Kidney graft functionality 1 year after kidney transplantation

OBJECTIVE

To determine the evolution, associated factors and the outcomes of transplanted people one year after the evolution of a cohort in Mexico.

METHOD

Kidney transplant cohort from 2013 to 2017 in Mexico. 1118 patients were analyzed. Five outcomes were studied: overall survival, kidney graft, patient survival, delayed function, and acute dysfunction. Kaplan-Meier was used for kidney graft survival. For risk, bivariate and multivariate analyzes were performed with a significant value of p < 0.05.

RESULTS

Of the 1118 kidney transplant patients, 57 (5.09%) had kidney graft loss, 52 (4.65%) died during the one-year follow-up; survival of the patient of 95.35% and of the graft 90.25%.

CONCLUSIONS

The risk factors for the outcomes were transplantation from a deceased donor, recipient over 50 years of age and use of polyclonal agents. Infections and age are related to the death of the patient.

[Holter heart rhythm disorders in patients with acute kidney injury during hemodialysis]

BACKGROUND

The presence of acute renal injury has been associated with increased cardiovascular morbidity and mortality (sudden death and arrhythmias).

OBJECTIVE

To know the frequency of heart rhythm disorders documented by Holter in patients in need of intermittent hemodialysis due to acute renal injury.

MATERIAL AND METHODS

A prospective observational study was conducted including patients with a diagnosis of acute renal injury who received intermittent hemodialysis; demographic, clinical and laboratory data were collected from 28 patients. Monitoring was carried out through Holter before, during and after the hemodialysis session. Nonparametric statistics were used, with a significant value of p < 0.05. Risks were established with logistic regression.

RESULTS

There was a significant difference in supraventricular extra systoles (82.1% vs. 57.1%), ventricular extra systoles (26.7% vs. 3.6%), and supraventricular tachycardia (6.7% vs. 3.6%). The rest of the rhythm alterations without significance.

CONCLUSIONS

Intermittent hemodialysis is a factor associated with the appearance of heart rhythm disorders. The death of patients with acute renal injury and substitution was related to ventricular extra systole detected by transhemodialysis Holter.

Change in the Pattern of Posttransplantation Anemia in Kidney Receptors: Sex Role in Recipients and Type of Donor

OBJECTIVE

Posttransplant anemia (PTA) in kidney recipients is a complication that has repercussions mainly of cardiovascular consequence. The objective of this study is to determine the prevalence of anemia, as well as the relationship between kidney recipient and donor sex, in the presence or absence of anemia at 12 months after kidney transplant (KT).

MATERIAL AND METHODS

Observational, longitudinal study of KTs made over a 5-year period, from 2013 to 2017, in a renal transplant unit from La Raza National Health Care Medical Center. Three hundred twenty-eight records were analyzed. Hemoglobin (Hb) and the presence or absence of anemia according to the definition by the World Health Organization were analyzed. The association between kidney recipient sex and donor type (living or deceased) was evaluated. Analysis of central tendency and dispersion were performed and the mean difference was established with χ² test or Student t test. Significance level was set at P < .05.

RESULTS

The mean Hb (standard deviation) before KT was 10.38 (2.16) g/dL; Hb at 12 months was 14.47 (2.37) g/dL with an absolute increase of 4.09 g/dL. Before KT, male kidney recipients had a mean Hb of 10.54 (2.17) g/dL. At 12 months post-KT, mean Hb was 15.33 (2.25) with a change of 4.79 g/dL. Before KT, female kidney recipients had a mean Hb of 10.16 (2.13) g/dL. At 12 months post-KT, mean Hb was 13.31 (2.01) with a change of 3.15 g/dL. The difference between both sexes was 1.64 g/dL at the end of 12 months. Sixteen out of 152 (10.5%) patients had a serum creatinine (Cr) < 1.2 mg/dL and anemia; 36 out of 176 (20.5%) patients had a Cr ≥ 1.2 mg/dL and anemia (P = .014). In the bivariate logistic regression with an odds ratio of 2.047 (95% confidence interval, 1027-4078; P = .042) for higher Cr levels and the presence of persistent anemia.

