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Marra G, Tappero S, Barletta F, Marquis A, Allasia M, Oderda M, Dariane C, Timsit MO, Branchereau J, Mesnard B, Tilki D, Olsburgh J, Kulkarni M, Kasivisvanathan V, Lebacle C, Breda A, Galfano A, Gandaglia G, Briganti A, Montorsi F, Biancone L, Gontero P. Radical Prostatectomy for Nonmetastatic Prostate Cancer in Renal Transplant Recipients: Outcomes for a Large Contemporary Cohort and a Matched Comparison to Patients Without a Transplant. Eur Urol Focus 2024:S2405-4569(24)00042-7. [PMID: 38453584 DOI: 10.1016/j.euf.2024.02.008] [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: 12/04/2023] [Revised: 01/29/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND AND OBJECTIVE It is unknown whether renal transplant receipt (RTR) status can affect perioperative and oncological outcomes of radical prostatectomy (RP). Our aim was to evaluate oncological and functional outcomes of RTR patients treated with RP for cN0M0 prostate cancer (PCa) via comparison with a no-RTR cohort. METHODS RTR patients who had undergone RP at seven European institutions during 2001-2022 were identified. A multi-institutional cohort of no-RTR patients treated with RP during 2004-2022 served as the comparator group. Propensity score matching (PSM) at a ratio of 1:4 was used to match no-RTR patients to the RTR cohort according to age, prostate-specific antigen, and final pathology features. We used Kaplan-Meier plots and multivariable Cox, logistic, and Poisson log-linear regression models to test the outcomes of interest. KEY FINDINGS AND LIMITATIONS After PSM, we analyzed data for 102 RTR and 408 no-RTR patients. RTR patients experienced higher estimated blood loss (EBL), longer length of hospital stay (LOS) and time to catheter removal, higher postoperative complication rates, and a lower continence recovery rate (all p < 0.001). On multivariable analyses, RTR independently predicted unfavorable operative time (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.18-1.25), LOS (OR 1.57, 95% CI 1.32-1.86), EBL (OR 2.24, 95% CI 2.18-2.30), and time to catheter removal (OR 1.93, 95% CI 1.68-2.21), but not complications or continence recovery. There were no significant differences for any oncological outcomes (biochemical recurrence, local or systemic progression) between the RTR and no-RTR groups. While no PCa deaths were recorded, the overall mortality rate was significantly higher in the RTR group (17% vs 0.5%, p < 0.001). CONCLUSIONS AND CLINICAL IMPLICATIONS Although RP is feasible for RTR patients, the procedure poses non-negligible surgical challenges, with longer operative time and LOS and higher EBL, but no major differences in terms of complications and continence recovery. The RTR group had similar oncological outcomes to the no-RTR group but significantly higher overall mortality related to causes other than PCa. Therefore, careful selection for RP is required among candidates with previous RTR. PATIENT SUMMARY Removal of the prostate for prostate cancer is possible in patients who have had a kidney transplant, and cancer control outcomes are comparable to those for the general population. However, transplant patients have a higher risk of death from causes other than prostate cancer and the prostate surgery is likely to be more challenging.
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Affiliation(s)
- Giancarlo Marra
- Department of Surgical Sciences, Division of Urology, University of Turin and Città della Salute e della Scienza, Turin, Italy.
| | - Stefano Tappero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Francesco Barletta
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Marquis
- Department of Surgical Sciences, Division of Urology, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Marco Allasia
- Department of Surgical Sciences, Division of Urology, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Marco Oderda
- Department of Surgical Sciences, Division of Urology, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Charles Dariane
- Department of Urology, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Julien Branchereau
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
| | - Benoit Mesnard
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
| | - Derya Tilki
- Department of Urology, Martini Klinik, Hamburg, Germany
| | | | | | | | - Cedric Lebacle
- Department of Urology, Kremlin-Bicêtre Hospital, Le Kremlin-Bicêtre, Paris, France
| | - Alberto Breda
- Department of Urology, Fundacio Puigvert, Barcelona, Spain
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Luigi Biancone
- Department of Nephrology, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Paolo Gontero
- Department of Surgical Sciences, Division of Urology, University of Turin and Città della Salute e della Scienza, Turin, Italy
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Pernin V, Glyda M, Viklický O, Lõhmus A, Wennberg L, Witzke O, von Zur-Mühlen B, Anaokar S, Hurst M, Kazeem G, Undre N, Kuypers DRJ. Long-term Prolonged-release Tacrolimus-based Immunosuppression in De Novo Kidney Transplant Recipients: 5-Y Prospective Follow-up of Patients in the ADVANCE Study. Transplant Direct 2023; 9:e1432. [PMID: 36875940 DOI: 10.1097/TXD.0000000000001432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/15/2022] [Indexed: 02/11/2023] Open
Abstract
Although prolonged-release tacrolimus (PR-T) is widely approved for posttransplantation immunosuppression in kidney recipients, large-scale studies are required to assess long-term outcomes. We present follow-up data from the Advagraf-based Immunosuppression Regimen Examining New Onset Diabetes Mellitus in Kidney Transplant Recipients (ADVANCE) trial, in which kidney transplant patients (KTPs) received corticosteroid minimization with PR-T. Methods ADVANCE was a 24-wk, randomized, open-label, phase-4 study. De novo KTPs received PR-T with basiliximab and mycophenolate mofetil and were randomized to receive an intraoperative corticosteroid bolus plus tapered corticosteroids until day 10 (arm 1) or an intraoperative corticosteroid bolus (arm 2). In this 5-y, noninterventional follow-up, patients received maintenance immunosuppression according to standard practice. The primary endpoint was graft survival (Kaplan-Meier). Secondary endpoints included patient survival, biopsy-confirmed acute rejection-free survival, and estimated glomerular filtration rate (4-variable modification of diet in renal disease). Results Follow-up study included 1125 patients. Overall graft survival at 1 and 5 y posttransplantation was 93.8% and 88.1%, respectively, and was similar between treatment arms. At 1 and 5 y, patient survival was 97.8% and 94.4%, respectively. Five-year graft and patient survival rates in KTPs who remained on PR-T were 91.5% and 98.2%, respectively. Cox proportional hazards analysis demonstrated similar risk of graft loss and death between treatment arms. Five-year biopsy-confirmed acute rejection-free survival was 84.1%. Mean ± standard deviation values of estimated glomerular filtration rate were 52.7 ± 19.5 and 51.1 ± 22.4 mL/min/1.73 m2 at 1 and 5 y, respectively. Fifty adverse drug reactions were recorded, probably tacrolimus-related in 12 patients (1.5%). Conclusions Graft survival and patient survival (overall and for KTPs who remained on PR-T) were numerically high and similar between treatment arms at 5 y posttransplantation.
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Zeng S, Yang Y, Li S, Hocher CF, Chu C, Wang Z, Zheng Z, Krämer BK, Hocher B. 25(OH)D-but not 1,25(OH) 2D-Is an independent risk factor predicting graft loss in stable kidney transplant recipients. Front Med (Lausanne) 2023; 10:1141646. [PMID: 37153084 PMCID: PMC10156982 DOI: 10.3389/fmed.2023.1141646] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Background Vitamin D deficiency (VDD) or vitamin D insufficiency is common in kidney transplant recipients (KTRs). The impact of VDD on clinical outcomes in KTRs remain poorly defined and the most suitable marker for assessing vitamin D nutritional status in KTRs is unknown so far. Methods We conducted a prospective study including 600 stable KTRs (367 men, 233 women) and a meta-analysis to pool existing evidence to determine whether 25(OH)D or 1,25(OH)2D predicted graft failure and all-cause mortality in stable KTRs. Results Compared with a higher 25(OH)D concentration, a low concentration of 25(OH)D was a risk factor for graft failure (HR 0.946, 95% CI 0.912-0.981, p = 0.003), whereas 1,25 (OH)2D was not associated with the study end-point graft loss (HR 0.993, 95% CI 0.977-1.009, p = 0.402). No association was found between either 25(OH)D or 1,25 (OH)2D and all-cause mortality. We furthermore conducted a meta-analysis including 8 studies regarding the association between 25(OH)D or 1,25(OH)2D and graft failure or mortality, including our study. The meta-analysis results were consistent with our study in finding that lower 25(OH)D levels were significantly associated with the risk of graft failure (OR = 1.04, 95% CI: 1.01-1.07), but not associated with mortality (OR = 1.00, 95% CI: 0.98-1.03). Lower 1,25(OH)2D levels were not associated with the risk of graft failure (OR = 1.01, 95% CI: 0.99-1.02) and mortality (OR = 1.01, 95% CI: 0.99-1.02). Conclusion Baseline 25(OH)D concentrations but not 1,25(OH)2D concentrations were independently and inversely associated with graft loss in adult KTRs.
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Affiliation(s)
- Shufei Zeng
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yide Yang
- Key Laboratory of Molecular Epidemiology of Hunan Province, Changsha, China
| | - Shuping Li
- Department of Nephrology, Center of Kidney and Urology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Carl-Friedrich Hocher
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology/Pneumonology), University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
- Klinik für Innere Medizin, Bundeswehrkrankenhaus Berlin, Berlin, Germany
| | - Chang Chu
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology/Pneumonology), University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Ziqiang Wang
- Department of Nephrology, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Zhihua Zheng
- Department of Nephrology, Center of Kidney and Urology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Bernhard K. Krämer
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology/Pneumonology), University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
- European Center for Angioscience (ECAS), Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Berthold Hocher
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology/Pneumonology), University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
- Institute of Medical Diagnostics, IMD, Berlin, Germany
- *Correspondence: Berthold Hocher,
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Marra G, Soria F, Peretti F, Oderda M, Dariane C, Timsit MO, Branchereau J, Hedli O, Mesnard B, Tilki D, Olsburgh J, Kulkarni M, Kasivisvanathan V, Lebacle C, Rodriguez-Faba O, Breda A, Soeterik T, Gandaglia G, Todeschini P, Biancone L, Gontero P. Prostate Cancer in Renal Transplant Recipients: Results from a Large Contemporary Cohort. Cancers (Basel) 2022; 15:cancers15010189. [PMID: 36612184 PMCID: PMC9818510 DOI: 10.3390/cancers15010189] [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: 09/19/2022] [Revised: 10/18/2022] [Accepted: 11/18/2022] [Indexed: 12/31/2022] Open
Abstract
Objectives: The aim of this study was to assess the natural history of prostate cancer (PCa) in renal transplant recipients (RTRs) and to clarify the controversy over whether RTRs have a higher risk of PCa and poorer outcomes than non-RTRs, due to factors such as immunosuppression. Patients and Methods: We performed a retrospective multicenter study of RTRs diagnosed with cM0 PCa between 2001 and 2019. Primary outcomes were overall (OS) and cancer-specific survival (CSS). Secondary outcomes included biochemical recurrence and/or progression after active surveillance (AS) and evaluation of variables possibly influencing PCa aggressiveness and outcomes. Management modalities included surgery, radiation, cryotherapy, HIFU, AS, and watchful waiting. Results: We included 166 men from nine institutions. Median age and eGFR at diagnosis were 67 (IQR 60−73) and 45.9 mL/min (IQR 31.5−63.4). ASA score was >2 in 58.4% of cases. Median time from transplant to PCa diagnosis was 117 months (IQR 48−191.5), and median PSA at diagnosis was 6.5 ng/mL (IQR 5.02−10). The biopsy Gleason score was ≥8 in 12.8%; 11.6% and 6.1% patients had suspicion of ≥cT3 > cT2 and cN+ disease. The most frequent management method was radical prostatectomy (65.6%), followed by radiation therapy (16.9%) and AS (10.2%). At a median follow-up of 60.5 months (IQR 31−106) 22.9% of men (n = 38) died, with only n = 4 (2.4%) deaths due to PCa. Local and systemic progression rates were 4.2% and 3.0%. On univariable analysis, no major influence of immunosuppression type was noted, with the exception of a protective effect of antiproliferative agents (HR 0.39, 95% CI 0.16−0.97, p = 0.04) associated with a decreased risk of biochemical recurrence (BCR) or progression after AS. Conclusion: PCa diagnosed in RTRs is mainly of low to intermediate risk and organ-confined at diagnosis, with good cancer control and low PCa death at intermediate follow-up. RTRs have a non-negligible risk of death from causes other than PCa. Aggressive upfront management of the majority of RTRs with PCa may, therefore, be avoided.
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Affiliation(s)
- Giancarlo Marra
- Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, 10126 Turin, Italy
- Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, 75014 Paris, France
- Department of Urology, Hôpital Tenon, 75020 Paris, France
- Correspondence: ; Tel./Fax: +39-0116337591
| | - Francesco Soria
- Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, 10126 Turin, Italy
| | - Federica Peretti
- Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, 10126 Turin, Italy
| | - Marco Oderda
- Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, 10126 Turin, Italy
| | - Charles Dariane
- Department of Urology, Hôpital Européen Georges Pompidou, 75015 Paris, France
| | - Marc-Olivier Timsit
- Department of Urology, Hôpital Européen Georges Pompidou, 75015 Paris, France
| | - Julien Branchereau
- Institut de Transplantation Urologie Nèphrologie (ITUN), CHU Nantes, 44093 Nantes, France
- Nuffield Department of Surgical Sciences, Oxford University, Oxford OX1 2JD, UK
| | - Oussama Hedli
- Institut de Transplantation Urologie Nèphrologie (ITUN), CHU Nantes, 44093 Nantes, France
| | - Benoit Mesnard
- Institut de Transplantation Urologie Nèphrologie (ITUN), CHU Nantes, 44093 Nantes, France
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany
| | | | | | | | - Cedric Lebacle
- Department of Urology, Kremlin-Bicêtre Hospital, 94270 Le Kremlin-Bicêtre, France
| | | | - Alberto Breda
- Department of Urology, Fundacio Puigvert, 08025 Barcelona, Spain
| | - Timo Soeterik
- Department of Urology, Saint Antonius Hospital, 3543 AZ Utrecht, The Netherlands
| | | | - Paola Todeschini
- Department of Nephrology, Sant’Orsola Malpighi Hospital, 40138 Bologna, Italy
| | - Luigi Biancone
- Department of Nephrology, Sant’Orsola Malpighi Hospital, 40138 Bologna, Italy
- Department of Nephrology, University of Turin and Città della Salute e della Scienza, 10126 Turin, Italy
| | - Paolo Gontero
- Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, 10126 Turin, Italy
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Pani A, Capasso G. Global Dialysis Perspective: Italy. Kidney360 2022; 3:1948-1952. [PMID: 36514410 PMCID: PMC9717646 DOI: 10.34067/kid.0007462021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 08/26/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Antonello Pani
- Nephrology and Dialysis, Università degli Studi di Cagliari, G. Brotzu Hospital, Cagliari, Italy
| | - Giovambattista Capasso
- Department of Translational Medical Science, University of Campania Luigi Vanvitelli, Naples, Italy
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Akbariromani H, Haseeb R, Nazly S, Pandey S, Anirudh Chunchu V, Dhakal S, Claudine Avena MA, Ali N. Efficacy of Direct Renin Inhibitors in Slowing Down the Progression of Diabetic Kidney Disease: A Meta-Analysis. Cureus 2022; 14:e28608. [PMID: 36204481 PMCID: PMC9527562 DOI: 10.7759/cureus.28608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2022] [Indexed: 11/14/2022] Open
Abstract
Albuminuria is a risk factor for chronic kidney disease and cardiovascular events in diabetic people. The pathogenic processes in these circumstances have been documented to be significantly influenced by enhanced renin-angiotensin system activity. The current meta-analysis was carried out to assess the efficacy of direct renin inhibitors in preventing the progression of diabetic kidney disease. This meta-analysis was conducted as per the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched the relevant medical literature through PubMed, Cochrane library and EMBASE. The primary efficacy outcome was a percentage change in urine albumin-creatinine ratio (UACR) (in mg/g) level. Other primary efficacy outcomes included remission from microalbuminuria to normal albuminuria and progression from microalbuminuria to macroalbuminuria. Four randomized control studies were identified and included in the current meta-analysis involving 9,609 participants. The use of direct renin inhibitors was superior in reducing mean UACR compared to angiotensin receptor blockers and angiotensin-converting enzyme inhibitors. The pooled mean difference in UACR between direct renin inhibitors and the control group was 9.42% (95% CI: -15.70 to -3.15: p-value=0.003). The odds of progression from microalbuminuria to normal albuminuria are 1.26 times higher in patients receiving direct renin inhibitors compared to patients in the control group (OR: 1.26, 95% CI: 1.08-1.46, p-value=0.002). The odds of remission from microalbuminuria to macroalbuminuria were 20% lower in patients receiving direct renin inhibitors compared to patients in the control group (OR: 0.80, 95% CI: 0.69-0.93, p-value=0.003). The use of aliskiren is associated with a significant reduction in UACR, increased remission from microalbuminuria to normal albuminuria and decreased progression from microalbuminuria to macroalbuminuria.
