograft dysfunction compared to TCMR. DSA screening should be routinely used in this group for early diagnosis and treatment of AMR.
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Affiliation(s)
- Erol Demir
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Kamil Kayaş
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Cansu Erel
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Bilge Caparali
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Tuba Elif Ozler
- Haseki Education Research Hospital, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Ahmet Burak Dirim
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Nezahat Muge Catikkas
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Nurana Guller
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Seda Safak
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Ali Riza Ucar
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Ozgur Akin Oto
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Halil Yazici
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Yasar Kerem Caliskan
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Sebahat Usta Akgul
- Istanbul University, Istanbul Faculty of Medicine, Department of Medical Biology, Istanbul, Turkey
| | - Sonay Temurhan
- Istanbul University, Istanbul Faculty of Medicine, Department of Medical Biology, Istanbul, Turkey
| | - Yasemin Ozluk
- Istanbul University, Istanbul Faculty of Medicine, Department of Pathology, Istanbul, Turkey
| | - Isin Kilicaslan
- Istanbul University, Istanbul Faculty of Medicine, Department of Pathology, Istanbul, Turkey
| | - Alaattin Yildiz
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Aydin Turkmen
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Mehmet Sukru Sever
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
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21
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Mirioglu S, Gurel E, Guzel-Dirim M, Kara A, Ozluk Y, Aktar I, Dirim AB, Ciftkaya A, Oto OA, Caliskan YK, Kilicaslan I, Yazici H, Turkmen A, Sever MS. P0406ASSOCIATION OF MICROHEMATURIA WITH OUTCOMES IN ADULT PATIENTS WITH IGA NEPHROPATHY. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Although hematuria is the cardinal symptom of IgA nephropathy (IgAN), its effects on the outcome have not been studied extensively. We, therefore, aimed to analyze the association between microhematuria and clinicopathological features as well as outcome parameters in adult patients with IgAN.
Method
129 adults with IgAN, diagnosed by kidney biopsy, and followed up for a median duration of 54.5 (IQR: 24.25-92.75) months, were included in this retrospective study. Urinary sediment analyses during the bouts of macrohematuria were not taken into consideration. For the purpose of this analysis, microhematuria was described as ≥5 red blood cells per high-power field (RBCs/hpf) and classified as mild (5-9 RBCs/hpf), moderate (10-19 RBCs/hpf), or severe (≥20 RBCs/hpf). Study outcome (event) was defined as at least a 50% reduction in baseline eGFR or development of stage 5 chronic kidney disease (eGFR <15 ml/min/1.73 m2). eGFRs of the patients were calculated by using CKD-EPI formula.
Results
Demographic, clinical, laboratory and histopathological features of patients at the time of diagnosis are summarized in the table. Usage of ACEi/ARBs [75/81 (92.5%) vs 45/48 (93.75%), p=0.803], fish oil [30/81 (37%) vs 19/48 (39.5%), p=0.773], azathioprine [16/81 (19.7%) vs 10/48 (20.8%), p=0.882] and mycophenolic acid derivatives [14/81 (17.2%) vs 11/48 (22.9%), p=0.434] were comparable among the patients with and without microhematuria. Corticosteroids were more frequently used in patients with microhematuria [41/81 (50.6%) vs 17/48 (35.4%)], although this difference was not statistically significant (p=0.093). Overall 30 patients (23.2%) reached the study outcome, and there were no differences between patients with (19, 23.4%) and without (11, 22.9%) microhematuria (p=0.944). Kaplan-Meier analysis revealed that event free survival rates were similar across study groups: 77.1% for patients without microhematuria; while 80% for mild, 77.3% for moderate, and 72.7% for severe microhematuria (p=0.436) (Figure). Microhematuria did not predict the study outcome when multivariable Cox regression analyses were performed [HR: 1.847 (95% CI: 0.696-4.904), p=0.218]. Throughout the follow-up, microhematuria disappeared (dropped below 5 RBCs/hpf) in 43 patients (53%), 8 of whom (18.6%) reached the study outcome as compared to 11 patients (28.9%) with persistent microhematuria (p=0.273). Disappearance of microhematuria was not a predictor of study outcome, as well [HR: 0.386 (95% CI: 0.068-2.180), p=0.281].
Conclusion
Microhematuria is not associated with renal outcomes of adult patients with IgAN.
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Affiliation(s)
- Safak Mirioglu
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Erdem Gurel
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Merve Guzel-Dirim
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Asli Kara
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Yasemin Ozluk
- Istanbul University Istanbul Faculty of Medicine, Department of Pathology, Istanbul, Turkey
| | - Irem Aktar
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Ahmet Burak Dirim
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Aylin Ciftkaya
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Ozgur Akin Oto
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Yasar Kerem Caliskan
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Isin Kilicaslan
- Istanbul University Istanbul Faculty of Medicine, Department of Pathology, Istanbul, Turkey
| | - Halil Yazici
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Aydin Turkmen
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Mehmet Sukru Sever
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
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22
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Akyildiz A, Uludag O, Mirioglu S, Ucar AR, Demir E, Caliskan YK, Ozluk Y, Turkmen A, Sever MS, Yazici H. P0353EFFECT OF RITUXIMAB IN PATIENTS WITH RELAPSED OR REFRACTORY PRIMARY MEMBRANOUS NEPHROPATHY. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
Membranous nephropathy (MN) is the most common cause of glomerulonephritis in non-diabetic adults. B-cell dysfunction is an important pathway involved in pathogenesis. We, therefore, investigated effects of rituximab (RTX) on the outcome of patients with relapsed or refractory primary MN.
Method
In this retrospective analysis, 48 patients with primary MN were evaluated. Patients, who had relapsed or refractory biopsy-proven disease, with a nephrotic-range proteinuria despite at least six months of prior immunosuppressive therapy using corticosteroids, calcineurin inhibitors or mycophenolic acid derivatives, which were used according to KDIGO guidelines. All patients received at least 2 doses of 375 mg/m2 of RTX. Proteinuria and serum albumin levels of the patients were recorded at baseline, and 3,6,12,18 and 24 months.
Results
Of 48 patients who participated in this study, 27(56.3%) were male. Mean age was 45.3±17.2 years. Results of serum anti-phospholipase-A2-receptor (PLA2R) were available in 31 patients, 23 of whom (74%) were positive. Proteinuria levels at 3, 6, 12, 18, and 24 months after treatment with RTX showed a significant decrease when compared to baseline (p<0.05) (Figure 1): From 7±3.5 g/24h at baseline to 2.6±2.4 g/24h at 12 months. Serum albumin levels at 3, 6, 12, 18, and 24 months after RTX significantly increased compared to baseline values (p<0.05) (Figure 2): From 2.97±0.76 g/dl at baseline to 3.88±0.67 g/dl at 12 months.