CONCLUSIONS

There is a prevalence of anemia in female kidney recipients and recipients of kidneys from deceased donors. There is a higher risk of persistent anemia in the case of patients with some degree of graft failure at 12 months.

Alelos HLA más comunes y asociados con riesgo o protección en enfermedad renal crónica de etiología no determinada

Introduction

Chronic kidney disease accounts for part of overall health expenditure; a potential etiology is related to variations, absence or presence of some human leukocyte antigen (HLA) alleles.

Method

An analysis of HLA reports of 1965 kidney recipients with no determined etiology, and 1361 kidney donors was performed. It was carried out with Luminex based in cell flow fluorometry for the A, B, DRB1 and DQA loci. An analysis was performed with contingency tables in order to determine the odds ratio (OR) and confidence intervals (CI). Quantitative analysis was also carried out.

Results

Of the 101 alleles found, 13 showed association, 7 with risk for chronic kidney disease, with the most significant being HLA-DR17 with an OR of 3.91 (95 % CI = 2.96-5.17) and the one with the highest significance for protection being HLA-DR9, with an OR of 0.043 (95 % CI = 0.005-0.3224).

Conclusions

It is necessary to understand that kidney diseases can be associated with yet unknown immune processes, where the association of the absence or presence of any allele should be known.

[Factors associated with uncontrolled hypertension]

OBJECTIVE

To assess health care characteristics for hypertensive patients and their association with uncontrolled hypertension in a primary care outpatient clinic.

MATERIAL AND METHODS

DESIGN

Cross-sectional.A review was conducted of 50% of 8080 (n= 4040) files. Patient, physician and primary health care clinic characteristics were recorded.

RESULTS

The factors associated with uncontrolled hypertension were: age (OR, 1.43; CI95% : 1.015-1.030), BMI (OR, 1.03; CI95%: 1.02-1.05), creatinine serum levels (OR, 1.16; CI95%: 1.03-1.30), three or more different antihypertensive drugs (OR, 1.48; CI95%: 1.31-1.07), to be treated by a physician with more than 20 years of medical practice (OR, 1.21; CI95%; 1.06-1.39) or by a non-specialist physician (OR, 1.43; CI95%: 1.20-1.71) and to be treated in the morning shift (OR, 1.21; CI95%: 1.07- 1.56).

CONCLUSIONS

Hypertension is well-controlled in the majority of patients. Patient-related factors are important in uncontrolled hypertension; however, health care system characteristics also play an important role.

[Hyperleptinemia as a risk factor in obesity-related hypertension]

BACKGROUND AND OBJECTIVE

Obesity is a risk factor for high blood pressure (HBP). However, the mechanism has not been dilucidated yet. High concentrations of leptin (LEP) contributing to an increased blood pressure in obese patients via increase in the activity of the sympathetic nervous system. We explored the physiopathologic role of hyperleptinemia in HBP with regard to obesity.

SUBJECTS AND METHOD

Prospective and comparative study. Between February 2001 and December 2002, we studied 499 subjects, 255 with HBP and 244 without hypertension. The relationship between weight, LEP, insulin, and serum lipids with blood pressure was assessed.

RESULTS

Patients with HBP versus patients without HBP had a higher body mass index (30.4 +/- 3.9 to 25.5 +/- 1.7 kg/m2) (p < 0.01), higher serum concentrations of: creatinine (0.99 +/- 0.16 to 0.88 +/- 0.16 mg/dl), total cholesterol (219.5 +/- 50.4 to 190.6 +/- 40.0 mg/dl), cLDL (126.9 +/- 52.2 to 108.3 +/- 53.3 mg/dl), triglycerides (221.1 +/- 123.8 to 164.5 +/- 86.5 mg/dl), LEP (14.9 +/- 8.4 to 6.7 +/- 3.5 ng/ml) and insulin (24.2 +/- 6.5 to 16.8 +/- 4.7 mU/ml) (p < 0.01). In the univariate and multivariate analysis, obesity, dyslipidemia, hyperleptinemia and hyperinsulinemia were independent risk factors for HBP (p < 0.01).

CONCLUSIONS

We suggest that hyperleptinemia has a direct role in the physiopathologic mechanism of obesity-associated HBP, and it could be considered as an independent risk factor for HBP and cardiovascular disease.