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Lefuel P, Bollondi Pauly C, Dufey Teso A, Martin PY, Escher M, Séchaud L, Da Rocha G. « Jeux sérieux », une nouvelle approche pour aborder le projet de soins anticipé avec les patients dialysés. Nephrol Ther 2022; 18:263-269. [DOI: 10.1016/j.nephro.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 12/01/2022]
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Marra G, Agnello M, Giordano A, Soria F, Oderda M, Dariane C, Timsit MO, Brancherau J, Hedli O, Mesnard B, Tilki D, Olsburgh J, Kulkarni M, Kasivisvanathan V, Breda A, Biancone L, Gontero P. Robotic Radical Prostatectomy for Prostate Cancer in Renal Transplant Recipients: Results from a Multicenter Series. Eur Urol 2022; 82:639-645. [PMID: 35750583 DOI: 10.1016/j.eururo.2022.05.024] [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: 03/13/2022] [Revised: 05/19/2022] [Accepted: 05/26/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Despite an expected increase in prostate cancer (PCa) incidence in the renal transplant recipient (RTR) population in the near future, robot-assisted radical prostatectomy (RARP) in these patients has been poorly detailed. It is not well understood whether results are comparable to RARP in the non-RTR setting. OBJECTIVE To describe the surgical technique for RARP in RTR and report results from our multi-institutional experience. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective review of the experience of four referral centers. SURGICAL PROCEDURE Transperitoneal RARP with pelvic lymph node dissection in selected patients. MEASUREMENTS We measured patient, PCa, and graft baseline features; intraoperative and postoperative parameters; complications, (Clavien classification); and oncological and functional outcomes. RESULTS AND LIMITATIONS We included 41 men. The median age, American Society of Anesthesiologists score, preoperative renal function, and prostate-specific antigen were 60 yr (interquartile range [IQR] 57-64), 2 points (IQR 2-3), 45 ml/min (IQR 30-62), and 6.5 ng/ml (IQR 5.2-10.2), respectively. Four men (9.8%) had a biopsy Gleason score >7. The majority of the patients (70.7%) did not undergo lymphadenectomy. The median operating time, hospital stay, and catheterization time were 201 min (IQR 170-250), 4 d (IQR 2-6), and 10 d (IQR 7-13), respectively. At final pathology, 11 men had extraprostatic extension and seven had positive surgical margins. At median follow-up of 42 mo (IQR 24-65), four men had biochemical recurrence, including one case of local PCa persistence and one local recurrence. No metastases were recorded while two patients died from non-PCa-related causes. Continence was preserved in 86.1% (p not applicable) and erections in 64.7% (p = 0.0633) of those who were continent/potent before the procedure. Renal function remained unchanged (p = 0.08). No intraoperative complications and one major (Clavien 3a) complication were recorded. CONCLUSIONS RARP in RTR is safe and feasible. Overall, operative, oncological, and functional outcomes are comparable to those described for the non-RTR setting, with graft injury remaining undescribed. Further research is needed to confirm our findings. PATIENT SUMMARY Robot-assisted removal of the prostate is safe and feasible in patients who have a kidney transplant. Cancer control, urinary and sexual function results, and surgical complications seem to be similar to those for patients without a transplant, but further research is needed.
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Affiliation(s)
- Giancarlo Marra
- Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy; Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France; Department of Urology, Hôpital Tenon, Paris, France.
| | - Marco Agnello
- Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Andrea Giordano
- Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Francesco Soria
- Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Marco Oderda
- Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Charles Dariane
- Department of Urology, Hôpital Européen Georges Pompidou and Necker Hospital, Paris, France
| | - Marc-Olivier Timsit
- Department of Urology, Hôpital Européen Georges Pompidou and Necker Hospital, Paris, France
| | - Julien Brancherau
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
| | - Oussama Hedli
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
| | - Benoit Mesnard
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey
| | | | | | - Veeru Kasivisvanathan
- Department of Urology, Guy's Hospital, London, UK; Division of Surgery, University College London, London, UK
| | - Alberto Breda
- Department of Urology, Fundacio Puigvert, Barcelona, Spain
| | - Luigi Biancone
- Department of Nephrology, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Paolo Gontero
- Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy
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Piwkowska A, Zdrojewski Ł, Heleniak Z, Dębska-ślizień A. Novel Markers in Diabetic Kidney Disease—Current State and Perspectives. Diagnostics (Basel) 2022; 12:1205. [PMID: 35626360 PMCID: PMC9140176 DOI: 10.3390/diagnostics12051205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/01/2022] [Accepted: 05/07/2022] [Indexed: 02/05/2023] Open
Abstract
Diabetic kidney disease (DKD) is a leading cause of end-stage renal disease. Along with the increasing prevalence of diabetes, DKD is expected to affect a higher number of patients. Despite the major progress in the therapy of DKD and diabetes mellitus (DM), the classic clinical diagnostic tools in DKD remain insufficient, delaying proper diagnosis and therapeutic interventions. We put forward a thesis that there is a need for novel markers that will be early, specific, and non-invasively obtained. The ongoing investigations uncover new molecules that may potentially become new markers of DKD—among those are: soluble α-Klotho and proteases (ADAM10, ADAM17, cathepsin, dipeptidyl peptidase 4, caspase, thrombin, and circulating microRNAs). This review summarizes the current clinical state-of-the-art in the diagnosis of DKD and a selection of potential novel markers, based on up-to-date literature.
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Marrocos MSM, Teixeira AA, Quinto BM, Canzian MEF, Manfredi S, Batista MC. Diabetes acts on mortality in hemodialysis patients predicted by asymmetric dimethylarginine and inflammation. Nefrologia 2022; 42:177-185. [PMID: 36153914 DOI: 10.1016/j.nefroe.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/10/2021] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The mortality rate of diabetic patients on dialysis is higher than that of non-diabetic patients. Asymmetric dimethylarginine and inflammation are strong predictors of death in hemodialysis. This study aimed to evaluate asymmetric dimethylarginine and C-reactive protein interaction in predicting mortality in hemodialysis according to the presence or absence of diabetes. METHODS Asymmetric dimethylarginine and C-reactive protein were measured in 202 patients in maintenance hemodialysis assembled from 2011 to 2012 and followed for four years. Effect modification of C-reactive protein on the relationship between asymmetric dimethylarginine and all-cause mortality was investigated dividing the population into four categories according to the median of asymmetric dimethylarginine and C-reactive protein. RESULTS Asymmetric dimethylarginine and C-reactive protein levels were similar between diabetics and non-diabetics. Asymmetric dimethylarginine - median IQR μM - (1.95 1.75-2.54 versus 1.03 0.81-1.55 P=0.000) differed in non-diabetics with or without evolution to death (HR 2379 CI 1.36-3.68 P=0.000) and was similar in diabetics without or with evolution to death. Among non-diabetics, the category with higher asymmetric dimethylarginine and C-reactive protein levels exhibited the highest mortality (69.0% P=0.000). No differences in mortality were seen in diabetics. A joint effect was found between asymmetric dimethylarginine and C-reactive protein, explaining all-cause mortality (HR 15.21 CI 3.50-66.12 P=0.000). CONCLUSIONS Asymmetric dimethylarginine is an independent predictor of all-cause mortality in non-diabetic patients in hemodialysis. Other risk factors may overlap asymmetric dimethylarginine in people with diabetes. Inflammation dramatically increases the risk of death associated with high plasma asymmetric dimethylarginine in hemodialysis.
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Affiliation(s)
- Mauro Sergio Martins Marrocos
- Universidade Federal de São Paulo, Rua Pedro de Toledo, 781 14 andar, Vila Clementino, CEP: 04039-032 São Paulo, SP, Brazil; Hospital do Servidor Público do Estado de São Paulo, Rua Pedro de Toledo, 1800, CEP: 04039-901 São Paulo, SP, Brazil.
| | - Andrei Alkmim Teixeira
- Universidade Federal de São Paulo, Rua Pedro de Toledo, 781 14 andar, Vila Clementino, CEP: 04039-032 São Paulo, SP, Brazil
| | - Beata Marie Quinto
- Universidade Federal de São Paulo, Rua Pedro de Toledo, 781 14 andar, Vila Clementino, CEP: 04039-032 São Paulo, SP, Brazil
| | | | - Silvia Manfredi
- Universidade Federal de São Paulo, Rua Pedro de Toledo, 781 14 andar, Vila Clementino, CEP: 04039-032 São Paulo, SP, Brazil
| | - Marcelo Costa Batista
- Universidade Federal de São Paulo, Rua Pedro de Toledo, 781 14 andar, Vila Clementino, CEP: 04039-032 São Paulo, SP, Brazil; Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, Morumbi, CEP 05652-900 São Paulo, SP, Brazil
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Wang J, Huang L, Xu M, Yang L, Deng X, Li B, Rajakani K. Study on the Clinical Implications of NLR and PLR for Diagnosing Frailty in Maintenance Hemodialysis Patients and Their Correlations with Patient Prognosis. Journal of Healthcare Engineering 2022; 2022:1-7. [PMID: 35070222 PMCID: PMC8769815 DOI: 10.1155/2022/1267200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 12/23/2021] [Indexed: 12/30/2022]
Abstract
Objective To explore the clinical implications of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) for diagnosing frailty in patients with maintenance hemodialysis (MHD) and their correlations with patient prognosis. Methods A total of 185 patients with MHD admitted to the hemodialysis center of our hospital were selected, 72 of whom were diagnosed with frailty according to the Chinese version of Tilburg Frailty Indicator (TFI). The relevant data were collected, and the influencing factors of frailty in MHD patients were analyzed by one-way analysis of variance (ANOVA) and multivariate logistic regression. The value of NLR and PLR in diagnosing frailty in MHD patients was observed, and patients' all-cause mortality was compared during the 3-year follow-up. The influences of different levels of NLR and PLR on the survival of MHD patients were investigated. Results Multivariate regression analysis identified that serum albumin, dialysis adequacy, NLR, and PLR are independent risk factors for frailty in MHD patients (P < 0.05). The area under the receiver operating characteristic (ROC) curve of NLR and PLR in diagnosing frailty in MHD patients was 0.859 and 0.799, respectively. Compared with the nonfrailty group, the 3-year mortality was higher, and the 3-year survival rate assessed by survival analysis was lower in the frailty group (P < 0.05). Patients with high NLR and PLR levels showed a lower 3-year survival rate. Conclusions Dialysis adequacy, serum albumin, NLR, and PLR are independently associated with frailty in MHD patients. NLR and PLR are of a certain diagnostic value for frailty in MHD patients. MHD patients with frailty have an unfavorable prognosis, as of those with high NLR and PLR levels.
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12
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Abstract
The year 2021 was the last full year of Alberto Ortiz’s editorship at Clinical Kidney Journal (CKJ). On May 2022, Maria José Soler will start her term as the Editor-in-Chief. Over these years, CKJ obtained its first journal impact factor and has consolidated its position among the top journals in the field, consistently ranking among the top 25% (first quartile) journals in Urology and Nephrology. The 2020 journal impact factor rose to 4.45, becoming the top open access journal in Nephrology and the ninth ranked Nephrology journal overall. We now review the recent history of the journal and the most highly cited topics which include the epidemiology of kidney disease, chronic kidney disease topics, such as the assessment and treatment of chronic kidney disease, onconephrology, cardionephrology, glomerular disease, transplantation and coronavirus disease 2019 (COVID-19).
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Gallo E, Mingozzi S, Mella A, Fop F, Presta R, Burdese M, Boaglio E, Torazza MC, Giraudi R, Leonardi G, Lavacca A, Gontero P, Sedigh O, Bosio A, Verri A, Dolla C, Biancone L. Clinical outcomes and temporal trends of immunological and non-immunological rare diseases in adult kidney transplant. BMC Nephrol 2021; 22:386. [PMID: 34789191 PMCID: PMC8600810 DOI: 10.1186/s12882-021-02571-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rare diseases (RDs) encompass many difficult-to-treat conditions with different characteristics often associated with end-stage renal disease (ESRD). However, data about transplant outcomes in adult patients are still lacking and limited to case reports/case series without differentiation between immunological/non-immunological RDs. METHODS Retrospective analysis among all adult kidney transplanted patients (KTs) with RDs (RDsKT group) performed in our high-volume transplantation center between 2005 and 2016. RDs were classified according to the Orphanet code system differentiating between immunological and non-immunological diseases, also comparing clinical outcomes and temporal trends to a control population without RDs (nRDsKT). RESULTS Among 1381 KTs, 350 patients (25.3%) were affected by RDs (RDsKTs). During a f/up > 5 years [median 7.9 years (4.8-11.1)], kidney function and graft/patient survival did not differ from nRDsKTs. Considering all post-transplant complications, RDsKTs (including, by definition, patients with primary glomerulopathy except on IgA nephropathy) have more recurrent and de-novo glomerulonephritis (14.6% vs. 9.6% in nRDsKTs; p = 0.05), similar rates of de-novo cancers, post-transplant diabetes, dysmetabolism, hematologic disorders, urologic/vascular problems, and lower infectious episodes than nRDsKTs (63.7% vs 72.7%; p = 0.013). Additional stratification for immunological and non-immunological RDsKTs or transplantation periods (before/after 2010) showed no differences or temporal trends between groups. CONCLUSIONS Kidney transplant centers are deeply involved in RDs management. Despite their high-complex profile, both immunological and non-immunological RDsKTs experienced favorable patients' and graft survival.
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Affiliation(s)
- Ester Gallo
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Silvia Mingozzi
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Alberto Mella
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Fabrizio Fop
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Roberto Presta
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Manuel Burdese
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Elena Boaglio
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Maria Cristina Torazza
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Roberta Giraudi
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Gianluca Leonardi
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Antonio Lavacca
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, Città Della Salute e Della Scienza Hospital and University of Turin, 10126, Turin, Italy
| | - Omidreza Sedigh
- Division of Urology, Department of Surgical Sciences, Città Della Salute e Della Scienza Hospital and University of Turin, 10126, Turin, Italy
| | - Andrea Bosio
- Division of Urology, Department of Surgical Sciences, Città Della Salute e Della Scienza Hospital and University of Turin, 10126, Turin, Italy
| | - Aldo Verri
- Division of Vascular Surgery, Department of Thoracic-Vascular Surgery, Città Della Salute e Della Scienza Hospital, 10126, Turin, Italy
| | - Caterina Dolla
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Luigi Biancone
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy.
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Kang SH, Kim AY, Do JY. Comparison of lean mass indices as predictors of mortality in incident peritoneal dialysis patients. PLoS One 2021; 16:e0254942. [PMID: 34293044 PMCID: PMC8297877 DOI: 10.1371/journal.pone.0254942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022] Open
Abstract
Background Few studies have considered optimal adjusted lean mass indices for prediction of clinical outcomes in peritoneal dialysis (PD) patients. We aimed to evaluate clinical variables using various adjusted indices in PD patients. Methods Total 528 incident PD patients were included. Lean mass was measured using dual energy X-ray absorptiometry. Appendicular lean mass (ALM) was calculated using the sum for both upper and lower extremities. Each ALM index was calculated using ALM per body weight (ALM/BW), height squared (ALM/Ht2), or body mass index (ALM/BMI). Limb/trunk lean mass (LTLM) ratio was defined as the sum for both upper and lower extremities divided by trunk lean mass. Results A total of 528 patients were analyzed men: 286, women: 242. In area under the receiver operating characteristic curve analyses, LTLM alone was associated with 1 year mortality. In the LTLM ratio, the cut-off value for 1-year mortality was ≤ 0.829 in men and ≤ 0.717 in women, respectively. In both sexes, LTLM ratio alone showed statistical significance in all-cause mortality in both univariate and multivariate Cox-regression analyses. Compared with other indices, the LTLM ratio was independent of edema and fat in both sexes. Edema- and C-reactive protein-adjusted correlation analysis showed that LTLM ratio alone was associated with serum albumin in men. Although statistical significance was not obtained for women, the correlation coefficient was highest for the LTLM ratio compared with other indices. Conclusion Among various indices using lean mass, LTLM ratio was independent of volume status and fat mass and was associated with mortality in incident PD patients.