Conclusion
Treatment with RTXiseffective in patients suffering from relapsed or refractory primary MN.
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Affiliation(s)
- Arif Akyildiz
- Istanbul Faculty of Medicine, Department of Internal Medicine, Turkey
| | - Omer Uludag
- Istanbul Faculty of Medicine, Department of Internal Medicine, Turkey
| | - Safak Mirioglu
- Cerrahpasa Medical Faculty, Division of Nephrology, Department of Internal Medicine, Turkey
| | - Ali Riza Ucar
- Istanbul Faculty of Medicine, Division of Nephrology, Department of Internal Medicine, Turkey
| | - Erol Demir
- Istanbul Faculty of Medicine, Division of Nephrology, Department of Internal Medicine, Turkey
| | - Yasar Kerem Caliskan
- Istanbul Faculty of Medicine, Division of Nephrology, Department of Internal Medicine, Turkey
- Saint Louis University School of Medicine, Division of Nephrology and Hypertension, Saint Louis, United States of America
| | - Yasemin Ozluk
- Istanbul Faculty of Medicine, Department of Pathology, Turkey
| | - Aydin Turkmen
- Istanbul Faculty of Medicine, Division of Nephrology, Department of Internal Medicine, Turkey
| | - Mehmet Sukru Sever
- Istanbul Faculty of Medicine, Division of Nephrology, Department of Internal Medicine, Turkey
| | - Halil Yazici
- Istanbul Faculty of Medicine, Division of Nephrology, Department of Internal Medicine, Turkey
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23
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Massy ZA, Caskey FJ, Finne P, Harambat J, Jager KJ, Nagler E, Stengel B, Sever MS, Vanholder R, Blankestijn PJ, Bruchfeld A, Capasso G, Fliser D, Fouque D, Goumenos D, Soler MJ, Rychlík I, Spasovski G, Stevens K, Wanner C, Zoccali C. Nephrology and Public Policy Committee propositions to stimulate research collaboration in adults and children in Europe. Nephrol Dial Transplant 2020; 34:1469-1480. [PMID: 31197325 PMCID: PMC6736134 DOI: 10.1093/ndt/gfz089] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Indexed: 12/18/2022] Open
Abstract
The strengths and the limitations of research activities currently present in Europe are explored in order to outline how to proceed in the near future. Epidemiological and clinical research and public policy in Europe are generally considered to be comprehensive and successful, and the European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) is playing a key role in the field of nephrology research. The Nephrology and Public Policy Committee (NPPC) aims to improve the current situation and translation into public policy by planning eight research topics to be supported in the coming 5 years by ERA-EDTA.
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Affiliation(s)
- Ziad A Massy
- Division of Nephrology, Ambroise Paré Hospital, APHP, Paris-Ile-de-France-West University (UVSQ), Boulogne-Billancourt, Paris, France.,INSERM U1018 Team5, Paris-Saclay University, Villejuif, France
| | - Fergus J Caskey
- Consultant Senior Lecturer, Population Health Sciences University of Bristol, UK
| | - Patrik Finne
- Finnish Registry for Kidney Diseases, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jerome Harambat
- Pediatric Nephrology Unit, Pellegrin-Enfants Hospital, Bordeaux University Hospital, and University of Bordeaux, INSERM, Team LEHA, Bordeaux, France
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Evi Nagler
- European Renal Best Practice, London, UK
| | | | - Mehmet Sukru Sever
- Department of Nephrology/Internal Medicine, Istanbul School of Medicine, Istanbul University, Millet Caddesi, Istanbul, Turkey
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Corneel Heymanslaan, Ghent, Belgium
| | - Peter J Blankestijn
- Department of Nephrology, University Medical Center, Utrecht, The Netherlands
| | - Annette Bruchfeld
- Department of Renal Medicine, CLINTEC, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - Giovambattista Capasso
- Department of Medical Translational Sciences, University of "Luigi Vanvitelli" Naples and Biogem, Ariano Irpino, Italy
| | - Danilo Fliser
- Department of Internal Medicine IV-Nephrology and Hypertension, Saarland University Medical Centre, Homburg, Germany
| | - Denis Fouque
- Department of Nephrology, Dialysis, Nutrition, Université de Lyon, CARMEN, Centre Hospitalier Lyon Sud, Pierre Bénite Cedex, France
| | | | - Maria Jose Soler
- Department of Nephrology, Vall d'Hebron University Hospital, Barcelona, Spain.,Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ivan Rychlík
- 1st Department of Internal Medicine, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Goce Spasovski
- Department of Nephrology, Medical Faculty, University of Skopje, Skopje, Former Yugoslav, Republic of Macedonia
| | - Kathryn Stevens
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Christoph Wanner
- Department of Medicine, Division of Nephrology, University Hospital, Wuerzburg, Germany
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24
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Bahat G, Ilhan B, Erdogan T, Halil M, Savas S, Ulger Z, Akyuz F, Bilge AK, Cakir S, Demirkan K, Erelel M, Guler K, Hanagasi H, Izgi B, Kadioglu A, Karan A, Kulaksizoglu IB, Mert A, Ozturk S, Satman I, Sever MS, Tukek T, Uresin Y, Yalcin O, Yesilot N, Oren MM, Karan MA. Turkish inappropriate medication use in the elderly (TIME) criteria to improve prescribing in older adults: TIME-to-STOP/TIME-to-START. Eur Geriatr Med 2020; 11:491-498. [PMID: 32297261 PMCID: PMC7280176 DOI: 10.1007/s41999-020-00297-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 12/03/2019] [Accepted: 02/04/2020] [Indexed: 01/30/2023]
Abstract
Aim To meet the current need in different European countries for improving prescribing in older adults, we aimed to create an update screening tool getting origin from the two user friendly criterion sets: the STOPP/STARTv2 criteria and CRIME criteria. Findings Based on thorough literature review, 55 criteria were added, 17 criteria were removed, and 60 criteria were modified. As a result, 153 TIME criteria composed of 112 TIME-to-STOP and 41 TIME-to-START criteria were introduced. Message TIME criterion set is an update screening tool reported from Eastern Europe that included experts from geriatrics and other specialties frequently giving care to older adults and some additional practical explanations for clinical use. Electronic supplementary material The online version of this article (10.1007/s41999-020-00297-z) contains supplementary material, which is available to authorized users. Purpose To improve prescribing in older adults, criterion sets have been introduced from different countries. While current criterion sets are useful to some extent, they do not meet the need in some European countries. Turkish inappropriate medication use in the elderly (TIME) criteria was planned to meet this need. Methods In phase 1, the user friendly sets: STOPP/START version2 and CRIME criteria were combined. National experts composed of geriatricians and non-geriatricians were invited to review and comment. In phase 2, thorough literature review was performed and reference-based revisions, omissions, and additions were made. Explanatory additions were added to some criteria to improve application in practice. In phase 3, all working group members reviewed the criteria/explanations and agreed on the final content. Results Phase 1 was performed by 49 expert academicians between May and October 2016. Phase 2 was performed by 23 working group academicians between October 2016 and November 2018 and included face-to-face interviews between at least two geriatrician members and one criterion-related specialist. Phase 3 was completed between November 2018–March 2019 with review and approval of all criteria by working group academicians. As a result, 55 criteria were added, 17 criteria were removed, and 60 criteria were modified from the first draft. A total of 153 TIME criteria composed of 112 TIME-to-STOP and 41 TIME-to-START criteria were introduced. Conclusion TIME criteria is an update screening tool that differs from the current useful tools by the interactive study of experts from geriatrics and non-geriatrics, inclusion of practical explanations for some criteria and by its eastern European origin. TIME study respectfully acknowledges its roots from STOPP/START and CRIME criteria. Studies are needed whether it would lead improvements in older adults’ health. Electronic supplementary material The online version of this article (10.1007/s41999-020-00297-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gulistan Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey.
