1
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Oomen L, de Jong H, Bouts AHM, Keijzer-Veen MG, Cornelissen EAM, de Wall LL, Feitz WFJ, Bootsma-Robroeks CMHHT. A pre-transplantation risk assessment tool for graft survival in Dutch pediatric kidney recipients. Clin Kidney J 2023; 16:1122-1131. [PMID: 37398686 PMCID: PMC10310505 DOI: 10.1093/ckj/sfad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Indexed: 07/04/2023] Open
Abstract
Background A prediction model for graft survival including donor and recipient characteristics could help clinical decision-making and optimize outcomes. The aim of this study was to develop a risk assessment tool for graft survival based on essential pre-transplantation parameters. Methods The data originated from the national Dutch registry (NOTR; Nederlandse OrgaanTransplantatie Registratie). A multivariable binary logistic model was used to predict graft survival, corrected for the transplantation era and time after transplantation. Subsequently, a prediction score was calculated from the β-coefficients. For internal validation, derivation (80%) and validation (20%) cohorts were defined. Model performance was assessed with the area under the curve (AUC) of the receiver operating characteristics curve, Hosmer-Lemeshow test and calibration plots. Results In total, 1428 transplantations were performed. Ten-year graft survival was 42% for transplantations before 1990, which has improved to the current value of 92%. Over time, significantly more living and pre-emptive transplantations have been performed and overall donor age has increased (P < .05).The prediction model included 71 829 observations of 554 transplantations between 1990 and 2021. Other variables incorporated in the model were recipient age, re-transplantation, number of human leucocyte antigen (HLA) mismatches and cause of kidney failure. The predictive capacity of this model had AUCs of 0.89, 0.79, 0.76 and 0.74 after 1, 5, 10 and 20 years, respectively (P < .01). Calibration plots showed an excellent fit. Conclusions This pediatric pre-transplantation risk assessment tool exhibits good performance for predicting graft survival within the Dutch pediatric population. This model might support decision-making regarding donor selection to optimize graft outcomes. Trial registration ClinicalTrials.gov Identifier: NCT05388955.
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Affiliation(s)
| | - Huib de Jong
- Department of Pediatric Nephrology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Antonia H M Bouts
- Department of Pediatric Nephrology, Amsterdam University Medical Center, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Mandy G Keijzer-Veen
- Department of Pediatric Nephrology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elisabeth A M Cornelissen
- Department of Pediatric Nephrology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Liesbeth L de Wall
- Department of Urology, Division of Pediatric Urology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Wout F J Feitz
- Department of Urology, Division of Pediatric Urology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Charlotte M H H T Bootsma-Robroeks
- Department of Pediatric Nephrology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Pediatrics, Pediatric Nephrology, Beatrix Children's Hospital, Groningen, The Netherlands
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2
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Haapio M, van Diepen M, Steenkamp R, Helve J, Dekker FW, Caskey F, Finne P. Predicting mortality after start of long-term dialysis-International validation of one- and two-year prediction models. PLoS One 2023; 18:e0280831. [PMID: 36812268 PMCID: PMC9946236 DOI: 10.1371/journal.pone.0280831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 01/10/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Mortality prediction is critical on long-term kidney replacement therapy (KRT), both for individual treatment decisions and resource planning. Many mortality prediction models already exist, but as a major shortcoming most of them have only been validated internally. This leaves reliability and usefulness of these models in other KRT populations, especially foreign, unknown. Previously two models were constructed for one- and two-year mortality prediction of Finnish patients starting long-term dialysis. These models are here internationally validated in KRT populations of the Dutch NECOSAD Study and the UK Renal Registry (UKRR). METHODS We validated the models externally on 2051 NECOSAD patients and on two UKRR patient cohorts (5328 and 45493 patients). We performed multiple imputation for missing data, used c-statistic (AUC) to assess discrimination, and evaluated calibration by plotting average estimated probability of death against observed risk of death. RESULTS Both prediction models performed well in the NECOSAD population (AUC 0.79 for the one-year model and 0.78 for the two-year model). In the UKRR populations, performance was slightly weaker (AUCs: 0.73 and 0.74). These are to be compared to the earlier external validation in a Finnish cohort (AUCs: 0.77 and 0.74). In all tested populations, our models performed better for PD than HD patients. Level of death risk (i.e., calibration) was well estimated by the one-year model in all cohorts but was somewhat overestimated by the two-year model. CONCLUSIONS Our prediction models showed good performance not only in the Finnish but in foreign KRT populations as well. Compared to the other existing models, the current models have equal or better performance and fewer variables, thus increasing models' usability. The models are easily accessible on the web. These results encourage implementing the models into clinical decision-making widely among European KRT populations.