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Affiliation(s)
- Seok Hui Kang
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - A. Young Kim
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Jun Young Do
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
- * E-mail:
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15
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Marrocos MSM, Teixeira AA, Quinto BM, Canzian MEF, Manfredi S, Batista MC. Diabetes acts on mortality in hemodialysis patients predicted by asymmetric dimethylarginine and inflammation. Nefrologia 2021; 42:S0211-6995(21)00110-7. [PMID: 34238597 DOI: 10.1016/j.nefro.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The mortality rate of diabetic patients on dialysis is higher than that of non-diabetic patients. Asymmetric dimethylarginine and inflammation are strong predictors of death in hemodialysis. This study aimed to evaluate asymmetric dimethylarginine and C-reactive protein interaction in predicting mortality in hemodialysis according to the presence or absence of diabetes. METHODS Asymmetric dimethylarginine and C-reactive protein were measured in 202 patients in maintenance hemodialysis assembled from 2011 to 2012 and followed for four years. Effect modification of C-reactive protein on the relationship between asymmetric dimethylarginine and all-cause mortality was investigated dividing the population into four categories according to the median of asymmetric dimethylarginine and C-reactive protein. RESULTS Asymmetric dimethylarginine and C-reactive protein levels were similar between diabetics and non-diabetics. Asymmetric dimethylarginine - median IQR μM - (1.95 1.75-2.54 versus 1.03 0.81-1.55 P=0.000) differed in non-diabetics with or without evolution to death (HR 2379 CI 1.36-3.68 P=0.000) and was similar in diabetics without or with evolution to death. Among non-diabetics, the category with higher asymmetric dimethylarginine and C-reactive protein levels exhibited the highest mortality (69.0% P=0.000). No differences in mortality were seen in diabetics. A joint effect was found between asymmetric dimethylarginine and C-reactive protein, explaining all-cause mortality (HR 15.21 CI 3.50-66.12 P=0.000). CONCLUSIONS Asymmetric dimethylarginine is an independent predictor of all-cause mortality in non-diabetic patients in hemodialysis. Other risk factors may overlap asymmetric dimethylarginine in people with diabetes. Inflammation dramatically increases the risk of death associated with high plasma asymmetric dimethylarginine in hemodialysis.
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Affiliation(s)
- Mauro Sergio Martins Marrocos
- Universidade Federal de São Paulo, Rua Pedro de Toledo, 781 14 andar, Vila Clementino, CEP: 04039-032 São Paulo, SP, Brazil; Hospital do Servidor Público do Estado de São Paulo, Rua Pedro de Toledo, 1800, CEP: 04039-901 São Paulo, SP, Brazil.
| | - Andrei Alkmim Teixeira
- Universidade Federal de São Paulo, Rua Pedro de Toledo, 781 14 andar, Vila Clementino, CEP: 04039-032 São Paulo, SP, Brazil
| | - Beata Marie Quinto
- Universidade Federal de São Paulo, Rua Pedro de Toledo, 781 14 andar, Vila Clementino, CEP: 04039-032 São Paulo, SP, Brazil
| | | | - Silvia Manfredi
- Universidade Federal de São Paulo, Rua Pedro de Toledo, 781 14 andar, Vila Clementino, CEP: 04039-032 São Paulo, SP, Brazil
| | - Marcelo Costa Batista
- Universidade Federal de São Paulo, Rua Pedro de Toledo, 781 14 andar, Vila Clementino, CEP: 04039-032 São Paulo, SP, Brazil; Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, Morumbi, CEP 05652-900 São Paulo, SP, Brazil
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16
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Wu H, Lau ESH, Yang A, Szeto CC, Ma RCW, Kong APS, Chow E, So WY, Chan JCN, Luk AOY. Trends in kidney failure and kidney replacement therapy in people with diabetes in Hong Kong, 2002-2015: A retrospective cohort study. Lancet Reg Health West Pac 2021; 11:100165. [PMID: 34327367 PMCID: PMC8315404 DOI: 10.1016/j.lanwpc.2021.100165] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 12/14/2022]
Abstract
Background There are limited population-wide trend data on kidney failure and kidney replacement therapy (KRT) in people with diabetes. We conducted a retrospective cohort study to report incidence trends of kidney failure and KRT and related mortality in people with diabetes in Hong Kong between 2002 and 2015. Methods We used territory-wide electronic medical records including laboratory, diagnostic and procedural data to identify people with kidney failure and KRT. We used Joinpoint regression models to estimate the average annual percent change (AAPC) of kidney failure and KRT incidence for entire study period, and annual percent change (APC) for each linear trend segment, along with 1-year and 5-year mortality rates. Findings During 4.9 million person-years of follow-up of 712,222 people with diabetes, 31,425 developed kidney failure, among whom 23.0% (n=7,233) received KRT. The incidence of kidney failure declined by 46.8% from 2002 to 2007 (APC: -11.6, 95% CI: -16.3, -6.7), then flattened from 2007 to 2015 (APC: -0.9, 95% CI: -3.1, 1.3). The incidence of KRT remained constant (AAPC: -1.6, 95% CI: -4.4, 1.2). The 1-year mortality rates declined statistically significantly after both kidney failure and KRT. The 5-year mortality rates declined after kidney failure but the decline was not statistically significant after KRT. Interpretation The findings of our study highlight the importance of developing new strategies to prevent a looming epidemic of kidney failure in people with diabetes in Hong Kong. Funding Asia Diabetes Foundation
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Key Words
- AAPC, Average annual percent change
- APC, Annual percent change
- EMR, Electronic medical record
- HA, Hospital Authority
- HD, Hemodialysis
- HKDSD, Hong Kong Diabetes Surveillance Database
- KRT, Kidney replacement therapy
- PD, Peritoneal dialysis
- RAAS, Renin-angiotensin-aldosterone system
- RAMP-DM, Risk Assessment and Management Programme-Diabetes Mellitus
- diabetes
- incidence
- kidney failure
- kidney replacement therapy
- mortality
- trend
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Affiliation(s)
- Hongjiang Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Eric S H Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Aimin Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Cheuk-Chun Szeto
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Alice P S Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Elaine Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Wing-Yee So
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.,Hong Kong Hospital Authority, Hong Kong Special Administrative Region, People's Republic of China
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
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17
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Groeneweg KE, van der Toorn FA, Roelen DL, van Kooten C, Heidt S, Claas FHJ, Reinders MEJ, de Fijter JW, Soonawala D. Single antigen testing to reduce early antibody-mediated rejection risk in female recipients of a spousal donor kidney. Transpl Immunol 2021; 67:101407. [PMID: 33975014 DOI: 10.1016/j.trim.2021.101407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/25/2021] [Accepted: 05/06/2021] [Indexed: 11/19/2022]
Abstract
Female recipients of a spousal donor kidney transplant are at greater risk of donor-specific pre-immunization, which may increase the risk of acute antibody-mediated rejection (ABMR). We assessed the incidence of early ABMR (within two weeks after transplantation), risk factors for ABMR and graft function in 352 complement-dependent cytotoxicity test-negative LURD transplant recipients, transplanted between 1997 and 2014 at the Leiden University Medical Center in The Netherlands. Risk factors for immunization were retrieved from the health records. As methods to screen for preformed donor-specific antibodies (pDSA) have developed through time, we retrospectively screened those with ABMR for pDSA using pooled-antigen bead (PAB) and single-antigen bead (SAB) assays. The cumulative incidence of rejection in the first six months after transplantation was 18% (TCMR 15%; early ABMR 3%). Early ABMR resulted in inferior graft survival and was more common in women who received a kidney from their spouse (10%) than in other women (2%) and men (<1%). The SAB assay retrospectively identified pDSA in seven of nine cases of early ABMR (78%), while the PAB detected pDSA in only three cases (33%). Seeing that early ABMR occurred in 10% of women who received a kidney from their spouse, a SAB assay should be included in the pre-transplant assessment of this group of women, regardless of the result of the PAB assay.
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Affiliation(s)
- Koen E Groeneweg
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, the Netherlands.
| | | | - Dave L Roelen
- Department of Immunology, Leiden University Medical Center, the Netherlands
| | - Cees van Kooten
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, the Netherlands
| | - Sebastiaan Heidt
- Department of Immunology, Leiden University Medical Center, the Netherlands
| | - Frans H J Claas
- Department of Immunology, Leiden University Medical Center, the Netherlands
| | - Marlies E J Reinders
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, the Netherlands
| | - Johan W de Fijter
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, the Netherlands
| | - Darius Soonawala
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, the Netherlands; Department of Internal Medicine, Haga Teaching Hospital, The Hague, the Netherlands
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Kelly DM, Anders HJ, Bello AK, Choukroun G, Coppo R, Dreyer G, Eckardt KU, Johnson DW, Jha V, Harris DCH, Levin A, Lunney M, Luyckx V, Marti HP, Messa P, Mueller TF, Saad S, Stengel B, Vanholder RC, Weinstein T, Khan M, Zaidi D, Osman MA, Ye F, Tonelli M, Okpechi IG, Rondeau E. International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Western Europe. Kidney Int Suppl (2011) 2021; 11:e106-e118. [PMID: 33981476 DOI: 10.1016/j.kisu.2021.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/09/2020] [Accepted: 01/06/2021] [Indexed: 01/08/2023] Open
Abstract
Populations in the high-income countries of Western Europe are aging due to increased life expectancy. As the prevalence of diabetes and obesity has increased, so has the burden of kidney failure. To determine the global capacity for kidney replacement therapy and conservative kidney management, the International Society of Nephrology conducted multinational, cross-sectional surveys and published the findings in the International Society of Nephrology Global Kidney Health Atlas. In the second iteration of the International Society of Nephrology Global Kidney Health Atlas, we aimed to describe the availability, accessibility, quality, and affordability of kidney failure care in Western Europe. Among the 29 countries in Western Europe, 21 (72.4%) responded, representing 99% of the region's population. The burden of kidney failure prevalence varied widely, ranging from 760 per million population (pmp) in Iceland to 1612 pmp in Portugal. Coverage of kidney replacement therapy from public funding was nearly universal, with the exceptions of Germany and Liechtenstein where part of the costs was covered by mandatory insurance. Fourteen (67%) of 21 countries charged no fees at the point of care delivery, but in 5 countries (24%), patients do pay some out-of-pocket costs. Long-term dialysis services (both hemodialysis and peritoneal dialysis) were available in all countries in the region, and kidney transplantation services were available in 19 (90%) countries. The incidence of kidney transplantation varied widely between countries from 12 pmp in Luxembourg to 70.45 pmp in Spain. Conservative kidney care was available in 18 (90%) of 21 countries. The median number of nephrologists was 22.9 pmp (range: 9.47-55.75 pmp). These data highlight the uniform capacity of Western Europe to provide kidney failure care, but also the scope for improvement in disease prevention and management, as exemplified by the variability in disease burden and transplantation rates.
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Affiliation(s)
- Dearbhla M Kelly
- Wolfson Centre for the Prevention of Stroke and Dementia, University of Oxford, John Radcliffe Hospital, Oxford, UK.,Department of Nephrology, Beaumont Hospital, Dublin, Ireland
| | - Hans-Joachim Anders
- Division of Nephrology, Department of Internal Medicine IV, University Hospital of the Ludwig Maximilians University Munich, Munich, Germany
| | - Aminu K Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Gabriel Choukroun
- Nephrology Dialysis Transplantation Department, CHU Amiens, MP3CV Research Unit, Amiens University, Amiens, France
| | - Rosanna Coppo
- Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
| | - Gavin Dreyer
- Department of Nephrology, Barts Health National Health Service Trust, London, UK
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - David W Johnson
- Department of Nephrology, Metro South and Ipswich Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Translation Research Institute, Brisbane, Queensland, Australia
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India.,School of Public Health, Imperial College, London, UK.,Manipal Academy of Higher Education, Manipal, India
| | - David C H Harris
- Centre for Transplantation and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meaghan Lunney
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Valerie Luyckx
- Nephrology, Cantonal Hospital Graubunden, Chur, Switzerland.,Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Child Health and Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Hans-Peter Marti
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Division of Nephrology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Piergiorgio Messa
- Nephrology, Dialysis and Renal Transplant Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Thomas F Mueller
- Nephrology Clinic, University Hospital Zurich, Zürich, Switzerland
| | - Syed Saad
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Benedicte Stengel
- Center for Research in Epidemiology and Population Health (CESP), National Institute of Health and Medical Research (INSERM), Villejuif, France.,University Paris Saclay, Villejuif, France
| | - Raymond C Vanholder
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium.,European Kidney Health Alliance, Brussels, Belgium
| | - Talia Weinstein
- Department of Nephrology, Tel Aviv Medical Center, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Maryam Khan
- Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - Deenaz Zaidi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mohamed A Osman
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Feng Ye
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Ikechi G Okpechi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Eric Rondeau
- Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hopitaux de Paris, Paris, France.,Sorbonne Université, Paris, France
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Hugo C, Weihprecht H, Banas B, Schröppel B, Jank S, Arns W, Schenker P, Rath T, Hergesell O, Feldkamp T, Hermann B, Schiffer M. Renal Function and Patient-Reported Outcomes in Stable Kidney Transplant Patients Following Conversion From Twice-Daily Immediate-Release Tacrolimus to Once-Daily Prolonged-Release Tacrolimus: A 12-Month Observational Study in Routine Clinical Practice in Germany (ADAGIO). Transplant Proc 2021; 53:1484-1493. [PMID: 33610306 DOI: 10.1016/j.transproceed.2021.01.034] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 01/08/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This 12-month, noninterventional study on routine clinical practice in Germany evaluated renal function in stable kidney transplant recipients converted from immediate-release tacrolimus (IR-T) to prolonged-release tacrolimus (PR-T). METHODS Renal function was assessed in 183 patients by estimated glomerular filtration rate using the modification of diet in renal disease-4 formula. Self-reported gastrointestinal health-related quality of life, adherence, satisfaction with PR-T, suspected rejection episodes, and safety were also assessed at conversion and at 3, 6, and 12 months. RESULTS Conversion from IR-T to PR-T resulted in stable kidney function over 12 months, with a difference in estimated glomerular filtration rate between the first and final visits of 0.1 mL/min/1.73 m2 (95% confidence interval, -1.6, 1.8). Eight patients experienced an acute rejection episode (4.4%). At each assessment, gastrointestinal health-related quality of life was low and adherence was high. Most patients reported that they were very satisfied (69.8%) or satisfied (28.1%) with PR-T at the final visit. Among patients reporting a preference, 78.4% preferred PR-T, 2.2% preferred IR-T, and 19.4% reported no preference. The safety profile of PR-T was consistent with that previously described. CONCLUSION Conversion of stable kidney transplant recipients from IR-T to PR-T provided stable kidney and graft function over 12 months (Verband Forschender Arzneimittelhersteller--registered study: NIS ADV-02).