| | - Birkan Ilhan
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Tugba Erdogan
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Meltem Halil
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sumru Savas
- Division of Geriatrics, Department of Internal Medicine, Ege University Faculty of Medicine, Izmir, Turkey
| | - Zekeriya Ulger
- Department of Internal Medicine, Kirikkale University Medical School, Kirikkale, Turkey
| | - Filiz Akyuz
- Division of Gastroenterology, Department of Internal Medicine, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Ahmet Kaya Bilge
- Department of Cardiology, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Sibel Cakir
- Department of Psychiatry, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Hacettepe University Faculty of Pharmacy, Ankara, Turkey
| | - Mustafa Erelel
- Department of Pulmonary Medicine, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Kerim Guler
- Department of Internal Medicine, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Hasmet Hanagasi
- Department of Neurology, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Belgin Izgi
- Department of Ophthalmology, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Ates Kadioglu
- Department of Urology, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Ayse Karan
- Department of Physical Therapy and Rehabilitation, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | | | - Ali Mert
- Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Savas Ozturk
- Department of Nephrology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Ilhan Satman
- Division of Endocrinology, Department of Internal Medicine, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Mehmet Sukru Sever
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Tufan Tukek
- Department of Internal Medicine, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Yagiz Uresin
- Department of Pharmacology, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Onay Yalcin
- Department of Obstetrics and Gynecology, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Nilufer Yesilot
- Department of Neurology, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Meryem Merve Oren
- Department of Public Health, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Mehmet Akif Karan
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
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Mirioglu S, Caliskan Y, Ozluk Y, Dirim AB, Istemihan Z, Akyildiz A, Yazici H, Turkmen A, Kilicaslan I, Sever MS. Co-Deposition of IgM and C3 May Indicate Unfavorable Renal Outcomes in Adult Patients with Primary Focal Segmental Glomerulosclerosis. Kidney Blood Press Res 2019; 44:961-972. [PMID: 31437846 DOI: 10.1159/000501827] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 04/02/2019] [Accepted: 06/27/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS We aimed to investigate the effects of glomerular IgM and C3 deposition on outcomes of adult patients with primary focal segmental glomerulosclerosis (FSGS). METHODS In this retrospective analysis, 86 consecutive adult patients with biopsy-proven primary FSGS were stratified into 3 groups according to their histopathological features: IgM- C3-, IgM+ C3-, and IgM+ C3+. Primary outcome was defined as at least a 50% reduction in baseline estimated glomerular filtration rate (eGFR) or development of kidney failure, while complete or partial remission rates were secondary outcomes. RESULTS Glomerular IgM deposits were found in 44 (51.1%) patients, 22 (25.5%) of which presented with accompanying C3 deposition. Patients in IgM+ C3+ group had higher level of proteinuria (5.6 g/24 h [3.77-8.5], p = 0.073), higher percentage of segmental glomerulosclerosis (20% [12.3-27.2], p = 0.001), and lower levels of eGFR (69 ± 37.2 mL/min/1.73 m2, p = 0.029) and serum albumin (2.71 ± 0.85 g/dL, p = 0.045) at the time of diagnosis. Despite 86.3% of patients in IgM+ C3+ group (19/22) received immunosuppressive treatment, the primary outcome was more common in patients in the IgM+ C3+ group compared with patients in IgM+ C3- and IgM- C3- groups (11 [50%] vs. 2 [9%] and 11 [26.1%] respectively [p = 0.010]). Complete or partial remission rates were lower in patients in the IgM+ C3+ group (5/22, 22.7%), as well (p = 0.043). Multivariate Cox regression analysis revealed that IgM and C3 co-deposition was an independent risk factor associated with primary outcome (hazard ratio 3.355, 95% CI 1.349-8.344, p = 0.009). CONCLUSIONS Glomerular IgM and C3 co-deposition is a predictor of unfavorable renal outcomes in adult patients with primary FSGS.
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Affiliation(s)
- Safak Mirioglu
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey,
| | - Yasar Caliskan
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ahmet Burak Dirim
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zulal Istemihan
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Arif Akyildiz
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Yazici
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Isin Kilicaslan
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Sukru Sever
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Massy ZA, Caskey FJ, Finne P, Harambat J, Jager KJ, Nagler E, Stengel B, Sever MS, Vanholder R, Blankestijn PJ, Bruchfeld A, Capasso G, Fliser D, Fouque D, Goumenos D, Soler MJ, Rychlík I, Spasovski G, Stevens K, Wanner C, Zoccali C. Nephrology and Public Policy Committee propositions to stimulate research collaboration in adults and children in Europe. Nephrol Dial Transplant 2019; 34:1616. [PMID: 31361317 PMCID: PMC6736143 DOI: 10.1093/ndt/gfz154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bayraktar A, Catma Y, Akyildiz A, Demir E, Bakkaloglu H, Ucar AR, Dirim AB, Usta Akgul S, Temurhan S, Gok AFK, Ozluk Y, Kilicaslan I, Oguz FS, Sever MS, Aydin AE, Turkmen A. Infectious Complications of Induction Therapies in Kidney Transplantation. Ann Transplant 2019; 24:412-417. [PMID: 31296835 PMCID: PMC6652377 DOI: 10.12659/aot.915885] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Cytomegalovirus (CMV) and BK virus (BKV) are post-transplant opportunistic viral infections that affect patient and graft survival. This study was designed to evaluate the risk of BKV nephropathy and CMV disease in kidney transplant recipients who received induction therapy with ATG or basiliximab. Material/Methods We retrospectively analyzed information on 257 adult patients who underwent kidney transplantation between January 2007 and 2017. Patients were categorized into 3 groups according to the induction therapies. The primary endpoint was the onset of CMV disease or biopsy-confirmed BKV nephropathy. The secondary endpoints were biopsy-proven rejection episodes, graft loss, loss to follow-up, and death. Results We followed 257 patients for a median of 55.5 months. The incidence of CMV disease was significantly higher in the only ATG group compared to the group without induction treatment (p<0.001). There was no significant difference in the incidence of BKV nephropathy among groups (p>0.05). The dosage of ATG (OR, 10.685; 95% CI, 1.343 5 to 85.009; P=0.025) was independent risk factor for death. Conclusions This study demonstrated that a higher dosage of ATG in high-risk patients is associated with an increased risk of CMV disease and patient death, also, reducing the dosage may be a rational strategy for increasing graft and patient’s survival.