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Affiliation(s)
- Mikko Haapio
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- * E-mail:
| | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jaakko Helve
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Finnish Registry for Kidney Diseases, Helsinki, Finland
| | - Friedo W. Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fergus Caskey
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Patrik Finne
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Finnish Registry for Kidney Diseases, Helsinki, Finland
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3
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Wang Y, Veltkamp DMJ, van der Boog PJM, Hemmelder MH, Dekker FW, de Vries APJ, Meuleman Y. Illness Perceptions and Medication Nonadherence to Immunosuppressants After Successful Kidney Transplantation: A Cross-Sectional Study. Transpl Int 2022; 35:10073. [PMID: 35185376 PMCID: PMC8842226 DOI: 10.3389/ti.2022.10073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/10/2022] [Indexed: 11/17/2022]
Abstract
Background: Medication nonadherence to immunosuppressants is a well-known risk factor for suboptimal health outcomes in kidney transplant recipients (KTRs). This study examined the relationship between illness perceptions and medication nonadherence in prevalent Dutch KTRs and whether this relationship depended on post-transplant time. Methods: Eligible KTRs transplanted in Leiden University Medical Center were invited for this cross-sectional study. The illness perceptions and medication nonadherence were measured via validated questionnaires. Associations between illness perceptions and medication nonadherence were investigated using multivariable logistic regression models. Results: For the study, 627 participating KTRs were analyzed. 203 (32.4%) KTRs were considered nonadherent to their immunosuppressants with “taking medication more than 2 h from the prescribed dosing time” as the most prevalent nonadherent behaviour (n = 171; 27.3%). Three illness perceptions were significantly associated with medication nonadherence: illness identity (adjusted odds ratio [ORadj] = 1.07; 95% confidence interval [CI], 1.00–1.14), concern (ORadj = 1.07; 95%CI,1.00–1.14), and illness coherence (ORadj = 1.11; 95%CI,1.01–1.22). The relationships between illness perceptions and medication nonadherence did not differ depending on post-transplant time (p-values ranged from 0.48 to 0.96). Conclusion: Stronger negative illness perceptions are associated with medication nonadherence to immunosuppressants. Targeting negative illness perceptions by means of psychoeducational interventions could optimize medication adherence and consequently improve health outcomes in KTRs.
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Affiliation(s)
- Yiman Wang
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
- *Correspondence: Yiman Wang,
| | - Denise M. J. Veltkamp
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, Netherlands
| | - Paul J. M. van der Boog
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, Netherlands
- Transplant Center, Leiden University Medical Center, Leiden, Netherlands
| | - Marc H. Hemmelder
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, Netherlands
- CARIM School for Cardiovascular Research, University Maastricht, Maastricht, Netherlands
| | - Friedo W. Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Aiko P. J. de Vries
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, Netherlands
- Transplant Center, Leiden University Medical Center, Leiden, Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
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4
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Wang Y, Heemskerk MBA, Michels WM, de Vries APJ, Dekker FW, Meuleman Y. Donor type and 3-month hospital readmission following kidney transplantation: results from the Netherlands organ transplant registry. BMC Nephrol 2021; 22:155. [PMID: 33902492 PMCID: PMC8077946 DOI: 10.1186/s12882-021-02363-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/16/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hospital readmission after transplantation is common in kidney transplant recipients (KTRs). In this study, we aim to compare the risk of 3-month hospital readmission after kidney transplantation with different donor types in the overall population and in both young (< 65 years) and elderly (≥65 years) KTRs. METHODS We included all first-time adult KTRs from 2016 to 2018 in the Netherlands Organ Transplant Registry. Multivariable logistic regression models were used to estimate the effect while adjusting for baseline confounders. RESULTS Among 1917 KTRs, 615 (32.1%) had at least one hospital readmission. Living donor kidney transplantation (LDKT) recipients had an adjusted OR of 0.76 (95%CI, 0.61 to 0.96; p = 0.02) for hospital readmission compared to deceased donor kidney transplantation (DDKT) recipients. In the young and elderly, the adjusted ORs were 0.69 (95%CI, 0.52 to 0.90, p = 0.01) and 0.93 (95%CI, 0.62 to 1.39, p = 0.73) and did not differ significantly from each other (p-value for interaction = 0.38). In DDKT, the risk of hospital readmission is similar between recipients with donation after cardiac death (DCD) or brain death (DBD) and the risk was similar between the young and elderly. CONCLUSION A lower risk of post-transplant 3-month hospital readmission was found in recipients after LDKT compared to DDKT, and this benefit of LDKT might be less dominant in elderly patients. In DDKT, having either DCD or DBD donors is not associated with post-transplant 3-month hospital readmission, regardless of age. Tailored patient management is needed for recipients with DDKT and elderly KTRs.