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Affiliation(s)
- Christian Hugo
- Division of Nephrology, Medizinische Klinik und Poliklinik III, Technische Universität Dresden, Dresden, Germany
| | - Horst Weihprecht
- Department of Internal Medicine, Division of Nephrology, University Hospital Augsburg, Augsburg, Germany.
| | - Bernhard Banas
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | | | - Sabine Jank
- Department of Nephrology, Transplantation KfH-Kidney Center, Nuremberg, Germany
| | - Wolfgang Arns
- Cologne Merheim Medical Center, Cologne General Hospital, Cologne, Germany
| | - Peter Schenker
- Department of Surgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Thomas Rath
- Department of Nephrology and Transplantation, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - Olaf Hergesell
- Nephrologisches Zentrum Villingen-Schwenningen, Villingen-Schwenningen, Erlangen, Germany
| | - Thorsten Feldkamp
- Department of Internal Medicine IV, Universitätsklinikum Schleswig Holstein, Kiel, Germany
| | | | - Mario Schiffer
- Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Germany
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de Almeida EAF, Raimundo M, Coelho A, Sá H. Incidence, prevalence and crude survival of patients starting dialysis in Portugal (2010-16): analysis of the National Health System individual registry. Clin Kidney J 2020; 14:869-875. [PMID: 34386218 PMCID: PMC8355448 DOI: 10.1093/ckj/sfaa023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/02/2020] [Indexed: 12/13/2022] Open
Abstract
Background The Portuguese Society of Nephrology (PSN) reported that Portugal has one of the highest incidences of dialysis in Europe. However, this claim was based on aggregated data supplied by dialysis providers, hampering comparisons between countries. In 2009, an individual registry of patients starting dialysis was set up by the Portuguese Ministry of Health. We analysed individual data of patients starting dialysis from January 2010 until December 2016. Methods Demography, starting treatment day, modality, regional distribution and outcomes, such as death, recovery of renal function, transfer to renal transplantation, peritoneal dialysis or conservative management, were extracted. Incidence, prevalence and survival analysis were calculated and compared with the PSN registry. Results Out of 19 190 registrations, 16 775 were incident patients (61.8% men). Yearly incidence of renal replacement therapy was 250, 248, 229, 239, 230, 231 and 244 per million population (p.m.p.) for 2010 to 2016, compared with 235, 224, 218, 230, 234, 225 and 239 p.m.p. reported by the PSN registry. On the other hand, prevalence increased from 998 p.m.p. in 2010 to 1286 p.m.p. in 2016, compared with 1010 p.m.p. in 2010 increasing to 1203 p.m.p. in 2016 from the PSN registry. The regions of Alentejo (122.9 p.m.p.) and the the Centre (160.8 p.m.p.) had the lowest regional incidence, while Lisbon had the highest (386 p.m.p. in 2016). Unadjusted survival analysis revealed that 93.5% of the patients were alive on the 91st day, whereas 85.2 and 78.3% were alive at 1 and 2 years, respectively. Crude survival at 7 years was 40%. Conclusions For the first time, an individual registry of patients starting dialysis in Portugal was subject to analysis and added new information about long-term survival and regional differences in the incidence and prevalence of renal replacement therapy. We were able to confirm that Portugal has one of the world's highest incidences and prevalences of dialysis. We also demonstrate, for the first time, a striking regional difference in the incidence of dialysis and an excellent early and long-term survival of patients on dialysis. These results compare well with other European countries in terms of the dialysis efficiency.
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Affiliation(s)
- Edgar A F de Almeida
- Department of Nephrology, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Serviço de Nefrologia, Hospital Beatriz Ângelo, Loures, Portugal
- Correspondence to: Edgar A. F. de Almeida; E-mail:
| | - Mário Raimundo
- Department of Nephrology, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Serviço de Nefrologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - Anabela Coelho
- Comissão Nacional de Acompanhamento da Diálise (CNAD), Direção Geral da Saúde, Lisboa, Portugal
| | - Helena Sá
- Department of Nephrology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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21
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Burlacu A, Genovesi S, Basile C, Ortiz A, Mitra S, Kirmizis D, Kanbay M, Davenport A, van der Sande F, Covic A. Coronary artery disease in dialysis patients: evidence synthesis, controversies and proposed management strategies. J Nephrol 2020; 34:39-51. [PMID: 32472526 DOI: 10.1007/s40620-020-00758-5] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/23/2020] [Indexed: 12/31/2022]
Abstract
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality among patients with end-stage renal disease (ESRD). Clustering of traditional atherosclerotic and non-traditional risk factors drive the excess rates of coronary and non-coronary CVD in this population. The incidence, severity and mortality of coronary artery disease (CAD) as well as the number of complications of its therapy is higher in dialysis patients than in non-chronic kidney disease patients. Given the lack of randomized clinical trial evidence in this population, current practice is informed by observational data with a significant potential for bias. Furthermore, guidelines lack any recommendation for these patients or extrapolate them from trials performed in non-dialysis patients. Patients with ESRD are more likely to be asymptomatic, posing a challenge to the correct identification of CAD, which is essential for appropriate risk stratification and management. This may lead to "therapeutic nihilism", which has been associated with worse outcomes. Here, the ERA-EDTA EUDIAL Working Group reviews the diagnostic work-up and therapy of chronic coronary syndromes, unstable angina/non-ST elevation and ST-elevation myocardial infarction in dialysis patients, outlining unclear issues and controversies, discussing recent evidence, and proposing management strategies. Indications of antiplatelet and anticoagulant therapies, percutaneous coronary intervention and coronary artery bypass grafting are discussed. The issue of the interaction between dialysis session and myocardial damage is also addressed.
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Affiliation(s)
- Alexandru Burlacu
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, and 'Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Simonetta Genovesi
- Nephrology Unit, San Gerardo Hospital, Monza, Italy, University of Milan-Bicocca, Milan, Italy
| | - Carlo Basile
- Division of Nephrology, Miulli General Hospital, Via Battisti 192, Acquaviva delle Fonti, 74121, Taranto, Italy. .,Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy.
| | - Alberto Ortiz
- FRIAT and REDINREN, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
| | - Sandip Mitra
- Manchester Academy of Health Sciences Centre, Manchester University Hospitals Foundation Trust and University of Manchester, Oxford Road, Manchester, UK
| | | | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
| | - Andrew Davenport
- Division of Medicine, UCL Centre for Nephrology, Royal Free Hospital, University College London, London, UK
| | - Frank van der Sande
- Division of Nephrology, Department of Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center-'C.I. Parhon' University Hospital, and 'Grigore T. Popa' University of Medicine, Iasi, Romania.,The Academy of Romanian Scientists (AOSR), Bucharest, Romania
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22
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Cartwright EJ, Zs Goh Z, Foo M, Chan CM, Htay H, Griva K. eHealth interventions to support patients in delivering and managing peritoneal dialysis at home: A systematic review. Perit Dial Int 2020; 41:32-41. [PMID: 32301380 DOI: 10.1177/0896860820918135] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Peritoneal dialysis (PD) requires patients to develop a variety of self-management skills in order to effectively deliver and manage their dialysis at home. eHealth interventions may provide patients with accessible information to develop the skills and knowledge they require to manage their treatment. This review aims to identify and evaluate 'active' eHealth interventions in supporting patients on PD. Six databases were included within the review using the terms Peritoneal Dialysis, eHealth, telemedicine and remote consultation. Studies which explored patients who were delivering PD, an intervention where the main component involved a digital device and required active engagement from patients were included. The primary outcomes examined were identified using the core outcomes recommended by the Standardised Outcomes in Nephrology in Peritoneal Dialysis initiative (PD infection, cardiovascular disease, mortality, PD failure and life participation). Hospitalisation rates were also considered as a primary outcome. Secondary outcomes included quality of life, patient skills, patient knowledge and satisfaction. Using the inclusion criteria, 15 studies (1334 participants) were included in the study. The effectiveness of eHealth interventions was mixed. Due to high heterogeneity, a meta-analysis was not possible, and quality of evidence was low. Risk of bias across the randomised studies was unclear but bias across non-randomised studies was identified as critical. There were no reported adverse effects of eHealth interventions within the included studies. Despite the high interest of eHealth interventions in PD, good quality evidence is needed to explore their effectiveness before a wider application of eHealth interventions.
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Affiliation(s)
- Emma J Cartwright
- Lee Kong Chian School of Medicine, 54761Nanyang Technological University, Singapore
| | - Zack Zs Goh
- Lee Kong Chian School of Medicine, 54761Nanyang Technological University, Singapore
| | | | | | - Htay Htay
- 37581Singapore General Hospital, Singapore
| | - Konstadina Griva
- Lee Kong Chian School of Medicine, 54761Nanyang Technological University, Singapore
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23
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Dong ZX, Tian M, Li H, Wu Y, Du XG, Dong JW, Xiao HH, Dong LP, Song XH. Association of Serum Uric Acid Concentration and Its Change with Cardiovascular Death and All-Cause Mortality. Dis Markers 2020; 2020:7646384. [PMID: 32076464 DOI: 10.1155/2020/7646384] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/29/2019] [Accepted: 12/23/2019] [Indexed: 02/07/2023]
Abstract
Objective There is no consensus on the role of abnormal uric acid (UA) levels in the prognosis of patients undergoing hemodialysis. We therefore aimed to investigate the effects of changes in UA concentration on the risk of all-cause death and cardiac death in such patients. Method In this retrospective cohort study, patients admitted to two hemodialysis centers performing maintenance hemodialysis (MHD) in Wuhan First Hospital and Fourth Hospital Hemodialysis Center from January 1, 2007, to October 31, 2017, were included. Results In all, 325 patients undergoing MHD aged 59.7 ± 14.7 years, including 195 men (60%), were enrolled, with a median follow-up of 37 months. Serum UA (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability ( Conclusion Low UA levels were closely related to all-cause mortality in patients undergoing MHD. Although UA levels had no significant effect on cardiac death, they had a good predictive value for long-term prognosis in patients on MHD.
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Abstract
Chronic kidney diseases (CKDs) are the most common forms of kidney disease all around the world. The incidence of CKD is rising, which is mainly driven by population aging as well as by a global rise in hypertension, metabolic syndrome, and metabolic risk factors, particularly obesity and type-2 diabetes. The high mortality, morbidity of CKD, and the health care costs of the renal replacement therapy have led investigators to seek recent and potentially modifiable risk factors such as non-alcoholic fatty liver disease (NAFLD). NAFLD is the hepatic manifestation of metabolic syndrome and the most common cause of chronic liver disease. It incorporates a spectrum of liver diseases ranging from simple steatosis to steatohepatitis, liver cirrhosis, and hepatocellular carcinoma. On the basis of recent publications, the prevalence of CKD is significantly increased among patients with NAFLD, and the prevalence of NAFLD is also higher in CKD patients than in patients without NAFLD. These findings suggest that patients with NAFLD should be screened for CKD and patients with CKD and metabolic syndrome should be screened for NAFLD. Patients with NAFLD and CKD should be treated and followed up by a multidisciplinary team that involves specialists in hepatology, nephrology, diabetes, and cardiology.
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Affiliation(s)
- J Nagy
- 1 2nd Department of Internal Medicine, Nephrological and Diabetological Centre, Clinical Centre, Medical School, University of Pécs, Pécs, Hungary
| | - T Kovács
- 1 2nd Department of Internal Medicine, Nephrological and Diabetological Centre, Clinical Centre, Medical School, University of Pécs, Pécs, Hungary
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25
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Banas B, Krämer BK, Krüger B, Kamar N, Undre N. Long-Term Kidney Transplant Outcomes: Role of Prolonged-Release Tacrolimus. Transplant Proc 2020; 52:102-10. [PMID: 31901329 DOI: 10.1016/j.transproceed.2019.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 11/02/2019] [Indexed: 01/08/2023]
Abstract
Tacrolimus has significantly improved outcomes for kidney transplant patients and remains the cornerstone of immunosuppressive therapy. While improvements in short-term outcomes in transplantation have been achieved in recent years, maintaining long-term graft survival remains a challenge in kidney transplantation. Minimizing risk factors for poor long-term kidney graft function and survival, and modifying tacrolimus regimens in the early and maintenance phases post-transplantation are essential to maintain long-term kidney transplant outcomes. Tacrolimus has a narrow therapeutic window, resulting in a tightly defined range of optimal drug exposure. Underimmunosuppression is associated with long-term risks, such as the development of donor-specific antibodies and antibody-mediated rejection, with a high possibility of a decline in kidney function and progression to graft failure. Conversely, prolonged overimmunosuppression carries a risk of drug-related adverse events. This review provides an overview of the differences in the formulation, delivery, and pharmacokinetic profiles between immediate- and prolonged-release tacrolimus and evaluates the effect of prolonged-release tacrolimus on the risk factors for poor outcomes in kidney transplantation. Recent evidence is used to provide guidance on target tacrolimus trough levels in the early and maintenance phases post-transplantation, with a view to improving long-term kidney graft function.
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26
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Izeidi PPM, Nlandu YM, Lepira FB, Makulo JR, Engole YM, Mokoli VM, Bukabau JB, Kwilu FN, Nseka NM, Sumaili EK. Cost estimate of chronic hemodialysis in Kinshasa, the Democratic Republic of the Congo: A prospective study in two centers. Hemodial Int 2019; 24:121-128. [DOI: 10.1111/hdi.12802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 10/15/2019] [Accepted: 10/29/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Patrick P. M. Izeidi
- Dialysis UnitGeneral Hospital of Kinshasa Kinshasa Democratic Republic of the Congo
| | - Yannick M. Nlandu
- Nephrology Unit, Department of Internal Medicine, Faculty of MedicineKinshasa University Hospital, University of Kinshasa Kinshasa Democratic Republic of the Congo
| | - François B. Lepira
- Nephrology Unit, Department of Internal Medicine, Faculty of MedicineKinshasa University Hospital, University of Kinshasa Kinshasa Democratic Republic of the Congo
| | - Jean‐Robert R. Makulo
- Nephrology Unit, Department of Internal Medicine, Faculty of MedicineKinshasa University Hospital, University of Kinshasa Kinshasa Democratic Republic of the Congo
| | - Yannick M. Engole
- Nephrology Unit, Department of Internal Medicine, Faculty of MedicineKinshasa University Hospital, University of Kinshasa Kinshasa Democratic Republic of the Congo
| | - Vieux M. Mokoli
- Nephrology Unit, Department of Internal Medicine, Faculty of MedicineKinshasa University Hospital, University of Kinshasa Kinshasa Democratic Republic of the Congo
| | - Justine B. Bukabau
- Nephrology Unit, Department of Internal Medicine, Faculty of MedicineKinshasa University Hospital, University of Kinshasa Kinshasa Democratic Republic of the Congo
| | - Fulbert N. Kwilu
- Kinshasa School of Public HealthUniversity of Kinshasa Kinshasa Democratic Republic of the Congo
| | - Nazaire M. Nseka
- Nephrology Unit, Department of Internal Medicine, Faculty of MedicineKinshasa University Hospital, University of Kinshasa Kinshasa Democratic Republic of the Congo
| | - Ernest K. Sumaili
- Nephrology Unit, Department of Internal Medicine, Faculty of MedicineKinshasa University Hospital, University of Kinshasa Kinshasa Democratic Republic of the Congo
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27
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Ceretta ML, Noordzij M, Luxardo R, De Meester J, Abad Diez JM, Finne P, Heaf JG, Couchoud C, Kramar R, Collart F, Cases A, Palsson R, Reisæter AV, Rydell H, Massy ZA, Jager KJ, Kramer A. Changes in co-morbidity pattern in patients starting renal replacement therapy in Europe-data from the ERA-EDTA Registry. Nephrol Dial Transplant 2019; 33:1794-1804. [PMID: 29361126 DOI: 10.1093/ndt/gfx355] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 11/24/2017] [Indexed: 12/31/2022] Open
Abstract
Background Patients starting renal replacement therapy (RRT) for end-stage renal disease often present with one or more co-morbidities. This study explored the prevalence of co-morbidities in patients who started RRT in Europe during the period from 2005 to 2014. Methods Using data from patients aged 20 years or older from all 11 national or regional registries providing co-morbidity data to the European Renal Association - European Dialysis and Transplant Association Registry, we examined the prevalence of the following co-morbidities: diabetes mellitus (DM) (primary renal disease and/or co-morbidity), ischaemic heart disease (IHD), congestive heart failure (CHF), peripheral vascular disease (PVD), cerebrovascular disease (CVD) and malignancy. Results Overall, 70% of 7578 patients who initiated RRT in 2014 presented with at least one co-morbidity: 39.0% presented with DM, 25.0% with IHD, 22.3% with CHF, 17.7% with PVD, 16.4% with malignancy and 15.5% with CVD. These percentages differed substantially between countries. Co-morbidities were more common in men than in women, in older patients than in younger patients, and in patients on haemodialysis at Day 91 when compared with patients on peritoneal dialysis. Between 2005 and 2014 the prevalence of DM and malignancy increased over time, whereas the prevalence of IHD and PVD declined. Conclusions More than two-thirds of patients initiating RRT in Europe have at least one co-morbidity. With the rising age at the start of RRT over the last decade, there have been changes in the co-morbidity pattern: the prevalence of cardiovascular co-morbidities decreased, while the prevalence of DM and malignancy increased.