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Affiliation(s)
- Adem Bayraktar
- Department of General Surgery, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yunus Catma
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Arif Akyildiz
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Erol Demir
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Huseyin Bakkaloglu
- Department of General Surgery, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Riza Ucar
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ahmet Burak Dirim
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sebahat Usta Akgul
- Department of Medical Biology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sonay Temurhan
- Department of Medical Biology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Fuat Kaan Gok
- Department of General Surgery, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Isin Kilicaslan
- Department of Pathology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Fatma Savran Oguz
- Department of Medical Biology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Sukru Sever
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Emin Aydin
- Department of General Surgery, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Aksoy E, Mirioglu S, Uludag O, Ozluk Y, Demir E, Caliskan Y, Yazici H, Kilicaslan I, Turkmen A, Sever MS. SP181COMPARISON OF VARIOUS FEATURES AND OUTCOMES IN ADULT PATIENTS WITH IMMUNE COMPLEX MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS AND C3 GLOMERULOPATHY. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp181] [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: 11/14/2022] Open
Affiliation(s)
- Elif Aksoy
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Safak Mirioglu
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Omer Uludag
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Ozluk
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Erol Demir
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasar Caliskan
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Yazici
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Isin Kilicaslan
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Mirioglu S, Dertsiz B, Caliskan Y, Ozluk Y, Ucar AR, Yazici H, Kilicaslan I, Turkmen A, Sever MS. SP196EFFICACY OF RITUXIMAB IN ADULT PATIENTS WITH REFRACTORY PRIMARY FOCAL SEGMENTAL GLOMERULOSCLEROSIS. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp196] [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: 11/13/2022] Open
Affiliation(s)
- Safak Mirioglu
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Berkay Dertsiz
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasar Caliskan
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Ozluk
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Riza Ucar
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Yazici
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Isin Kilicaslan
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Mirioglu S, Uludag O, Aksoy E, Caliskan Y, Ozluk Y, Usta-Akgul S, Ucar AR, Yazici H, Kilicaslan I, Turkmen A, Sever MS. SP782EFFECTS OF A STANDARDIZED TREATMENT APPROACH ON KIDNEY TRANSPLANT RECIPIENTS WITH ANTIBODY-MEDIATED REJECTION. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp782] [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: 11/12/2022] Open
Affiliation(s)
- Safak Mirioglu
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Omer Uludag
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Elif Aksoy
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasar Caliskan
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Ozluk
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Ali Riza Ucar
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Yazici
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Isin Kilicaslan
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Dirim AB, Mirioglu S, Demir E, Ozluk Y, Caliskan Y, Yazici H, Kilicaslan I, Yildiz A, Turkmen A, Sever MS. SP184EFFICACY OF ECULIZUMAB IN PATIENTS WITH REFRACTORY C3 GLOMERULONEPHRITIS. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp184] [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: 11/13/2022] Open
Affiliation(s)
| | - Safak Mirioglu
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Erol Demir
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Ozluk
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yasar Caliskan
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Yazici
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Isin Kilicaslan
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Alaattin Yildiz
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Yegit O, Demir E, Caliskan Y, Yazici H, Sever MS. Different Courses of Hepatitis B Reinfection After Renal Transplant: A Case Report. EXP CLIN TRANSPLANT 2019; 17:408-410. [DOI: 10.6002/ect.2016.0063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Abstract
BACKGROUND Natural and technological mass disasters strike densely populated areas on a regular basis, causing ever growing numbers of deaths and injured, economical losses, social problems, and damage to the environment. OBJECTIVE OF THE REVIEW This review aims to provide a comprehensive idea about the spectrum of main problems, essentially presenting a number of basic principles to save as many lives as possible after natural and man-made mega disasters. DISCUSSION Medical problems following disasters may be acute, acute-on-chronic, or chronic; they appear from the disaster period up till long thereafter. All these problems may be nonspecific, or specific for particular disaster types. Decreasing death toll after mass disasters can be accomplished by preparations before, and effective medical response after disasters. These interventions should be considered at both national/governmental and regional/hospital levels. Disaster medicine, the art and science of providing healthcare to the victims, differs significantly from routine medical practice because of disparities between demand and supply of rescue and healthcare, the need for unusual medical interventions, and the occurrence of ethical and legal dilemmas. CONCLUSIONS Adherence to the principles of disaster medicine, is vital to minimize the extent of medical, logistic, ethical, and legal problems, and saving as many lives as possible.
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Affiliation(s)
- Mehmet Sukru Sever
- Department of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy; "Chiara Fama" Professor of Nephrology, Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Milan, Italy
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
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Abstract
Progress in patient care and immunosuppressive medications has resulted in improved allograft survival in the early posttransplant period; however, substantial graft loss continues in the long term. Therefore, the number of dialysis patients with failed allografts is increasing progressively. These patients have a worse prognosis than naive dialysis patients. Cardiovascular causes are the leading cause of death, followed by infections and malignancies. Delay in return to dialysis, a chronic inflammatory state, infections, and cancer are contributing factors to mortality, whereas type of dialysis modality does not have a significant effect on outcomes. Graft nephrectomy is a risky operation; therefore, it should not be a routine procedure and rather should be performed only when indicated. Overall, most grafts are left in place, whereas graft nephrectomy is performed in atients with graft intolerance syndrome. Management of immunosuppressive drugs after graft failure is controversial. In the case of maintaining immunosuppression, there is increased risk of infections, cardiovascular diseases, and malignancies and also steroid-related adverse effects. On the other hand, discontinuation of immunosuppressants may result in loss of residual allograft function and also acute graft inflammation. Together, immunosuppressive drugs are almost always discontinued in these patients because of their inherent adverse effects. Considering the sequence of cessation, first antiproliferative drugs are stopped, followed by calcineurin inhibitors, and finally steroids. Because many studies show a clear survival benefit, every attempt should be made for a retransplant in patients with failed renal allografts.