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Affiliation(s)
- Yiman Wang
- Department of Clinical Epidemiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | | | - Wieneke M Michels
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.,Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Aiko P J de Vries
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.,Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
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5
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Kaboré R, Ferrer L, Couchoud C, Hogan J, Cochat P, Dehoux L, Roussey-Kesler G, Novo R, Garaix F, Brochard K, Fila M, Parmentier C, Fournier MC, Macher MA, Harambat J, Leffondré K. Dynamic prediction models for graft failure in paediatric kidney transplantation. Nephrol Dial Transplant 2021; 36:927-935. [PMID: 32989448 DOI: 10.1093/ndt/gfaa180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Several models have been proposed to predict kidney graft failure in adult recipients but none in younger recipients. Our objective was to propose a dynamic prediction model for graft failure in young kidney transplant recipients. METHODS We included 793 kidney transplant recipients waitlisted before the age of 18 years who received a first kidney transplantation before the age of 21 years in France in 2002-13 and survived >90 days with a functioning graft. We used a Cox model including baseline predictors only (sex, age at transplant, primary kidney disease, dialysis duration, donor type and age, human leucocyte antigen matching, cytomegalovirus serostatus, cold ischaemia time and delayed graft function) and two joint models also accounting for post-transplant estimated glomerular filtration rate (eGFR) trajectory. Predictive performances were evaluated using a cross-validated area under the curve (AUC) and R2 curves. RESULTS When predicting the risk of graft failure from any time within the first 7 years after paediatric kidney transplantation, the predictions for the following 3 or 5 years were accurate and much better with the joint models than with the Cox model (AUC ranged from 0.83 to 0.91 for the joint models versus 0.56 to 0.64 for the Cox model). CONCLUSION Accounting for post-transplant eGFR trajectory strongly increased the accuracy of graft failure prediction in young kidney transplant recipients.
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Affiliation(s)
- Rémi Kaboré
- INSERM, Bordeaux Population Health Research Center, University of Bordeaux, UMR1219, Bordeaux, France
| | - Loïc Ferrer
- INSERM, Bordeaux Population Health Research Center, University of Bordeaux, UMR1219, Bordeaux, France
| | - Cécile Couchoud
- Agence de la Biomédecine, REIN Registry, La Plaine-Saint Denis, France
| | - Julien Hogan
- Pediatric Nephrology Unit, Robert Debré Hospital, Centre de Référence Maladies Rénales Rares Marhea, APHP, Paris, France
| | - Pierre Cochat
- Pediatric Nephrology Unit, Femme-Mère-Enfant Hospital, Lyon University Hospital, Centre de Référence Maladies Rénales Rares Nephrogones, Bron, France
| | - Laurène Dehoux
- Pediatric Nephrology Unit, Necker Enfants-Malades Hospital, Centre de Référence Maladies Rénales Rares Marhea, APHP, Paris Descartes University, Paris, France
| | - Gwenaelle Roussey-Kesler
- Pediatric Nephrology Unit, Femme-Enfant-Adolescent Hospital, Nantes University Hospital, Nantes, France
| | - Robert Novo
- Pediatric Nephrology Unit, Jeanne de Flandre Hospital, Lille University Hospital, Lille, France
| | - Florentine Garaix
- Pediatric Nephrology Unit, Timone-Enfants Hospital, Marseille University Hospital, Marseille, France
| | - Karine Brochard
- Pediatric Nephrology Unit, Children's Hospital, Toulouse University Hospital, Centre de Référence Maladies Rénales Rares Sorare, Toulouse, France