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Affiliation(s)
- Maria L Ceretta
- Uruguayan Dialysis Registry, Uruguayan Society of Nephrology, Montevideo, Uruguay
| | - Marlies Noordzij
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Rosario Luxardo
- Nephrology Service, Hospital Italiano de Buenos Aires, CABA, Buenos Aires, Argentina
| | - Johan De Meester
- Department of Nephrology, Dialysis and Hypertension, Dutch-speaking Belgian Renal Registry (NBVN), Sint-Niklaas, Belgium
| | - Jose M Abad Diez
- Servicio Aragonés de la Salud, Gobierno de Aragón, Zaragoza, Spain
| | - Patrik Finne
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Finnish Registry for Kidney Diseases, Helsinki, Finland
| | - James G Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Cécile Couchoud
- REIN Registry, Agence de la biomédecine, Saint-Denis La Plaine, France
| | | | | | - Aleix Cases
- Nephrology Unit Hospital Clinic, Barcelona, Spain.,Registre de Malalts Renals de Catalunya, Barcelona, Spain
| | - Runolfur Palsson
- Division of Nephrology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Anna V Reisæter
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Helena Rydell
- Swedish Renal Registry, Jönköping, Sweden.,Lund University, Lund, Sweden.,Skane University Hospital, Lund, Sweden
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, Paris, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Unit 1018 team 5, Research Centre in Epidemiology and Population Health (CESP), University of Paris Ouest-Versailles-St Quentin-en-Yveline, Villejuif, 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
| | - Anneke Kramer
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Tuttle KR, Brosius FC, Adler SG, Kretzler M, Mehta RL, Tumlin JA, Tanaka Y, Haneda M, Liu J, Silk ME, Cardillo TE, Duffin KL, Haas JV, Macias WL, Nunes FP, Janes JM. JAK1/JAK2 inhibition by baricitinib in diabetic kidney disease: results from a Phase 2 randomized controlled clinical trial. Nephrol Dial Transplant 2019; 33:1950-1959. [PMID: 29481660 PMCID: PMC6212720 DOI: 10.1093/ndt/gfx377] [Citation(s) in RCA: 158] [Impact Index Per Article: 31.6] [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] [Received: 09/12/2017] [Accepted: 12/08/2017] [Indexed: 01/13/2023] Open
Abstract
Background Inflammation signaled by Janus kinases (JAKs) promotes progression of diabetic kidney disease (DKD). Baricitinib is an oral, reversible, selective inhibitor of JAK1 and JAK2. This study tested the efficacy of baricitinib versus placebo on albuminuria in adults with Type 2 diabetes at high risk for progressive DKD. Methods In this Phase 2, double-blind, dose-ranging study, participants were randomized 1:1:1:1:1 to receive placebo or baricitinib (0.75 mg daily; 0.75 mg twice daily; 1.5 mg daily; or 4 mg daily), for 24 weeks followed by 4–8 weeks of washout. Results Participants (N = 129) were 63±9.1 (mean±standard deviation) years of age, 27.1% (35/129) women and 11.6% (15/129) African-American race. Baseline hemoglobin A1c (HbA1c) was 7.3±1% and estimated glomerular filtration rate was 45.0±12.1 mL/min/1.73 m2 with first morning urine albumin–creatinine ratio (UACR) of 820 (407–1632) (median; interquartile range) mg/g. Baricitinib, 4 mg daily, decreased morning UACR by 41% at Week 24 compared with placebo (ratio to baseline 0.59, 95% confidence interval 0.38–0.93, P = 0.022). UACR was decreased at Weeks 12 and 24 and after 4–8 weeks of washout. Baricitinib 4 mg decreased inflammatory biomarkers over 24 weeks (urine C–X–C motif chemokine 10 and urine C–C motif ligand 2, plasma soluble tumor necrosis factor receptors 1 and 2, intercellular adhesion molecule 1 and serum amyloid A). The only adverse event rate that differed between groups was anemia at 32.0% (8/25) for baricitinib 4 mg daily versus 3.7% (1/27) for placebo. Conclusions Baricitinib decreased albuminuria in participants with Type 2 diabetes and DKD. Further research is required to determine if baricitinib reduces DKD progression.
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Affiliation(s)
- Katherine R Tuttle
- Providence Health Care, Spokane, WA, USA.,The Kidney Research Institute, Division of Nephrology, University of Washington School of Medicine, Seattle, WA, USA.,The Institute of Translational Health Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Frank C Brosius
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Sharon G Adler
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Matthias Kretzler
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ravindra L Mehta
- Division of Nephrology, University of California, San Diego, CA, USA
| | - James A Tumlin
- University of Tennessee College of Medicine, Chattanooga, TN, USA
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masakazu Haneda
- Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Jiajun Liu
- Eli Lilly and Company, Indianapolis, IN, USA
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29
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Conti G, Caccamo D, Siligato R, Gembillo G, Satta E, Pazzano D, Carucci N, Carella A, Campo GD, Salvo A, Santoro D. Association of Higher Advanced Oxidation Protein Products (AOPPs) Levels in Patients with Diabetic and Hypertensive Nephropathy. ACTA ACUST UNITED AC 2019; 55:medicina55100675. [PMID: 31591338 PMCID: PMC6843920 DOI: 10.3390/medicina55100675] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/21/2019] [Accepted: 10/01/2019] [Indexed: 02/06/2023]
Abstract
Background and Objectives: Diabetes mellitus (DM) and hypertension (HT) are characterized by cell damage caused by inflammatory and metabolic mechanisms induced by alteration in reduction-oxidative status. Serum advanced oxidation protein products (AOPP) are new markers of protein damage induced by oxidative stress. We evaluated serum levels of AOPP in a cohort of patients with DM and HT, with or without renal complications, compared with a control healthy population. Materials and Methods: The study group comprised of 62 patients with type 2 DM and 56 with HT. The 62 patients affected by DM were further distinguished in 24 subjects without renal impairment, 18 with diabetic nephropathy (DN), 20 with chronic kidney disease (CKD) stage 2–3 secondary to DN. The subgroup of 56 patients with primary HT comprised 26 subjects without renal complications and 30 with CKD (stage 2–3) secondary to HT. Thirty healthy controls, matched for age and sex, were recruited among blood donors. Results: Increased AOPP levels were found in DM patients compared with healthy subjects, although not significantly. This index was higher and more significant in patients with DN and CKD secondary to DN than in DM patients without nephropathy (p < 0.05) or controls (p < 0.0001). Patients with HT and with kidney impairment secondary to HT also had significantly higher AOPP serum levels than controls (p < 0.01 and p < 0.0001, respectively). There were no significant differences in mean AOPP levels among DM and HT patients. Conclusion: Our study showed that oxidative stress was higher in diabetic or hypertensive subjects than in healthy controls and, in particular, it appeared to be more severe in patients with renal complications. We suggest that the assessment of AOPP in diabetic and hypertensive patients may be important to predict the onset of renal failure and to open a new perspective on the adoption of antioxidant molecules to prevent CKD in those settings.
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Affiliation(s)
- Giovanni Conti
- Pediatric Nephrology Unit, AOU Policlinic "G Martino", University of Messina, 98125 Messina, Italy.
| | - Daniela Caccamo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, AOU Policlinic "G Martino", University of Messina, 98125 Messina, Italy.
| | - Rossella Siligato
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy.
| | - Guido Gembillo
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy.
| | - Ersilia Satta
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy.
| | - Dario Pazzano
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy.
| | - Nicolina Carucci
- Pediatric Nephrology Unit, AOU Policlinic "G Martino", University of Messina, 98125 Messina, Italy.
| | - Antonio Carella
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, AOU Policlinic "G Martino", University of Messina, 98125 Messina, Italy.
| | - Giuliana Del Campo
- Pediatric Nephrology Unit, AOU Policlinic "G Martino", University of Messina, 98125 Messina, Italy.
| | - Antonino Salvo
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy.
| | - Domenico Santoro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy.
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30
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Wang C, Zhang W, Wang Y, Wan H, Chen Y, Xia F, Zhang K, Wang N, Lu Y. Novel associations between sex hormones and diabetic vascular complications in men and postmenopausal women: a cross-sectional study. Cardiovasc Diabetol 2019; 18:97. [PMID: 31366359 PMCID: PMC6668151 DOI: 10.1186/s12933-019-0901-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/24/2019] [Indexed: 02/06/2023] Open
Abstract
Background Associations between sex hormones and vascular remodeling have been extensively studied, but the results vary widely among different races and sex. We aimed to investigate whether total testosterone (TT), estrogen (E2), and dehydroepiandrosterone (DHEA) associate with macrovascular complications and diabetic kidney disease (DKD) among community-dwelling patients with diabetes. Methods A total of 4720 participants with type 2 diabetes were recruited from Shanghai, China. Common carotid artery (CCA) plaques and diameter were assessed by ultrasound. Cardiovascular disease (CVD) was defined by prior diagnosis of coronary heart disease, myocardial infarction or stroke. DKD was defined according to the ADA Guidelines. Results (1) In men, TT was negatively associated with CCA diameter (regression coefficient (β) − 0.044, 95% CI − 0.087, 0). E2 levels were positively associated with CVD and CCA plaque prevalence (OR 1.151, 95% CI 1.038, 1.277 and OR 1.13, 95% CI 1.017, 1.255, respectively). DHEA was negatively associated with CVD (OR 0.809, 95% CI 0.734, 0.893). In postmenopausal women, TT levels were negatively associated with CCA diameter (β − 0.046, 95% CI − 0.083, − 0.010) and positively associated with CVD (OR 1.154, 95% CI 1.038, 1.284). (2) In both men and postmenopausal women, TT levels were negatively associated with the albumin/creatinine ratio and DKD (β − 0.098, 95% CI − 0.154, − 0.043 and OR 0.887, 95% CI 0.790, 0.997 vs. β − 0.084, 95% CI − 0.137, − 0.031 and OR 0.822, 95% CI 0.731, 0.924, respectively) and DHEA levels were positively associated with DKD (OR 1.167, 95% CI 1.038, 1.313 vs. OR 1.251, 95% CI 1.104, 1.418, respectively). Conclusions Our study indicates that macrovascular complications were associated with low TT, DHEA and high E2 in men and with high TT in postmenopausal women. DKD was associated with low TT and high DHEA levels in both genders. Sex hormone replacement therapy requires careful and comprehensive consideration. Trial registration ChiCTR1800017573, http://www.chictr.org.cn. Registered 04 August 2018 Electronic supplementary material The online version of this article (10.1186/s12933-019-0901-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chiyu Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Wen Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yuying Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Heng Wan
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Fangzhen Xia
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Kun Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
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31
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Kettler B, Scheffner I, Bräsen JH, Hallensleben M, Richter N, Heiringhoff KH, Lehner F, Klempnauer J, Gwinner W. Kidney graft survival of >25 years: a single center report including associated graft biopsy results. Transpl Int 2019; 32:1277-1285. [PMID: 31188498 DOI: 10.1111/tri.13469] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 10/29/2018] [Accepted: 06/07/2019] [Indexed: 11/28/2022]
Abstract
Only few centers have reported their observations on patients with very long-term kidney graft survival of more than 25 years. Eighty-six subjects were identified in our center with graft survival of >25 years. Donor age was 31.3 ± 18.5 years. Mean duration of transplantation was 30.3 ± 3.6 years. At last follow-up, the cystatin C clearance was 47 ± 23 ml/min. Transplant biopsies for cause were performed in 30 subjects at a median of 28.4 years (19.1-40.3) after transplantation. Acute or chronic active T cell-mediated rejection was present in five cases and histological characteristics of acute or chronic active humoral rejection in eight cases. More than 80% of biopsies had inflammatory infiltrates in nonatrophic or atrophic cortical areas. The number of HLA mismatches were higher in biopsied subjects (3.0 ± 1.8 vs. 2.2 ± 1.7 without biopsy). Immunosuppressive therapy was adapted in most biopsied subjects; impaired graft function and proteinuria was unchanged at last follow-up. Sixty percent of all subjects had hyperparathyroidism (iPTH of the whole group: 132 ± 157 pg/ml), which was predominantly secondary, as judged by serum calcium and graft function. Young donor age was certainly a prerequisite of longterm graft survival. Nonetheless, inflammation or rejection in most biopsied patients suggests an important role of alloreactivity even in this late course.
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Affiliation(s)
- Bastian Kettler
- Clinic for General-, Abdominal- and Transplant-Surgery, Medical School Hannover, Hannover, Germany
| | - Irina Scheffner
- Clinic for Nephrology, Medical School Hannover, Hannover, Germany
| | - Jan H Bräsen
- Institute for Transfusion Medicine, Medical School Hannover, Hannover, Germany
| | - Michael Hallensleben
- Nephropathology Unit, Institute for Pathology, Medical School Hannover, Hannover, Germany
| | - Nicolas Richter
- Clinic for General-, Abdominal- and Transplant-Surgery, Medical School Hannover, Hannover, Germany
| | - Karl-Heinz Heiringhoff
- Clinic for General-, Abdominal- and Transplant-Surgery, Medical School Hannover, Hannover, Germany
| | - Frank Lehner
- Clinic for General-, Abdominal- and Transplant-Surgery, Medical School Hannover, Hannover, Germany
| | - Jürgen Klempnauer
- Clinic for General-, Abdominal- and Transplant-Surgery, Medical School Hannover, Hannover, Germany
| | - Wilfried Gwinner
- Clinic for Nephrology, Medical School Hannover, Hannover, Germany
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32
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van der Borg WE, Verdonk P, de Jong-Camerik JG, Schipper K, Abma TA. A continuous juggle of invisible forces: How fatigued dialysis patients manage daily life. J Health Psychol 2019; 26:917-934. [PMID: 31170828 DOI: 10.1177/1359105319853340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Dialysis patients commonly experience severe fatigue. Fatigue is known as an intrusive symptom strongly affecting perceived quality of life. A total of 23 interviews were conducted to explore how dialysis patients respond to fatigue symptoms and its consequences in daily life. A constructivist grounded theory approach guided data analysis and conceptualization of findings. Patients find themselves within a continuous decision loop, considering ones (physical) abilities and questioning ones normative beliefs and values. This inner process interacts with the outside world, and contains various ambiguities. Improved understanding of this demanding process could help to better address fatigue and positively contribute to the quality of life of dialysis patients.
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33
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Lascasas JMSS, Fonseca I, Malheiro J, Santos S, Campos A, Castro A, Moreira C, Correia S, Beirão I, Lobato L, Cabrita A. Demographic, clinical characteristics and cardiovascular disease burden in a Portuguese cohort of older chronic kidney disease patients. ACTA ACUST UNITED AC 2019; 41:29-37. [PMID: 31063177 PMCID: PMC6534027 DOI: 10.1590/2175-8239-jbn-2018-0120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Received: 03/30/2018] [Accepted: 09/23/2018] [Indexed: 12/18/2022]
Abstract
Introduction: Chronic kidney disease (CKD) is an independent risk factor for several
unfavorable outcomes including cardiovascular disease (CVD), particularly in
the elderly, who represent the most rapidly growing segment of the end-stage
kidney disease (ESKD) population. Portugal has the highest European
unadjusted incidence and prevalence rates of ESKD. In 2012, we started to
follow a cohort of elderly CKD patients, we describe their baseline
characteristics, risk profile, and cardiovascular disease burden. Methods: All CKD patients aged 65 years and older referred to our department during
2012 were enrolled. Baseline data included: demographic, CKD stage,
medication, comorbid conditions. Estimated glomerular filtration rate (eGFR)
was calculated by the CKD-EPI formula. Results: A total of 416 patients, 50% referred by primary care physicians, aged 77 ± 7
years, 52% male, with a median eGFR of 32 mL/min/1.73m2
participated in the study. Fifty percent had diabetes (DM), 85%
dyslipidemia, 96% hypertension; 26% were current/former smokers, and 24% had
a body mass index > 30 kg/m2. The prevalence of CVD was 62%
and higher in stage 4-5 patients; in diabetics, it gradually increased with
CKD progression (stage 3a < stage 3b < stage 4-5) (39, 58, 82%;
p < 0.001). Conclusions: At baseline, our CKD elderly cohort had a higher burden of CVD. The
prevalence of CVD was greater than in other European CKD cohorts. Lower
level of eGFR was associated with a greater burden of CVD and was more
pronounced in diabetics, highlighting the importance of strategically
targeting cardiovascular risk reduction in these patients.