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Affiliation(s)
- Ali Riza Ucar
- From the Department of Internal Medicine, Division of Nephrology, Istanbul School of Medicine, Millet Caddesi, Capa, Istanbul, Turkey
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Demir E, Artan AS, Sunnetcioglu E, Usta Akgul S, Temurhan S, Kekik C, Catikkas NM, Caliskan Y, Yazici H, Savran FO, Turkmen A, Kilicaslan I, Ozluk Y, Sever MS. SP148THE EFFECT OF BIOMARKERS AND OXFORD CLASSIFICATION ON PROGRESSION OF Ig A NEPHROPATHY. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp148] [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: 11/14/2022] Open
Affiliation(s)
- Erol Demir
- Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ayse Serra Artan
- Department of Internal Medicine, Division of Nephrology, Bezmialem University, Istanbul, Turkey
| | - Ecem Sunnetcioglu
- Department of Pathology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sebahat Usta Akgul
- Department of Medical Biology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sonay Temurhan
- Department of Medical Biology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Cigdem Kekik
- Department of Medical Biology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Nezahat Muge Catikkas
- Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Yasar Caliskan
- Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Halil Yazici
- Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Fatma Oguz Savran
- Department of Medical Biology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Aydin Turkmen
- Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Isin Kilicaslan
- Department of Pathology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Sukru Sever
- Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Garayeva Guller N, Demir E, Ucar AR, Celik AM, Yazici H, Caliskan Y, Yildiz A, Turkmen A, Bozfakioglu S, Sever MS. SP690LONG-TERM OUTCOMES OFKIDNEY TRANSPLANTATIONIN GENETIC DISEASES. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp690] [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: 11/14/2022] Open
Affiliation(s)
- Nurana Garayeva Guller
- Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Erol Demir
- Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ali Rıza Ucar
- Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ayse Merve Celik
- Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Halil Yazici
- Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Yasar Caliskan
- Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Alaattin Yildiz
- Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Aydin Turkmen
- Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Semra Bozfakioglu
- Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Sukru Sever
- Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Demir E, Sunnetcioglu E, Aksoy E, Temurhan S, Akgül S, Artan AS, Catikkas NM, Kekik C, Yazici H, Caliskan Y, Kilicaslan I, Savran FO, Turkmen A, Ozluk Y, Sever MS. FP163GLOMERULAR DEPOSITION OF CD68 AND C4D: SIGNIFICANT MARKERS FOR PROGRESSION OF IGA NEPHROPATHY ? Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fp163] [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: 11/14/2022] Open
Affiliation(s)
- Erol Demir
- Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ecem Sunnetcioglu
- Department of Pathology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Elif Aksoy
- Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sonay Temurhan
- Department of Medical Biology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sebahat Akgül
- Department of Medical Biology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ayse Serra Artan
- Department of Internal Medicine, Division of Nephrology, Bezmialem University, Istanbul, Turkey
| | - Nezahat Muge Catikkas
- Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Cigdem Kekik
- Department of Medical Biology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Halil Yazici
- Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Yasar Caliskan
- Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Isin Kilicaslan
- Department of Pathology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Fatma Oguz Savran
- Department of Medical Biology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Aydin Turkmen
- Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Sukru Sever
- Department of Internal Medicine, Division of Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Demir E, Karaoglan C, Yegen G, Sair B, Yazici H, Turkmen A, Sever MS. Extreme hypercalcemia in a kidney transplant recipient. CEN Case Rep 2018; 7:229-233. [PMID: 29705974 DOI: 10.1007/s13730-018-0334-1] [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: 12/26/2017] [Accepted: 04/21/2018] [Indexed: 10/17/2022] Open
Abstract
Post-transplant hypercalcemia is a major problem in renal transplant recipients, which may negatively affect both graft and patient survival. In this paper, we present a 66-year-old male kidney transplant recipient, who was admitted to our clinic with symptoms of fever, nausea, vomiting and lethargy. Laboratory data showed good renal function; however, a serum calcium level of 22.1 mg/dL. The patient was treated by isotonic saline together with furosemide and methylprednisolone. Because of treatment resistance, subcutaneous calcitonin and ibandronate were added to the treatment protocol as well. Since all these medications were not effective, hemodialysis with low-calcium (1.25 mmol/L) dialysate was applied for three consecutive days, which resulted in normalization of serum calcium. Several investigations were carried out for diagnosing the underlying etiology. Positron-emission tomography (PET)/CT revealed a strong diffuse uptake of FDG in the bones and spleen. A bone marrow biopsy showed diffuse interstitial infiltration of CD20 + neoplastic B cells and, thus, post transplant lymphoproliferative disease (PTLD) was diagnosed. Tacrolimus was switched to everolimus, mycophenolate mofetil was stopped, while treatment with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) was initiated. Despite all therapeutic interventions, the patient died of septic shock in the intensive care unit on the 10th day of emergency service admission. Importance of hemodialysis as an emergent treatment modality in extreme hypercalcemia, and unfavorable course of PTLD were underlined.
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Affiliation(s)
- Erol Demir
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Cagla Karaoglan
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gulcin Yegen
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Betul Sair
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Yazici
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Sukru Sever
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Abstract
Tuberculosis is a major problem in the posttransplantation period, because of its high incidence and prevalence, difficulty in diagnosis as well as high risk of morbidity and mortality. In solid-organ transplant recipients, the diagnosis of tuberculosis is complex because it is paucisymptomatic. Tuberculin skin testing results may be negative, and interferon-gamma release assays may be insufficiently sensitive. Furthermore, imaging technique findings are mostly atypical, and sputum smear results can be negative despite the presence of active disease. Therefore, most tuberculosis cases are overlooked, and thus, treatment initiation is often delayed. The treatment of tuberculosis falls under 2 headings: that of active disease and latent disease. The drugs for treating these 2 entities are similar; however, their protocols are completely different. Active disease in the immunocompetent patient is treated mostly by giving isoniazid, rifampicin, pyrazinamide, and ethambutol for 2 months (intensive phase), followed by isoniazid and rifampicin for 4 months (continuation phase). The treatment of immunosuppressed patients is controversial; a similar protocol or longer duration of treatment has been suggested as compared to immunocompetent patients. Because there is a drug interaction between antituberculosis drugs (rifamycins) and immunosuppressants (calcineurin/mammalian target of rapamycin inhibitors and glucocorticoids), the risk of graft rejection increases during the treatment of tuberculosis. For the treatment of latent tuberculosis, in regions with a high prevalence of tuberculosis, universal prophylaxis with isoniazid for 6 months (preferably 9 months) has been recommended. In countries where the risk of tuberculosis is lower, no prophylaxis has been proposed. We propose that the best solution is to individualize therapy for patients at greatest risk of the disease. To conclude, posttransplant tuberculosis is still an important source of comorbidity in transplant recipients because of its high frequency, problems in diagnosis and treatment and association with increased risk of morbidity and mortality.