| | - Marc Fila
- Pediatric Nephrology Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital, Centre de Référence Maladies Rénales Rares Sorare, Montpellier, France
| | - Cyrielle Parmentier
- Pediatric Nephrology Unit, Trousseau Hospital, Centre de Référence Maladies Rénales Rares Marhea, APHP, Paris, France
| | | | - Marie-Alice Macher
- Agence de la Biomédecine, REIN Registry, La Plaine-Saint Denis, France.,Pediatric Nephrology Unit, Robert Debré Hospital, Centre de Référence Maladies Rénales Rares Marhea, APHP, Paris, France
| | - Jérôme Harambat
- INSERM, Bordeaux Population Health Research Center, University of Bordeaux, UMR1219, Bordeaux, France.,Pediatric Nephrology Unit, Pellegrin-Enfants Hospital, Bordeaux University Hospital, Centre de Référence Maladies Rénales Rares Sorare, Bordeaux, France.,INSERM, Clinical Investigation Center-Clinical Epidemiology-CIC-1401, Bordeaux, France
| | - Karen Leffondré
- INSERM, Bordeaux Population Health Research Center, University of Bordeaux, UMR1219, Bordeaux, France.,INSERM, Clinical Investigation Center-Clinical Epidemiology-CIC-1401, Bordeaux, France
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6
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Incidence of chronic kidney disease hospitalisations and mortality in Espírito Santo between 1996 to 2017. PLoS One 2019; 14:e0224889. [PMID: 31697772 PMCID: PMC6837757 DOI: 10.1371/journal.pone.0224889] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/23/2019] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) has a set of clinical and laboratory abnormalities where renal function loss is noted. The high prevalence of comorbidity of people living with CKD, its economic impact and its prognosis have made it a public health problem, justifying the need to implement preventive measures. OBJECTIVE To analyse the mortality and incidence of hospital admissions for CKD. METHODS Ecological study with a time series design using secondary microdata of deaths and hospital admissions from patients with CKD from 1996 to 2017 in the State of Espírito Santo, Brazil. RESULTS The average mortality rate of CKD during the studied years was 2.92 per 100,000 inhabitants per year. During this period global mortality was a stationary phenomenon. In women, the trend of mortality from 2005 on increased 7,87% per year. Between 2008 and 2017, the average incidence hospital admissions due to CKD per year was 45.76 per 100,000 inhabitants. It was observed that the overall hospital admission increased by the equivalent of 6.23% per year. More than a half of mortality and hospitalisations correspond to male patients over 50 years of age. In terms of mortality, 32.99% corresponded to Caucasian patients, while 35.13% of hospitalisations were mixed race. CONCLUSION We found that age and gender are factors associated with deaths and hospitalisations for chronic kidney disease. While hospitalisation increases 6.23% per year, global mortality remains stationary. However, from 2005 onwards a trend towards increasing of 7.87%/annual in mortality was observed in women.
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7
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Living Donor Kidney Transplantation Should Be Promoted Among "Elderly" Patients. Transplant Direct 2019; 5:e496. [PMID: 31723590 PMCID: PMC6791595 DOI: 10.1097/txd.0000000000000940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 08/14/2019] [Indexed: 01/10/2023] Open
Abstract
Age criteria for kidney transplantation have been liberalized over the years resulting in more waitlisted elderly patients. What are the prospects of elderly patients on the waiting list?