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Affiliation(s)
- Josefina Maria Sousa Santos Lascasas
- Centro Hospitalar do Porto, Hospital de Santo António, Departamento de Nefrologia, Porto, Portugal.,Universidade do Porto, Instituto de Ciências Biomédicas Abel Salazar, Unidade Multidisciplinar de Investigação Biomédica, Porto, Portugal
| | - Isabel Fonseca
- Centro Hospitalar do Porto, Hospital de Santo António, Departamento de Nefrologia, Porto, Portugal.,Universidade do Porto, Instituto de Ciências Biomédicas Abel Salazar, Unidade Multidisciplinar de Investigação Biomédica, Porto, Portugal.,Universidade do Porto, Instituto de Saúde Pública, Porto, Portugal
| | - Jorge Malheiro
- Centro Hospitalar do Porto, Hospital de Santo António, Departamento de Nefrologia, Porto, Portugal.,Universidade do Porto, Instituto de Ciências Biomédicas Abel Salazar, Unidade Multidisciplinar de Investigação Biomédica, Porto, Portugal
| | - Sofia Santos
- Centro Hospitalar do Porto, Hospital de Santo António, Departamento de Nefrologia, Porto, Portugal
| | - Andreia Campos
- Centro Hospitalar do Porto, Hospital de Santo António, Departamento de Nefrologia, Porto, Portugal
| | - Ana Castro
- Centro Hospitalar do Porto, Hospital de Santo António, Departamento de Nefrologia, Porto, Portugal
| | - Carla Moreira
- Centro Hospitalar do Porto, Hospital de Santo António, Departamento de Nefrologia, Porto, Portugal
| | - Sofia Correia
- Centro Hospitalar do Porto, Hospital de Santo António, Departamento de Nefrologia, Porto, Portugal
| | - Idalina Beirão
- Centro Hospitalar do Porto, Hospital de Santo António, Departamento de Nefrologia, Porto, Portugal.,Universidade do Porto, Instituto de Ciências Biomédicas Abel Salazar, Unidade Multidisciplinar de Investigação Biomédica, Porto, Portugal
| | - Luísa Lobato
- Centro Hospitalar do Porto, Hospital de Santo António, Departamento de Nefrologia, Porto, Portugal.,Universidade do Porto, Instituto de Ciências Biomédicas Abel Salazar, Unidade Multidisciplinar de Investigação Biomédica, Porto, Portugal
| | - António Cabrita
- Centro Hospitalar do Porto, Hospital de Santo António, Departamento de Nefrologia, Porto, Portugal
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Kramer A, Pippias M, Noordzij M, Stel VS, Andrusev AM, Aparicio-Madre MI, Arribas Monzón FE, Åsberg A, Barbullushi M, Beltrán P, Bonthuis M, Caskey FJ, Castro de la Nuez P, Cernevskis H, De Meester J, Finne P, Golan E, Heaf JG, Hemmelder MH, Ioannou K, Kantaria N, Komissarov K, Korejwo G, Kramar R, Lassalle M, Lopot F, Macário F, Mackinnon B, Pálsson R, Pechter Ü, Piñera VC, Santiuste de Pablos C, Segarra-Medrano A, Seyahi N, Slon Roblero MF, Stojceva-Taneva O, Vazelov E, Winzeler R, Ziginskiene E, Massy Z, Jager KJ. The European Renal Association - European Dialysis and Transplant Association (ERA-EDTA) Registry Annual Report 2016: a summary. Clin Kidney J 2019; 12:702-720. [PMID: 31583095 PMCID: PMC6768305 DOI: 10.1093/ckj/sfz011] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [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: 12/12/2018] [Indexed: 11/30/2022] Open
Abstract
Background This article summarizes the ERA-EDTA Registry’s 2016 Annual Report, by describing the epidemiology of renal replacement therapy (RRT) for end-stage renal disease (ESRD) in 2016 within 36 countries. Methods In 2017 and 2018, the ERA-EDTA Registry received data on patients undergoing RRT for ESRD in 2016 from 52 national or regional renal registries. In all, 32 registries provided individual patient data and 20 provided aggregated data. The incidence and prevalence of RRT and the survival probabilities of these patients were determined. Results In 2016, the incidence of RRT for ESRD was 121 per million population (pmp), ranging from 29 pmp in Ukraine to 251 pmp in Greece. Almost two-thirds of patients were men, over half were aged ≥65 years and almost a quarter had diabetes mellitus as their primary renal diagnosis. Treatment modality at the start of RRT was haemodialysis for 84% of patients. On 31 December 2016, the prevalence of RRT was 823 pmp, ranging from 188 pmp in Ukraine to 1906 pmp in Portugal. In 2016, the transplant rate was 32 pmp, varying from 3 pmp in Ukraine to 94 pmp in the Spanish region of Catalonia. For patients commencing RRT during 2007–11, the 5-year unadjusted patient survival probability on all RRT modalities combined was 50.5%. For 2016, the incidence and prevalence of RRT were higher among men (187 and 1381 pmp) than women (101 and 827 pmp), and men had a higher rate of kidney transplantation (59 pmp) compared with women (33 pmp). For patients starting dialysis and for patients receiving a kidney transplant during 2007–11, the adjusted patient survival probabilities appeared to be higher for women than for men.
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Affiliation(s)
- Anneke Kramer
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Maria Pippias
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marlies Noordzij
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Vianda S Stel
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anton M Andrusev
- State-financed health institution, City Clinical Hospital #52 of Moscow City Health Department, Moscow, Russia
| | | | | | - Anders Åsberg
- Department of Transplantation Medicine, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | | | | | - Marjolein Bonthuis
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,ESPN/ERA-EDTA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Fergus J Caskey
- UK Renal Registry, Southmead Hospital, Bristol, UK.,Population Health Sciences, University of Bristol, Bristol, UK
| | - Pablo Castro de la Nuez
- Information System of the Autonomic Transplant Coordination of Andalucia (SICATA), Seville, Andalucia, Spain
| | - Harijs Cernevskis
- Department of Internal Medicine, Riga Stradins University, Riga, Latvia
| | - Johan De Meester
- Department of Nephrology, Dialysis and Hypertension, Dutch-speaking Belgian Renal Registry (NBVN), Sint-Niklaas, Belgium
| | - Patrik Finne
- Finnish Registry for Kidney Diseases, Helsinki, Finland.,Nephrology, Abdominal Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Eliezer Golan
- Israel Renal Registry-ISNH, Hemodialysis Unit, Meir Medical Center, Kfar-Saba, Israel
| | - James G Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Marc H Hemmelder
- Dutch Renal Registry Renine, Nefrovisie Foundation, Utrecht, The Netherlands
| | - Kyriakos Ioannou
- Nephrology Department, Apollonion Private Hospital, Nicosia, Cyprus.,Nephrology Department, American Medical Center, Nicosia, Cyprus
| | - Nino Kantaria
- Georgian Renal Registry, Dialysis, Nephrology, and Transplantation Union of Georgia, Tbilisi State Medical University, Tbilisi, Georgia
| | - Kirill Komissarov
- Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus
| | - Grzegorz Korejwo
- Department of Nephrology, Gdańsk Medical University, Gdansk, Poland
| | | | - Mathilde Lassalle
- REIN Registry, Agence de la biomédecine, Saint-Denis La Plaine, France
| | - František Lopot
- Department of Medicine Prague, General University Hospital, Prague-Strahov, Czech Republic
| | - Fernando Macário
- Nephrology Department, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Bruce Mackinnon
- Scottish Renal Registry, Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Runólfur Pálsson
- Division of Nephrology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Ülle Pechter
- Department of Internal Medicine, Tartu University, Tartu, Estonia
| | - Vicente C Piñera
- Servicio de Nefrología, Hospital Universitario Valdecilla, Santander, Spain
| | - Carmen Santiuste de Pablos
- Registro de Enfermos Renales de la Región de Murcia, Servicio de Epidemiología, Consejería de Sanidad, IMIB-Arrixaca, Murcia, Spain
| | | | - Nurhan Seyahi
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University, Cerrahpaşa, Istanbul, Turkey
| | | | | | - Evgueniy Vazelov
- Dialysis Clinic, "Alexandrovska" University Hospital, Sofia Medical University, Sofia, Bulgaria
| | - Rebecca Winzeler
- Institute of Nephrology, Stadtspital Waid Zurich, Zurich, Switzerland
| | - Edita Ziginskiene
- Lithuanian Nephrology, Dialysis and Transplantation Association, Kaunas, Lithuania.,Nephrology Department, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ziad Massy
- Division of Nephrology, Ambroise Paré University Hospital, Boulogne-Billancourt, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Unit 1018 team5, Research Centre in Epidemiology and Population Health (CESP), University of Paris Ouest-Versailles-St Quentin-en-Yveline, Villejuif, France
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Abstract
The February 2015 issue of ckj started a new era with renewed efforts to be useful to the training and practicing nephrologists and a new focus on Clinical and Translational Nephrology. Four years later, it has become a truly global journal with contributors and readers from all over the world. The increase in quality of the published material has resulted in a nearly exponential growth of citations. Since 2016, ckj is listed in the new Emerging Sources Citation Index (ESCI) database from Clarivate Analytics and from January 2019 it will be listed in the full Science Citation Index. ckj will therefore receive its first official impact factor based upon 2018 citation to 2016 and 2017 articles. While no official impact factor was awarded for 2017, the estimated impact factors calculated from data available in Clarivate's Web of Science database rose to 2.987 in 2017, which would correspond to an estimated journal impact factor percentile of 72.4% in the Urology and Nephrology field.
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Affiliation(s)
- Alberto Ortiz
- Editor-in-Chief, Clinical Kidney Journal, IIS-Fundacion Jimenez Diaz, School of Medicine, Universidad Autonoma de Madrid; Fundacion Renal Iñigo Alvarez de Toledo-IRSIN and REDINREN, Madrid, Spain
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Eder S, Leierer J, Kerschbaum J, Rosivall L, Wiecek A, de Zeeuw D, Mark PB, Heinze G, Rossing P, Heerspink HL, Mayer G. Guidelines and clinical practice at the primary level of healthcare in patients with type 2 diabetes mellitus with and without kidney disease in five European countries. Diab Vasc Dis Res 2019; 16:47-56. [PMID: 30238781 DOI: 10.1177/1479164118795559] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The number of patients with type 2 diabetes mellitus and diabetes mellitus-associated chronic kidney disease varies considerably between countries. Next to differences in genetic as well as life style risk factors, varying practices in medical care delivery might cause this diversity. METHOD The PROVALID study recruited 4000 patients with type 2 diabetes mellitus at the primary level of healthcare in five European countries (Austria, Hungary, The Netherlands, Poland and Scotland). Baseline data were used to describe patient characteristics and compare the adherence to ADA (American Diabetes Association) and KDIGO (Kidney Disease: Improving Global Outcomes) guidelines with respect to metabolic and blood pressure control, use of renin-angiotensin system-blocking agents, statins and acetylsalicylic acid between the countries. RESULTS About 34.8% of the population had evidence of diabetes mellitus-associated chronic kidney disease. The median HbA1c level of the cohort was 6.8% (ranging from 6.5 in Poland to 7.0% in Scotland). Mean blood pressure was 136/79 (±17/10) and significantly higher in subjects with elevated albuminuria. These individuals also were more often treated with renin-angiotensin system-blocking agents (74.1% vs 84.6%), whereas the use of statins was driven by cardiovascular comorbidity. Acetylsalicylic acid was used in only 28.9% subjects. Despite similar cardiovascular comorbidities and renal function, the use of renin-angiotensin system-blocking agents varied significantly between the countries from 66.7% to 87.4%. An even higher variability was observed for patients >40 years of age using statins (39.8%-82.7%) and administration of acetylsalicylic acid in patients older than 50 years (5.2%-43.8%). CONCLUSION Our study shows that medical practice in type 2 diabetes mellitus patients with and without renal disease is different in European countries. Longitudinal follow-up will reveal if this diversity affects clinical endpoints.
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Affiliation(s)
- Susanne Eder
- 1 Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Johannes Leierer
- 1 Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Julia Kerschbaum
- 1 Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Laszlo Rosivall
- 2 International Nephrology Research and Training Center, Institute of Pathophysiology, Semmelweis University, Budapest, Hungary
| | - Andrzej Wiecek
- 3 Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - Dick de Zeeuw
- 4 Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Patrick B Mark
- 5 Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Georg Heinze
- 6 Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Peter Rossing
- 7 Steno Diabetes Center Copenhagen and Novo Nordisk Foundation Center for Basic Metabolic Research, Metabolism Center, University of Copenhagen, Copenhagen, Denmark
| | - Hiddo L Heerspink
- 4 Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gert Mayer
- 1 Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
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Bruzda-Zwiech A, Szczepańska J, Zwiech R. Xerostomia, thirst, sodium gradient and inter-dialytic weight gain in hemodialysis diabetic vs. non-diabetic patients. Med Oral Patol Oral Cir Bucal 2018; 23:e406-e412. [PMID: 29924756 PMCID: PMC6051689 DOI: 10.4317/medoral.22294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 04/23/2018] [Indexed: 11/22/2022] Open
Abstract
Background In hemodialysis (HD) patients, xerostomia and hyposalivation may intensify sensations of thirst, and contribute to the intake of fluids and excessive inter-dialytic weight gain (IWG). Since IWG is regarded to be higher in diabetic patients than in non-diabetics HD enhancing their mortality, it is crucial to define plausible underlying causes. Therefore, the study investigates factors contributing to the increased IWG in diabetic HD patients. Material and Methods The study included 97 HD patients (38 diabetics) receiving hemodialysis. All participants completed surveys comprising the Dialysis Thirst Inventory (DTI) and Xerostomia Inventory. Unstimulated whole saliva flow rate (USWFR) was measured, with USWFR below 0.1 mL/min being regarded as hyposalivation. Additionally, pre- and post-dialysis serum sodium concentration, sodium gradient and IWG were assessed. In diabetic HD patients, hemoglobin A1c (HbA1c) level was measured. Results Significantly higher scores were found in diabetic than non-diabetic HD patients with regard to DTI (21.2±7.7 vs. 17.1±6.2: Z=2.44, p=0.03) and xerostomia (40.5±6.1 vs. 29.9±14.4: Z=4.15, p=0.003). Hyposalivation was observed more often in diabetic HD patients (Z=2.23, p=0.04). IGW was significantly higher in participants with diabetes (Z=2.44, p=0.03), as was the pre-dialysis sodium serum (Z=3.4, p=0.008). High levels of HbA1c were associated with lower levels of serum sodium (r=-0.67 p<0.05). HbA1c positively correlated with pre-dialysis sodium gradient (r=0.66 p<0.05). However, multiple regression analysis found that the only predictors of increased IWG (>4.8 IWG%) in diabetic patients remained saliva flow rate and pre-dialysis sodium gradient. Conclusions Concomitant diabetes in hemodialysis patients appears to intensify subjective xerostomia and thirst sensation. It also leads to excessive IWG by the increase of pre-dialysis serum sodium gradient. Key words:Diabetes mellitus, hemodialysis, hyposalivation, inter-dialytic weight gain, sodium gradient.
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Affiliation(s)
- A Bruzda-Zwiech
- Department of Pediatric Dentistry Medical University of Lodz, Poland 92-213 Lodz, Pomorska 251,
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Chaabouni Y, Yaich S, Khedhiri A, Zayen MA, Kharrat M, Kammoun K, Jarraya F, Hmida MB, Damak J, Hachicha J. [Epidemiological profile of terminal chronic renal failure in the region of Sfax]. Pan Afr Med J 2018; 29:64. [PMID: 29875945 PMCID: PMC5987075 DOI: 10.11604/pamj.2018.29.64.12159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 06/25/2017] [Indexed: 11/11/2022] Open
Abstract
Introduction Terminal chronic renal failure is a truly global public health problem. In 2011, the cost of management of patients on dialysis has surpassed 90 million dinars (37.000 euro) in Tunisia, nearly 5% of the overall health spending. A better knowledge of the epidemiological profile of terminal chronic renal failure contributes to the implementation and evaluation of health strategies aimed to improve prevention and disease management. This study aimed to describe the epidemiological profile of incident cases in the Sfax Governorate over the period of 10 years. Methods We conducted a descriptive retrospective study over the period from January 2003 to December 2012. The incident cases of terminal chronic renal failure in the Sfax Governorate were included in the study. Results The diagnosis of terminal chronic renal failure was made in 1708 cases: 957 men and 751 women (sex-ratio = 1.27). The average age was 58.4 years [10-100 years]. The study of the evolution of the average age during the study period showed a tendency to increase with positive correlation coefficient (0.749) and p = 0.006. The main causal nephropathy was diabetic nephropathy (21.5%), with a significant increase in its frequency from one year to the other (positive correlation coefficient (0.770) with p = 0.009). Hemodialysis was the dialysis technique of choice, performed in 96% of patients. Conclusion A national registry is indispensable in order to better understand the epidemiological profile of terminal chronic renal failure in Tunisia and to improve its management.