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Affiliation(s)
- Erol Demir
- Department of Nephrology, İstanbul School of Medicine, Millet Caddesi, Çapa, İstanbul, Turkey
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Caliskan Y, Torun ES, Tiryaki TO, Oruc A, Ozluk Y, Akgul SU, Temurhan S, Oztop N, Kilicaslan I, Sever MS. Immunosuppressive Treatment in C3 Glomerulopathy: Is it Really Effective? Am J Nephrol 2017; 46:96-107. [PMID: 28700996 DOI: 10.1159/000479012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 02/28/2017] [Accepted: 06/17/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND C3 glomerulopathy (C3GP) is a recently identified and described disease that has a high risk of progressing into end-stage renal disease. We aimed to evaluate the effects of various immunosuppressive regimens on C3GP progression because there are conflicting data on the treatment modalities. METHODS In this retrospective study of 66 patients with C3GP, 27 patients received mycophenolate mofetil (MMF)-based treatment, 23 received non-MMF-based treatment (prednisolone or cyclophosphamide), and 16 received conservative care. The study groups were compared with each other with specific focus on primary outcomes defined as (1) kidney failure and (2) estimated glomerular filtration rate (eGFR) decline ≥50% from the baseline value. RESULTS Overall, 17 (25.8%) patients reached the primary outcome after a median period of 28 months. The number of patients who reached the primary outcome were similar among the study groups (MMF-based: 8/27 [29.6%], non-MMF-based: 4/23 [17.4%], and conservative care: 5/16 [31.3%], p = 0.520). In the Cox regression analysis, age (HR 0.912, p = 0.006), eGFR (HR 0.945, p = 0.001), and proteinuria levels (HR 1.418, p = 0.015) at the time of biopsy, percentage of crescentic (HR 1.035, p = 0.001) and sclerotic glomeruli (HR 1.041, p = 0.006), severity of interstitial fibrosis (HR 1.981, p = 0.048), as well as no remission of proteinuria (HR 2.418, p = 0.002) predicted the primary outcome. CONCLUSION Although patients receiving immunosuppressive treatments had higher proteinuria and lower serum albumin at baseline, there were no differences between these patients and those receiving conservative care alone in proteinuria remission or in the decline of renal function. Younger age, higher proteinuria, lower eGFR, and the presence of crescentic and sclerotic glomeruli, severity of interstitial fibrosis, and no remission of proteinuria predicted the progression of kidney disease.
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Affiliation(s)
- Yasar Caliskan
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Temurhan S, Akgul SU, Caliskan Y, Artan AS, Kekik C, Yazici H, Demir E, Caliskan B, Turkmen A, Oguz FS, Sever MS. A Novel Biomarker for Post-Transplant Recurrent IgA Nephropathy. Transplant Proc 2017; 49:541-545. [PMID: 28340830 DOI: 10.1016/j.transproceed.2017.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The serum levels of galactose-deficient immunoglobulin (Ig)A1 (Gd-IgA1) represent the most promising candidate biomarker for IgA nephropathy (IgAN). The aim of this study was to evaluate the serum levels of Gd-IgA1 as a novel noninvasive biomarker for post-transplant IgAN recurrence. METHODS Serum Gd-IgA1 levels of 18 patients with recurrent IgAN were compared with control renal transplant recipients (n = 23) with non-recurrent IgAN and control non-transplant IgAN patients (n = 44) and healthy relatives (n = 11). Serum Gd-IgA1 levels of patients were measured with the use of KM55 enzyme-linked immunosorbent assay (ELISA). The effects of serum Gd-IgA1 concentrations on IgAN recurrence, post-transplant events, and graft survival were evaluated. RESULTS All recurrent IgAN patients presented with renal dysfunction (mean serum creatinine, 1.62 ± 0.39 mg/dL) and detectable proteinuria at the time of diagnosis. Serum Gd-IgA1 levels of recurrent IgAN patients (8735 ± 10854 ng/mL [log10: 3.71 ± 0.45]) were significantly higher than those of non-recurrent IgAN patients (4790 ± 6089 ng/μL [log10: 3.31 ± 0.64]) (P = .027). Serum Gd-IgA1 levels of non-transplant IgAN patients were significantly higher (8791 ± 8700 ng/μL [log10: 3.79 ± 0.36]) than those of non-recurrent IgAN patients (4790 ± 6089 ng/μL [log10: 3.31 ± 0.64]) and healthy relatives (2615 ± 1611 ng/μL [log10: 3.34 ± 0.27]) (P < .001 and P = .021, respectively). Receiver-operating characteristic curve analysis revealed that the area under the curve for recurrence of IgAN was 0.69 (0.53-0.85) for serum Gd-IgA1 (P = .038). Biopsy-confirmed allograft rejection rates were similar in the recurrent IgAN group [3 (17%)] compared with the non-recurrent IgAN [6 (26%)] group (P = .47). Graft failure rate was not also significantly different in the recurrent IgAN group [4 (22.2%)] compared with the non-recurrent IgAN group [2 (8.7%)] (P = .224). CONCLUSIONS This novel lectin-independent Gd-IgA1 ELISA that can detect serum Gd-IgA1 in patients with recurrent IgAN can be used as a biomarker for diagnosis and activity assessment of post-transplant recurrent IgAN.