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Affiliation(s)
- Yosr Chaabouni
- Service de Néphrologie, CHU Hedi Chaker, Sfax, Tunisie, Unité de Recherche de Pathologie Rénale, Faculté de Médecine, Sfax, Tunisie
| | - Sourour Yaich
- Service de Médecine Communautaire, CHU Hedi Chaker, Sfax, Tunisie
| | - Azza Khedhiri
- Service de Néphrologie, CHU HediChaker, Sfax, Tunisie
| | | | - Mahmoud Kharrat
- Service de Néphrologie, CHU Hedi Chaker, Sfax, Tunisie, Unité de Recherche de Pathologie Rénale, Faculté de Médecine, Sfax, Tunisie
| | - Khawla Kammoun
- Service de Néphrologie, CHU Hedi Chaker, Sfax, Tunisie, Unité de Recherche de Pathologie Rénale, Faculté de Médecine, Sfax, Tunisie
| | - Faical Jarraya
- Service de Néphrologie, CHU Hedi Chaker, Sfax, Tunisie, Unité de Recherche de Pathologie Rénale, Faculté de Médecine, Sfax, Tunisie
| | - Mohamed Ben Hmida
- Service de Néphrologie, CHU Hedi Chaker, Sfax, Tunisie, Unité de Recherche de Pathologie Rénale, Faculté de Médecine, Sfax, Tunisie
| | - Jamal Damak
- Service de Médecine Communautaire, CHU Hedi Chaker, Sfax, Tunisie
| | - Jamil Hachicha
- Service de Néphrologie, CHU Hedi Chaker, Sfax, Tunisie, Unité de Recherche de Pathologie Rénale, Faculté de Médecine, Sfax, Tunisie
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Mukakarangwa MC, Chironda G, Bhengu B, Katende G. Adherence to Hemodialysis and Associated Factors among End Stage Renal Disease Patients at Selected Nephrology Units in Rwanda: A Descriptive Cross-Sectional Study. Nurs Res Pract 2018; 2018:4372716. [PMID: 29973988 DOI: 10.1155/2018/4372716] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 03/17/2018] [Accepted: 04/03/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction Worldwide, End Stage Renal Disease (ESRD) has become a public health concern increasing the number of patients maintained on hemodialysis prior to renal transplantation. Nonadherence to hemodialysis continues to impact on the care of ESRD patients, causing high increase in morbidity and mortality. Purpose of the Study The purpose of this study was to determine the level of adherence to hemodialysis and the associated factors among End Stage Renal Disease (ESRD) patients in selected nephrology units in Rwanda. Methods This was a descriptive cross-sectional design involving 41 participants. Participants were recruited using a purposive sampling technique. Demographic and adherence to hemodialysis data were collected with the use of structured interview schedules. Descriptive statistics were used to describe the demographic variables and the level of adherence to hemodialysis. Inferential statistics of chi-square was used to establish factors associated with adherence to hemodialysis. Results Twenty-one (51%) of ESRD participants adhered highly (scores < 80%) to HD. Seventeen (42%) adhered moderately (70–79%) to HD while three (7%) had low level of adherence to HD (below 70%). The factors associated with adherence to hemodialysis were age (mean = 27; 95% CI 26.76–29, 17; p = 038) and religion (95% CI 26.29–60.12, p = 003). Frequencies of education of health care workers about the importance of not missing dialysis (95% CI 26.71–42.56, p = .000), perceived relative importance of hemodialysis (95% CI 20.44–27.76, p = .020), and experiencing difficulties during the procedure (95% CI 20.80–28.36, p = .004) were significantly associated with adherence to hemodialysis. Conclusion. Adherence to hemodialysis is still a public health concern in Rwanda. Health care providers and particularly nurses should continue to advocate for adherence to HD for better health outcomes. Further research is needed to identify the barriers to HD in Rwanda.
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Al Salmi I, Metry AM, Al Ismaili F, Hola A, Al Riyami M, Khamis F, Al-Abri S. Transplant tourism and invasive fungal infection. Int J Infect Dis 2018; 69:120-129. [PMID: 29428409 DOI: 10.1016/j.ijid.2018.01.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 07/21/2017] [Revised: 01/27/2018] [Accepted: 01/29/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Deceased and live-related renal transplants (RTXs) are approved procedures that are performed widely throughout the world. In certain regions, commercial RTX has become popular, driven by financial greed. METHODS This retrospective, descriptive study was performed at the Royal Hospital from 2013 to 2015. Data were collected from the national kidney transplant registry of Oman. All transplant cases retrieved were divided into two groups: live-related RTX performed in Oman and commercial-unrelated RTX performed abroad. These groups were then divided again into those with and without evidence of fungal infection, either in the wound or renal graft. RESULTS A total of 198 RTX patients were identified, of whom 162 (81.8%) had undergone a commercial RTX that was done abroad. Invasive fungal infections (IFIs) were diagnosed in 8% of patients who had undergone a commercial RTX; of these patients, 76.9% underwent a nephrectomy and 23.1% continued with a functioning graft. None of the patients with RTXs performed at the Royal Hospital contracted an IFI. The most common fungal isolates were Aspergillus species (including Aspergillus flavus, Aspergillus fumigatus, Aspergillus nidulans, and Aspergillus nigricans), followed by Zygomycetes. However, there was no evidence of fungal infection including Aspergillus outside the graft site. Computed tomography (CT) findings showed infarction of the graft, renal artery thrombosis, aneurysmal dilatation of the external iliac artery, fungal ball, or just the presence of a perigraft collection. Of the total patients with IFIs, 23.1% died due to septic shock and 53.8% were alive and on hemodialysis. The remaining 23.1% who did not undergo nephrectomy demonstrated acceptable graft function. CONCLUSIONS This is the largest single-center study on commercial RTX reporting the highest number of patients with IFI acquired over a relatively short period of time. Aspergillus spp were the main culprit fungi, with no Candida spp being isolated. A high index of suspicion might be the most reasonable means to reduce the possible very poor outcomes. Improving legal transplant programs and strengthening the associated laws could prevent commercial transplant tourism.
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Affiliation(s)
- I Al Salmi
- The Renal Medicine Department, Royal Hospital, Muscat, Oman.
| | - A M Metry
- The Renal Medicine Department, Royal Hospital, Muscat, Oman.
| | - F Al Ismaili
- The Renal Medicine Department, Royal Hospital, Muscat, Oman.
| | - A Hola
- The Renal Medicine Department, Royal Hospital, Muscat, Oman.
| | - M Al Riyami
- Department of Pathology, Sultan Qaboos University Hospital, Muscat, Oman.
| | - F Khamis
- Infectious Disease Department, Royal Hospital, Muscat, Oman.
| | - S Al-Abri
- Infectious Disease Department, Royal Hospital, Muscat, Oman.
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Bossola M, Marino C, Di Napoli A, Agabiti N, Tazza L, Davoli M; Dialysis and Transplant Lazio Region Registry Scientific Committee. Functional impairment and risk of mortality in patients on chronic hemodialysis: results of the Lazio Dialysis Registry. J Nephrol 2018; 31:593-602. [PMID: 29572627 DOI: 10.1007/s40620-018-0484-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/17/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Functional impairment is associated with adverse outcomes in older people, as well as in patients on chronic hemodialysis. The aim of this study was to evaluate if functional impairment represents a risk factor for reduced survival in patients on chronic hemodialysis. METHODS All incident chronic hemodialysis patients of Lazio, a large region of central Italy, registered in the Dialysis and Transplant Lazio Region Registry (DTLRR) in the period 2008-2013 were considered eligible. Inclusion criteria were: age > 18 years, resident in Lazio, still doing dialysis after 90 days from incidence date, doing hemodialysis or hemodiafiltration treatment for > 9 h/week. Patients were stratified into three classes of functional activity: total autonomy, autonomy in some activities, and not self-sufficient. Functional activity was assessed for each patient by the referring physician for the DTLRR from the ~ 90 hemodialysis units of the Lazio region. Each patient was followed from date of first dialysis treatment to the end of the study (31/12/2015) or death or renal transplant, whichever occurred first. Cox proportional hazard models were performed to obtain mortality hazard ratios (HR), 95% confidence intervals (CI), for each class of functional activity adjusting for sex, age, country of birth, city of residence, body mass index (BMI), type of nephropathy, vascular access, previous nephrology counselling, weekly hours of hemodialysis, serum albumin, hemoglobin, and presence of comorbidities (e.g. vascular diseases, coronary disease, and diabetes). RESULTS A total of 3356 patients were studied. In the whole follow-up period, 1622 deaths occurred (48%). Functional impairment was associated with the risk of mortality: compared to 'total autonomy', the HR for 'autonomy in some activities' was 1.30 [95% CI: 1.14-1.49] and for 'not self-sufficient' 1.71 [1.47-1.99] (p for trend < 0.05). The number of evitable deaths attributable to reduced functional activity was 237. CONCLUSION Functional impairment represents a risk factor for reduced survival in chronic hemodialysis patients. There is a need for early identification of patients who might benefit from interventions aimed at preventing, reversing or delaying the functional impairment.
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Wilschut ED, Rotmans JI, Bos EJ, van Zoest D, Eefting D, Hamming JF, van der Bogt KE. Supervised preoperative forearm exercise to increase blood vessel diameter in patients requiring an arteriovenous access for hemodialysis: rationale and design of the PINCH trial. J Vasc Access 2018; 19:84-8. [DOI: 10.5301/jva.5000826] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Failure of maturation occurs in 30%-60% of arteriovenous fistula (AVF) creation for hemodialysis, with highest rates in distal radiocephalic fistulas. This is partly due to initial small blood vessel size with limited blood flow capacity. Forearm exercise has shown potential as stimulus for increasing blood vessel size in patients with end-stage renal disease (ESRD) and may promote maturation of AVFs in the upper limb when applied postoperatively. However, it is unknown if forearm exercise increases blood vessel size pre-operatively, which may contribute to more distal AVF creation and raise success rates of AVF surgery. This study will investigate these issues. Methods and results: The PINCH trial (refers to ‘pinching’) is an investigator-initiated, multicenter, single-blinded, randomized controlled trial with 1:1 randomization to perform supervised forearm exercises compared to no exercise 6 weeks pre-operatively before creation of an AVF. Forty patients receiving an AVF will be included. The main study endpoints are blood vessel diameter (cephalic or basilic vein and radial and ulnar artery), AVF surgical plan (radiocephalic or brachiobasilic/cephalic), and three-month (assisted) maturation rate. The burden of the performed forearm exercises will be evaluated using Kidney Disease Quality of Life (KDQOL-SF Dutch version 1.2) and exercise specific questionnaires. The PINCH trial is planned to start in November 2017. Enrollment is expected to be completed at the end of 2019. Conclusions: The PINCH study is the first trial to evaluate the effect of pre-operative, supervised forearm exercises on vein diameter and fistula maturation in hemodialysis patients. Trial registration: NTR6382.
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Weinrauch LA, D'Elia JA, Weir MR, Bunnapradist S, Finn PV, Liu J, Claggett B, Monaco AP. Infection and Malignancy Outweigh Cardiovascular Mortality in Kidney Transplant Recipients: Post Hoc Analysis of the FAVORIT Trial. Am J Med 2018; 131:165-172. [PMID: 28943384 DOI: 10.1016/j.amjmed.2017.08.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Now that long-term survival after successful renal transplantation is no longer limited by excessive cardiovascular risk, the primary care physician should consider that infection and malignancy are leading noncardiovascular causes of death even in the recipient with diabetes. METHODS We accessed the National Institutes of Health-sponsored Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) study population (4010 renal transplant recipients with elevated homocysteine levels) studied to determine whether folate and B12 supplementation would reduce cardiovascular end points. This trial had a null result. Patients were classified as being nondiabetic or having type 1 or type 2 diabetes. RESULTS We report an excess (cardiovascular and noncardiovascular) 6-year mortality risk associated with the presence of diabetes mellitus. Two thirds of fatal events in our renal transplant recipients were centrally adjudicated as noncardiovascular. The incidence of noncardiovascular death was 70% higher in the diabetic patient cohort than in the nondiabetic cohort. CONCLUSIONS These results demonstrate that infection (but not malignancy) risks are far higher in diabetic than nondiabetic immunosuppressed individuals (although noncardiovascular death rate in nondiabetic individuals also exceeded cardiovascular deaths) and may play a larger role in the excess mortality populations than previously thought. Given that follow-up in this study was 4 to 10 years after allograft surgery, there was a lesser degree of acute rejection requiring high-dose immunosuppression than in the initial postallograft years. This unique perspective allows transplant recipients to return to primary physicians when taking low doses of immunosuppressive agents and provides focus for follow-up care.
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Affiliation(s)
- Larry A Weinrauch
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Mass; Kidney and Hypertension Section, Joslin Diabetes Center, Boston, Mass; Departments of Medicine and Surgery, Beth Israel Deaconess Medical Center, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - John A D'Elia
- Kidney and Hypertension Section, Joslin Diabetes Center, Boston, Mass; Departments of Medicine and Surgery, Beth Israel Deaconess Medical Center, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Matthew R Weir
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Md
| | - Suphamai Bunnapradist
- Division of Nephrology, Department of Medicine, University of California at Los Angeles, Los Angeles, Calif
| | - Peter V Finn
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Mass
| | - Jiankang Liu
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Mass
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Mass
| | - Anthony P Monaco
- Departments of Medicine and Surgery, Beth Israel Deaconess Medical Center, Boston, Mass; Harvard Medical School, Boston, Mass; Division of Nephrology, New England Medical Center, Tufts University School of Medicine, Boston, Mass
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Kramer A, Pippias M, Noordzij M, Stel VS, Afentakis N, Ambühl PM, Andrusev AM, Fuster EA, Arribas Monzón FE, Åsberg A, Barbullushi M, Bonthuis M, Caskey FJ, Castro de la Nuez P, Cernevskis H, des Grottes JM, Garneata L, Golan E, Hemmelder MH, Ioannou K, Jarraya F, Kolesnyk M, Komissarov K, Lassalle M, Macario F, Mahillo-Duran B, Martín de Francisco AL, Palsson R, Pechter Ü, Resic H, Rutkowski B, Santiuste de Pablos C, Seyahi N, Simic Ogrizovic S, Slon Roblero MF, Spustova V, Stojceva-Taneva O, Traynor J, Massy ZA, Jager KJ. The European Renal Association - European Dialysis and Transplant Association (ERA-EDTA) Registry Annual Report 2015: a summary. Clin Kidney J 2018; 11:108-122. [PMID: 29423210 PMCID: PMC5798130 DOI: 10.1093/ckj/sfx149] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [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: 10/30/2017] [Accepted: 11/22/2017] [Indexed: 12/21/2022] Open
Abstract
Background This article summarizes the European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) Registry’s 2015 Annual Report. It describes the epidemiology of renal replacement therapy (RRT) for end-stage renal disease (ESRD) in 2015 within 36 countries. Methods In 2016 and 2017, the ERA-EDTA Registry received data on patients who were undergoing RRT for ESRD in 2015, from 52 national or regional renal registries. Thirty-two registries provided individual patient-level data and 20 provided aggregated-level data. The incidence, prevalence and survival probabilities of these patients were determined. Results In 2015, 81 373 individuals commenced RRT for ESRD, equating to an overall unadjusted incidence rate of 119 per million population (pmp). The incidence ranged by 10-fold, from 24 pmp in Ukraine to 232 pmp in the Czech Republic. Of the patients commencing RRT, almost two-thirds were men, over half were aged ≥65 years and a quarter had diabetes mellitus as their primary renal diagnosis. Treatment modality at the start of RRT was haemodialysis for 85% of the patients, peritoneal dialysis for 11% and a kidney transplant for 4%. By Day 91 of commencing RRT, 82% of patients were receiving haemodialysis, 13% peritoneal dialysis and 5% had a kidney transplant. On 31 December 2015, 546 783 individuals were receiving RRT for ESRD, corresponding to an unadjusted prevalence of 801 pmp. This ranged throughout Europe by more than 10-fold, from 178 pmp in Ukraine to 1824 pmp in Portugal. In 2015, 21 056 kidney transplantations were performed, equating to an overall unadjusted transplant rate of 31 pmp. This varied from 2 pmp in Ukraine to 94 pmp in the Spanish region of Cantabria. For patients commencing RRT during 2006–10, the 5-year unadjusted patient survival probabilities on all RRT modalities combined was 50.0% (95% confidence interval 49.9–50.1).