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Affiliation(s)
- S Temurhan
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - S U Akgul
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Y Caliskan
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - A S Artan
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - C Kekik
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - H Yazici
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - E Demir
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - B Caliskan
- Haseki Training and Research Hospital, Pediatric Infectious Diseases Unit, Istanbul, Turkey
| | - A Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - F S Oguz
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - M S Sever
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Demir E, Tacar S, Sarihan I, Torun ES, Caliskan Y, Yazici H, Turkmen A, Sever MS. SP788EFFECTS OF IL-1β RECEPTOR ANTAGONIST IN KIDNEY TRANSPLANT RECIPIENTS. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx158.sp788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Demir E, Yeğit O, Erol A, Akgül SU, Çalışkan B, Bayraktar A, Çalışkan Y, Türkmen A, Savran FO, Sever MS. Relevance of Flow Cytometric Auto-Crossmatch to the Post-transplant Course of Kidney Transplant Recipients. Transplant Proc 2017; 49:477-480. [PMID: 28340816 DOI: 10.1016/j.transproceed.2017.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The crossmatch test is essential prior to kidney transplantation (tx) to confirm compatibility between the donor and the recipient. However, its results can be misleading due to "undetectable antibodies" in the recipient's serum. To establish if undetectable autoantibodies are responsible for a positive result, an auto-crossmatch test can be performed. In this study, we aim to determine the long-term prognostic value of auto-flow cytometric auto-crossmatch (FCXM) test on kidney survival in kidney tx recipients. MATERIALS AND METHODS The primary outcome variable was reduced renal function. Secondary endpoints were incidence of biopsy-confirmed chronic antibody-mediated rejection (CAMR) and recurrent glomerulonephritis (GN). RESULTS There were no differences regarding initial serum creatinine levels between the study and control groups (P = .441). Patients who had positive auto-B FCXM had a significantly reduced renal function compared with the control group (P = .016). Four patients developed biopsy-confirmed CAMR in the study group and 1 patient in the control group (P = .047). Five patients had biopsy-confirmed recurrent GN in the GN study group, and only 1 patient had recurrent GN in the GN control group (P = .026). DISCUSSION Kidney transplant recipients with positive auto-FCXM test had significantly reduced renal function and a higher incidence of recurrent GN and CAMR compared with the control group. The findings of this study suggest a potential role of auto-antibody causing positive auto-FCXM test result, meanwhile increasing the risk of CAMR, recurrent GN, and new-onset diabetes after tx.
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Affiliation(s)
- E Demir
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - O Yeğit
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A Erol
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - S U Akgül
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - B Çalışkan
- Haseki Training and Research Hospital, Pediatric Infectious Diseases Unit, Istanbul, Turkey
| | - A Bayraktar
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Y Çalışkan
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A Türkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - F O Savran
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - M S Sever
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Sever MS. Body Size and Outcomes in Dialysis and Transplant Patients - Does it Matter? ACTA ACUST UNITED AC 2016; 37:49-53. [PMID: 27883321 DOI: 10.1515/prilozi-2016-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The terminologies of "body size", "body mass index (BMI)", "body weight", "large BMI" and "obesity" are controversial for defining the effects of "adiposity" or "fat excess" on the outcomes of dialysis and transplant patients. However, probably these terminologies will be continued to be used in the future as well, because of being older and simpler terminologies. In the general population obesity is a powerful risk factor for cardiovascular morbidity and mortality, while, it conferred a survival advantage to dialysis patients. However, this may be a oversimplification, since obesity may still be a risk factor in non-sarcopenic hemodialysis patients. Obesity is associated with early post-transplant adverse effects (i.e. delayed graft function, graft failure, wound infections, also transplant costs) and unfavorable graft and patient survival. However, thanks to safer immunosuppressive protocols, recently graft and patient survival is similar in obese as those of the non-obese patients. On the other hand, morbid obesity may still be a cause of unfavorable patient and graft survival. Since obese transplant recipients have better life expectancy as compared to wait-listed hemodialysis patients, they should be transplanted as well, while morbidly obese patients should be asked to lose weight before being placed in the waiting lists.
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Akagun T, Yazici H, Caliskan Y, Ozluk Y, Sahin S, Turkmen A, Kılıcaslan I, Sever MS. The effect of histopathologic and clinical features on allograft survival in renal transplant patients with antibody-mediated rejection. Ren Fail 2016; 39:19-25. [PMID: 27776435 PMCID: PMC6014486 DOI: 10.1080/0886022x.2016.1244073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background: Antibody-mediated rejection is a frequent cause of graft failure; however, prognostic indications of this complication have not been well defined. The aim of this study was to evaluate the association of histopathological and clinical features and to determine the effect of these findings on allograft survival in patients with AMR. Methods: Fifty-two patients suffered from AMR (30 male; mean age 39 ± 11 years) were included in the study. Data were investigated retrospectively and graft survival was analyzed. All transplant biopsies were evaluated according to Banff 2009 classification. Results: Of the 52 cases, 45 were transplanted from living-donors. Twenty-one patients were diagnosed in the first 3-months after transplantation. Graft survival was 65% at 12 months and 54% at 36 months. Mean serum creatinine at time of biopsy was 3.8 ± 3.6 mg/dL. Thirty-five of the 52 cases showed diffuse C4d positivity, 12 cases showed focal and 5 remained C4d negative. One of the patients died, 13 experienced graft loss and 38 survived with functioning grafts. Serum creatinine levels at time of biopsy were correlated with graft survival (p = .021: OR = 1.10: 95 % CI = 1.015–1.199). In terms of the impact of pathological findings; tubulitis (p=.007: OR = 2.62: 95 % CI = 1.301–5.276), intimal arteritis (p=.017: OR = 2.85: 95% CI = 1.205–6.744) and interstitial infiltration (p=.004: OR = 3.37: 95% CI = 1.465–7.752) were associated with graft survival. Conclusions: Serum creatinine at time of biopsy, tubulitis, intimal arteritis and interstitial infiltration were significantly associated with graft survival. Antibody-mediated rejection is associated with reduced long-term graft survival.
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Affiliation(s)
- Tulin Akagun
- a Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Halil Yazici
- a Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Yasar Caliskan
- a Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Yasemin Ozluk
- b Department of Pathology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Sevgi Sahin
- c Nephrology Clinic , Acibadem Atakent Hospital , Istanbul , Turkey
| | - Aydin Turkmen
- a Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Isın Kılıcaslan
- b Department of Pathology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Mehmet Sukru Sever
- a Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey
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Asci G, Marcelli D, Celtik A, Grassmann A, Gunestepe K, Yaprak M, Tamer AF, Turan MN, Sever MS, Ok E. Comparison of Turkish and US haemodialysis patient mortality rates: an observational cohort study. Clin Kidney J 2016; 9:476-80. [PMID: 27274836 PMCID: PMC4886919 DOI: 10.1093/ckj/sfw027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 02/22/2016] [Accepted: 03/08/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are significant differences between countries in the mortality rates of haemodialysis (HD) patients. The extent of these differences and possible contributing factors are worthy of investigation. METHODS As of March 2009, all patients undergoing HD or haemodiafiltration for >3 months (n = 4041) in the Turkish clinics of the NephroCare network were enrolled. Data were prospectively collected for 2 years through the European Clinical Dialysis Database. Mean age ± standard deviation was 58.7 ± 14.7 years, 45.9% were female and 22.9% were diabetic. Comparison with US data was performed by applying an indirect standardization technique, using specific mortality rates for patients on HD by age, gender, race and primary diagnosis as provided by the 2012 US Renal Data System Annual Data Report as reference. RESULTS The crude mortality rate in Turkey was 95.1 per 1000 patient-years. Compared with the US reference population, the annual mortality rate for Turkey was significantly lower, irrespective of gender, age and diabetes. After adjustments for age, gender and diabetes, the mortality risk in the Turkish cohort was 50% lower than US whites [95% confidence interval (CI) 0.46-0.54, P < 0.001], 44% lower than US African-Americans (95% CI 0.52-0.61, P < 0.001) and 20% lower than Asian-Americans (95% CI 0.74-0.86, P < 0.05). CONCLUSIONS The annual mortality rate of prevalent HD patients was found to be significantly lower in the studied Turkish cohort compared with that published by the US Renal Data System Annual Data Report. Differences in practice patterns may contribute to the divergence.
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Affiliation(s)
- Gulay Asci
- Division of Nephrology , Ege University School of Medicine , Bornova, Izmir , Turkey
| | | | - Aygul Celtik
- Division of Nephrology , Ege University School of Medicine , Bornova, Izmir , Turkey
| | | | | | - Mustafa Yaprak
- Division of Nephrology , Ege University School of Medicine , Bornova, Izmir , Turkey
| | | | - Mehmet Nuri Turan
- Division of Nephrology , Ege University School of Medicine , Bornova, Izmir , Turkey
| | - Mehmet Sukru Sever
- Division of Nephrology , Istanbul University School of Medicine , Istanbul , Turkey
| | - Ercan Ok
- Division of Nephrology , Ege University School of Medicine , Bornova, Izmir , Turkey
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Artan AS, Kircelli F, Ok E, Yilmaz M, Asci G, Dogan C, Oto O, Gunestepe K, Basci A, Sever MS. Dialyzing women and men: does it matter? An observational study. Clin Kidney J 2016; 9:486-93. [PMID: 27274838 PMCID: PMC4886909 DOI: 10.1093/ckj/sfw013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/09/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Application and consequences of hemodialysis treatment may differ between genders; focusing on these differences may be useful to optimize outcomes. METHODS Data from 1 999 648 hemodialysis sessions performed in 10 984 (3316 incident and 7668 prevalent) patients, treated in 55 centers of the European Clinical Database (EuCliD)-Turkey, were analyzed, and various demographic, clinical, biochemical, therapeutic and prognostic parameters were compared. RESULTS There were 1905 male and 1411 female incident and 4339 male and 3329 female prevalent patients. For females, the mean age in incident (61.8 ± 14.9 years) and prevalent (58.3 ± 15.2 years) patients was higher than for males (60.2 ± 14.8 and 56.5 ± 14.9 years, respectively) (P < 0.001 for both analyses). Also, body mass index was higher, while the hemoglobin level, and the percentage of interdialytic weight gain and arteriovenous fistula were lower. Serum phosphorus was similar in both genders in incident cases, while it was lower in prevalent female patients. Serum parathyroid hormone levels were lower in incident, but higher in prevalent male cases. Erythropoiesis-stimulating agents and vitamin D preparations were more frequently used in female incident and prevalent patients. Hospitalization was more frequent in prevalent females, while it did not differ significantly in the incident cases. Overall, no significant difference was observed in survival rates at 3 years in both incident and prevalent male and female patients. CONCLUSIONS Many parameters differ significantly between female and male dialysis patients. Considering the effects of sex on several parameters may be a valuable approach for achieving better outcomes when formulating treatment strategies in this patient population.
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Affiliation(s)
- Ayse Serra Artan
- Division of Nephrology, Department of Internal Medicine , Istanbul Medical Faculty , Istanbul , Turkey
| | | | - Ercan Ok
- Ege Medical Faculty , Izmir , Turkey
| | - Murvet Yilmaz
- Bakirkoy Dr. Sadi Konuk Education and Research Hospital , Istanbul , Turkey
| | | | | | - Ozgur Oto
- Division of Nephrology, Department of Internal Medicine , Istanbul Medical Faculty , Istanbul , Turkey
| | | | - Ali Basci
- Ege Medical Faculty , Izmir , Turkey
| | - Mehmet Sukru Sever
- Division of Nephrology, Department of Internal Medicine , Istanbul Medical Faculty , Istanbul , Turkey
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Sever MS, Goral S. Kidney transplantation due to medical urgency: time for reconsideration? Nephrol Dial Transplant 2016; 31:1376-7. [PMID: 27190364 DOI: 10.1093/ndt/gfw035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 01/31/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Simin Goral
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Yilmaz M, Kircelli F, Artan AS, Oto O, Asci G, Gunestepe K, Basci A, Ok E, Sever MS. Naturally nonanemic dialysis patients: Who are they? Hemodial Int 2016; 20:522-529. [PMID: 27147461 DOI: 10.1111/hdi.12425] [Citation(s) in RCA: 2] [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] [Indexed: 11/29/2022]
Abstract
Introduction Not only anemia, but also erythropoiesis stimulating agent (ESA)s for treating anemia may adversely affect prognosis of chronic hemodialysis patients. Various features of naturally (with no ESA usage) nonanemic patients may be useful for defining several factors in the pathogenesis of anemia. Methods Data, retrieved from the European Clinical Database (EuCliD)-Turkey on naturally nonanemic prevalent chronic hemodialysis patients (n: 201) were compared with their anemic (those who required ESA treatment) counterparts (n: 3948). Findings Mean hemoglobin values were 13.5 ± 0.8 and 11.5 ± 0.9 g/dL in nonanemic and anemic patients, respectively (P < 0.001). Nonanemia status was associated with younger age, male gender, longer dialysis vintage, nondiabetic status, more frequent hepatitis-C virus seropositivity and more frequent arteriovenous fistula usage. Serum ferritin and CRP levels and urea reduction ratio were higher in ESA-requiring patients. One (99%) and two (95.3%) years survival rates of the "naturally nonanemic" patients were superior as compared to anemics (91.0% and 82.6%, respectively), (P < 0.001). Discussion "Naturally nonanemic" status is associated with better survival in prevalent chronic hemodialysis patients; underlying mechanisms in this favorable outcome should be investigated by randomized controlled trials including large number of patients.
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Affiliation(s)
- Murvet Yilmaz
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Nephrology, Istanbul, Turkey.
| | - Fatih Kircelli
- Fresenius Medical Care, Department of Nephrology, Turkey
| | - Ayse Serra Artan
- Istanbul Medical Faculty, Department of Nephrology, Istanbul, Turkey
| | - Ozgur Oto
- Istanbul Medical Faculty, Department of Nephrology, Istanbul, Turkey
| | - Gulay Asci
- Ege Medical Faculty, Department of Nephrology, Izmir, Turkey
| | | | - Ali Basci
- Ege Medical Faculty, Department of Nephrology, Izmir, Turkey
| | - Ercan Ok
- Ege Medical Faculty, Department of Nephrology, Izmir, Turkey
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