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Affiliation(s)
- Anneke Kramer
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Maria Pippias
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marlies Noordzij
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Vianda S Stel
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Nikolaos Afentakis
- Hellenic Renal Registry, Board of Registry, Coordination and Control of RRT, General Hospital of Athens 'G. Gennimatas', Athens, Greece
| | - Patrice M Ambühl
- Swiss Dialysis Registry, Renal Division, Stadtspital Waid Zürich, Zurich, Switzerland
| | - Anton M Andrusev
- Department of Peritoneal Dialysis, City Hospital #52, Moscow, Russian Federation.,Russian Dialysis Society, Moscow, Russian Federation
| | - Emma Arcos Fuster
- Catalan Renal Registry, Catalan Transplant Organization, Health Department, Generalitat of Catalonia, Barcelona, Spain
| | | | - Anders Åsberg
- Department of Transplantation, Oslo University Hospital Rikshospitalet and Norwegian Renal Registry, Oslo, Norway
| | | | - Marjolein Bonthuis
- ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Fergus J Caskey
- UK Renal Registry, Southmead Hospital, Bristol, UK.,Population Health Sciences, University of Bristol, Bristol, UK
| | - Pablo Castro de la Nuez
- Information System of Regional Transplant Coordination in Andalucia (SICATA), Seville, Andalucia, Spain
| | - Harijs Cernevskis
- Department of Internal Medicine, Riga Stradins University, Riga, Latvia
| | | | - Liliana Garneata
- "Carol Davila" University of Medicine and Pharmacy, Department of Internal Medicine and Nephrology "Dr Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Eliezer Golan
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar-Saba and Sackler Faculty of Medicine, Tel-Aviv, Israel
| | - Marc H Hemmelder
- Dutch Renal Registry Renine, Nefrovisie foundation, Utrecht, The Netherlands
| | - Kyriakos Ioannou
- Nephrology Department, Apollonion Private Hospital, Nicosia, Cyprus.,Nephrology Department, American Medical Center, Nicosia, Cyprus
| | - Faical Jarraya
- Research Unit 12ES14 and Nephrology Department, Sfax University, Sfax, Tunisia
| | - Mykola Kolesnyk
- State Institute of Nephrology, National Academy of Medical Sciences of Ukraine, Kiev, Ukraine
| | - Kirill Komissarov
- Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus
| | - Mathilde Lassalle
- REIN Registry, Agence de la biomédecine, Saint-Denis La Plaine, France
| | - Fernando Macario
- Portuguese Society of Nephrology, Nephrology Department, University Hospital of Coimbra, Coimbra, Portugal
| | - Beatriz Mahillo-Duran
- Spanish Renal Disease Patients Registry (REER), Organización Nacional de Trasplantes (ONT), Madrid, Spain
| | | | - Runolfur Palsson
- Division of Nephrology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Ülle Pechter
- Department of Internal Medicine, Tartu University, Tartu, Estonia
| | - Halima Resic
- Clinic for Hemodialysis, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Boleslaw Rutkowski
- Polish Renal Registry, Department of Nephrology, Transplantology and Internal Medicine, Medical University, Gdansk, Poland
| | - Carmen Santiuste de Pablos
- Registro de Enfermos Renales de la Región de Murcia, Servicio de Epidemiología, Consejería de Sanidad, IMIB-Arrixaca, Murcia, Spain
| | - Nurhan Seyahi
- Istanbul University, Cerrahpasa Medical Faculty, Nephrology, Istanbul, Turkey
| | | | | | | | | | - Jamie Traynor
- The Scottish Renal Registry, Meridian Court, Information Services Division Scotland, Glasgow, UK
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Hospital, Boulogne-Billancourt, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Unit 1018 team5, Research Centre in Epidemiology and Population Health (CESP), University of Paris Ouest-Versailles-St Quentin-en-Yveline, Villejuif, 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
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Santos J, Fonseca I. Incorporating Scoring Risk Models for Care Planning of the Elderly with Chronic Kidney Disease. Curr Gerontol Geriatr Res 2017; 2017:8067094. [PMID: 29317867 DOI: 10.1155/2017/8067094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/12/2017] [Indexed: 01/05/2023] Open
Abstract
Mortality in chronic kidney disease remains high, particularly among the elderly, who represent the most rapidly growing segment of the end-stage renal disease population in wealthier countries. The management of older adults with chronic kidney disease has become a clinical challenge, and care for those patients expected to progress to end-stage renal disease should focus on evaluating the overall benefit of offering renal replacement therapy to them. Predictive mortality models may help to inform shared decision-making in the trajectory of the elderly with chronic kidney disease. This review discusses current literature on the available predictive models for predicting survival in elderly chronic kidney disease patients and reflects the author's own interpretation and experience.
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Marra G, Dalmasso E, Agnello M, Munegato S, Bosio A, Sedigh O, Biancone L, Gontero P. Prostate cancer treatment in renal transplant recipients: a systematic review. BJU Int 2017; 121:327-344. [DOI: 10.1111/bju.14018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Giancarlo Marra
- Department of Urology; Molinette Hospital; University of Studies of Turin; Turin Italy
| | - Ettore Dalmasso
- Department of Urology; Molinette Hospital; University of Studies of Turin; Turin Italy
| | - Marco Agnello
- Department of Urology; Molinette Hospital; University of Studies of Turin; Turin Italy
| | - Stefania Munegato
- Department of Urology; Molinette Hospital; University of Studies of Turin; Turin Italy
| | - Andrea Bosio
- Department of Urology; Molinette Hospital; University of Studies of Turin; Turin Italy
| | - Omidreza Sedigh
- Department of Urology; Molinette Hospital; University of Studies of Turin; Turin Italy
| | - Luigi Biancone
- Department of Nephrology and Renal Transplantation; Molinette Hospital; University of Studies of Turin; Turin Italy
| | - Paolo Gontero
- Department of Urology; Molinette Hospital; University of Studies of Turin; Turin Italy
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Stel VS, Brück K, Fraser S, Zoccali C, Massy ZA, Jager KJ. International differences in chronic kidney disease prevalence: a key public health and epidemiologic research issue. Nephrol Dial Transplant 2017; 32:ii129-ii135. [PMID: 28206610 DOI: 10.1093/ndt/gfw420] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 11/08/2016] [Indexed: 01/09/2023] Open
Abstract
In this narrative review, we studied the association of risk factors for chronic kidney disease (CKD) and CKD prevalence at an ecological level and describe potential reasons for international differences in estimated CKD prevalence across European countries. We found substantial variation in risk factors for CKD such as in the prevalence of diabetes mellitus, obesity, raised blood pressure, physical inactivity, current smoking and salt intake per day. In general, the countries with a higher CKD prevalence also had a higher average score on CKD risk factors, and vice versa. There was no association between cardiovascular mortality rates and CKD prevalence. In countries with a high CKD prevalence, the prevention of noncommunicable diseases may be considered important, and, therefore, all five national response systems (e.g. an operational national policy, strategy or action plan to reduce physical inactivity and/or promote physical activity) have been implemented. Furthermore, both the heterogeneity in study methods to assess CKD prevalence as well as the international differences in the implementation of lifestyle measures will contribute to the observed variation in CKD prevalence. A robust public health approach to reduce risk factors in order to prevent CKD and reduce CKD progression risk is needed and will have co-benefits for other noncommunicable diseases.
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Affiliation(s)
- Vianda S Stel
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Katharina Brück
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Simon Fraser
- Academic Unit of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Carmine Zoccali
- CNR-IFC, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, Reggio Calabria, Italy
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Hospital, APHP, University of Paris Ouest-Versailles-St-Quentin-en-Yvelines (UVSQ), Boulogne-Billancourt/Paris, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, CESP, Team 5, Villejuif, France
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
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Radosa CG, Radosa JC, Weiss N, Schmidt C, Werth S, Hofmockel T, Plodeck V, Gatzweiler C, Laniado M, Hoffmann RT. Endovascular Creation of an Arteriovenous Fistula (endoAVF) for Hemodialysis Access: First Results. Cardiovasc Intervent Radiol 2017; 40:1545-1551. [PMID: 28785804 DOI: 10.1007/s00270-017-1750-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/14/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Surgical creation of a radiocephalic fistula is the gold standard of vascular access for hemodialysis. Recently, an endovascular approach for upper arm fistula creation (endoAVF) has been developed, which may be an alternative to open surgery. We describe a case series of eight cases showing feasibility, early complications and outcome of this novel treatment option. MATERIALS AND METHODS Between July 2015 and February 2016, we created an endoAVF in eight patients. Indications for endoAVF were confirmed by a multidisciplinary vascular board upon the exclusion for Cimino fistula candidates. Patients were suitable for the procedure after a pre-therapeutic ultrasound showed adequate brachial and ulnar vessels and no ipsilateral central venous stenosis. Patient characteristics, technical success, total patient radiation dose, complication rates, time to maturation of endoAVF and clinical effectiveness at six months were assessed retrospectively. RESULTS Creation of endoAVF using the everlinQ endoAVF system (TVA Medical Inc., Austin, TX, USA) was successful in all eight cases. There were one minor intraprocedural complication and no postoperative complications. Median time to endoAVF maturation was 63 days (range 26-137 days). One patient was lost to follow-up after the first monitoring visit. In the remaining seven patients, hemodialysis was started without problems. Patency after 6 months was 100%. DISCUSSION The endoAVF demonstrated to be feasible and safe for the creation of arteriovenous fistula suitable for hemodialysis access. Further studies with more patients and longer follow-up periods are needed to assess long-term outcomes and comparability to surgical dialysis access creation.
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Affiliation(s)
- Christoph Georg Radosa
- Department of Radiology, Dresden University Hospital, Fetscherstraße 74, 01307, Dresden, Germany
| | - Julia Caroline Radosa
- Department of Gynecology and Obstetrics, Saarland University Hospital, Kirrbergerstraße 100, 66421, Homburg, Saar, Germany
| | - Norbert Weiss
- Department of Internal Medicine III - Section Angiology, Dresden University Hospital, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christine Schmidt
- Department of Internal Medicine III - Section Angiology, Dresden University Hospital, Fetscherstraße 74, 01307, Dresden, Germany
| | - Sebastian Werth
- Department of Internal Medicine III - Section Angiology, Dresden University Hospital, Fetscherstraße 74, 01307, Dresden, Germany
| | - Thomas Hofmockel
- Department of Radiology, Dresden University Hospital, Fetscherstraße 74, 01307, Dresden, Germany
| | - Verena Plodeck
- Department of Radiology, Dresden University Hospital, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christian Gatzweiler
- Department of Visceral, Thoracic and Vascular Surgery, Dresden University Hospital, Fetscherstraße 74, 01307, Dresden, Germany
| | - Michael Laniado
- Department of Radiology, Dresden University Hospital, Fetscherstraße 74, 01307, Dresden, Germany
| | - Ralf-Thorsten Hoffmann
- Department of Radiology, Dresden University Hospital, Fetscherstraße 74, 01307, Dresden, Germany.
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Kinoshita Y, Ishikawa A, Hara K, Sugihara T, Ishibashi Y, Homma Y. Plasma cell neoplasm as a risk factor for early thrombosis of arteriovenous fistula. Hemodial Int 2017; 22:176-179. [PMID: 28762615 DOI: 10.1111/hdi.12581] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We hypothesized that presence of plasma cell neoplasms might be a risk for thrombosis of arteriovenous fistulas (AVFs) as well as other well-known factors including age, sex, race, and presence of diabetes mellitus or certain vascular disorders. METHODS In this single-center, retrospective study based on medical record data, we investigated the influence of plasma cell neoplasms and the above-mentioned factors on the occurrence of complete occlusive thrombosis of the AVF within 30 days after surgery for creation of the AVF. Thrombosis was defined as the absence of bruit or thrill on auscultation and palpation, throughout systole and diastole. FINDINGS We retrospectively assessed the medical records of 91 patients with end-stage renal failure, including 8 patients with plasma cell neoplasm (5 with multiple myeloma and 3 with amyloid light-chain amyloidosis), who underwent surgical creation of an AVF at the wrist or anatomical snuff box for the first time between April 2014 and December 2016. Early thrombosis (i.e., within 30 days of surgery) occurred in 50.0% (4/8) and 10.8% (9/83) of patients with and without plasma cell neoplasm, respectively (P = 0.013). Multivariate analysis revealed that, after adjusting for baseline characteristics, plasma cell neoplasm was the only significant risk factor for early AVF thrombosis (odds ratio, 38.8; 95% confidence interval, 4.0-378.9; P = 0.0017). DISCUSSION Considering the poor prognosis of plasma cell neoplasm and its association with higher risk for AVF thrombosis, another type of vascular access is likely to be more suitable than AVF in such patients.
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Affiliation(s)
| | - Akira Ishikawa
- Department of Urology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Konan Hara
- Department of Public Health/Health Policy, The University of Tokyo, Tokyo, Japan
| | - Toru Sugihara
- Department of Urology, Japanese Red Cross Medical Center, Tokyo, Japan
| | | | - Yukio Homma
- Department of Urology, Japanese Red Cross Medical Center, Tokyo, Japan
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50
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Santos J, Fonseca I, Malheiro J, Beirao I, Lobato L, Oliveira P, Cabrita A. End-stage renal disease versus death in a Portuguese cohort of elderly patients: an approach using competing event analysis. J Investig Med 2017; 65:1041-1048. [PMID: 28729248 DOI: 10.1136/jim-2017-000480] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2017] [Indexed: 12/17/2022]
Abstract
Chronic kidney disease (CKD) is higher in elderly, but mortality outweighs the risk of end-stage renal disease (ESRD). Our aim was to identify prognostic markers for ESRD or death in elderly CKD, within a competing-risk analysis. This is a longitudinal study of consecutive newly referred patients with CKD ages 65 years, followed until the time of the first event (ESRD or death), using a competing-risk analysis. A modified Charlson Comorbidity Index (mCCI) was subdivided into subgroups (0-2, 3-4, ≥5). Patients were followed for hospitalizations that occurred prior to the outcomes. Among 416 patients, age 76±8 years, 52% male, median estimated glomerular filtration rate of 32 mL/min per 1.73 m2, 50% had diabetes, and 67% cardiovascular disease. Over a median follow-up of 3.6 years, 36 patients progressed to ESRD (8.7%) and 103 died (24.8%). Older age (subdistribution HR (sHR)=1. 06; p<0.001), creatinine≥1.6 mg/dL (sHR=2.03, p=0.004), hemoglobin <11 g/dL (sHR=1.91, p=0.003), mCCI score≥5 (sHR=3.01, p<0.001) and having one or more hospitalizations (sHR=1.73, p<0.001) were associated with death before ESRD. The independent predictors for ESRD with competing risk of death were: lower age (sHR=0.94; p=0.009), creatinine≥1.6 mg/dL (sHR=3.26, p=0.006), hemoglobin <11 g/dL (sHR=2.15, p=0.027), peripheral vascular disease (sHR=3.45, p=0.001) and having one or more hospitalizations (sHR=1.56, p=0.031). Elderly referred patients with CKD are near threefold more likely to die than progress to ESRD. A competing-risk framework based on available clinical and laboratory data may discriminate between those outcomes and could be used as a decision-making tool.
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Affiliation(s)
- Josefina Santos
- Nephrology Department, Hospital de Santo António, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar Porto, Universidade do Porto, Porto, Portugal
| | - Isabel Fonseca
- Nephrology Department, Hospital de Santo António, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar Porto, Universidade do Porto, Porto, Portugal.,ISPUP5EPI Unit, Universidade do Porto, Porto, Portugal
| | - Jorge Malheiro
- Nephrology Department, Hospital de Santo António, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar Porto, Universidade do Porto, Porto, Portugal
| | - Idalina Beirao
- Nephrology Department, Hospital de Santo António, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar Porto, Universidade do Porto, Porto, Portugal
| | - Luisa Lobato
- Nephrology Department, Hospital de Santo António, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar Porto, Universidade do Porto, Porto, Portugal
| | - Pedro Oliveira
- ISPUP5EPI Unit, Universidade do Porto, Porto, Portugal.,Department of Population Studies, Instituto de Ciências Biomédicas Abel Salazar Porto, Universidade do Porto, Porto, Portugal
| | - Antonio Cabrita
- Nephrology Department, Hospital de Santo António, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal
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