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8
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Tsujikawa H, Tanaka S, Matsukuma Y, Kanai H, Torisu K, Nakano T, Tsuruya K, Kitazono T. Development of a risk prediction model for infection-related mortality in patients undergoing peritoneal dialysis. PLoS One 2019; 14:e0213922. [PMID: 30893369 PMCID: PMC6426225 DOI: 10.1371/journal.pone.0213922] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 03/04/2019] [Indexed: 02/07/2023] Open
Abstract
Background Assessment of infection-related mortality remains inadequate in patients undergoing peritoneal dialysis. This study was performed to develop a risk model for predicting the 2-year infection-related mortality risk in patients undergoing peritoneal dialysis. Methods The study cohort comprised 606 patients who started and continued peritoneal dialysis for 90 at least days and was drawn from the Fukuoka Peritoneal Dialysis Database Registry Study in Japan. The patients were registered from 1 January 2006 to 31 December 2016 and followed up until 31 December 2017. To generate a prediction rule, the score for each variable was weighted by the regression coefficients calculated using a Cox proportional hazard model adjusted by risk factors for infection-related mortality, including patient characteristics, comorbidities, and laboratory data. Results During the follow-up period (median, 2.2 years), 138 patients died; 58 of them of infectious disease. The final model for infection-related mortality comprises six factors: age, sex, serum albumin, serum creatinine, total cholesterol, and weekly renal Kt/V. The incidence of infection-related mortality increased linearly with increasing total risk score (P for trend <0.001). Furthermore, the prediction model showed adequate discrimination (c-statistic = 0.79 [0.72–0.86]) and calibration (Hosmer–Lemeshow test, P = 0.47). Conclusion In this study, we developed a new model using clinical measures for predicting infection-related mortality in patients undergoing peritoneal dialysis.
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Affiliation(s)
- Hiroaki Tsujikawa
- Department of Medicine and Clinical Science, Kyushu University, Fukuoka, Japan
| | | | - Yuta Matsukuma
- Department of Medicine and Clinical Science, Kyushu University, Fukuoka, Japan
| | | | - Kumiko Torisu
- Department of Integrated Therapy for Chronic Kidney Disease, Kyushu University, Fukuoka, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Kyushu University, Fukuoka, Japan
- * E-mail:
| | - Kazuhiko Tsuruya
- Department of Integrated Therapy for Chronic Kidney Disease, Kyushu University, Fukuoka, Japan
- Department of Nephrology, Nara Medical University, Nara, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Kyushu University, Fukuoka, Japan
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9
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Ozelsancak R, Tekkarismaz N, Torun D, Micozkadioglu H. Heart Valve Disease Predict Mortality in Hemodialysis Patients: A Single Center Experience. Ther Apher Dial 2018; 23:347-352. [PMID: 30421548 DOI: 10.1111/1744-9987.12774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 10/22/2018] [Accepted: 11/08/2018] [Indexed: 11/30/2022]
Abstract
Our aim is to investigate the clinical and laboratory findings affecting the mortality of the patients in 3 years follow-up who underwent hemodialysis at our center. In this retrospective, observational cohort study, 432 patients who underwent hemodialysis at our center for at least 5 months were included. The first recorded data and subsequent clinical findings of patients who died and survived were compared. Two hundred and ninety patients survived, 142 patients died. The mean age of the patients who died was higher (63.4 ± 12.3 years, vs. 52 ± 16.1 years, P = 0.0001), 60.5% of them had coronary artery disease (P = 0.0001), 93.7% of them had a heart valve disease. Duration of hemodialysis (survived 57 [21-260] months; died 44 [5-183] months, P = 0.000) was lower in patients who died. Serum potassium level before dialysis (5.1 ± 0.6; 4.9 ± 0.7 mEq/L, P = 0.030), parathyroid hormone (435 [4-3054]; 304 [1-3145] pg/mL, P = 0.0001), albumin (3.9 ± 0.4; 3.8 ± 0.4 mg/dL, P = 0.0001) and Kt/V (1.48 ± 0.3; 1.40 ± 0.3, P = 0.019) levels were lower, C-reactive protein (5[1-208]; 8.7[2-256] mg/L, P = 0.000) levels were higher in patients who died. Logistic regression analysis showed age (OR = 1.1), coronary artery disease (OR = 1.7) and more than one heart valve disease (OR = 2.4) are independent risk factors for mortality. Potassium level before dialysis (OR = 0.60), parathyroid hormone (OR = 0.99), and higher Kt/V (OR = 0.28) were found to be an advantage for survival. Age, coronary artery disease and especially pathology in more than one heart valve are risk factors for mortality. Heart valve problems might develop because of malnutrition and inflammation caused by the chronic renal failure.
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Affiliation(s)
- Ruya Ozelsancak
- Department of Nephrology, Baskent University School of Medicine Adana Turgut Noyan Teaching and Research Center, Adana, Turkey
| | - Nihan Tekkarismaz
- Department of Nephrology, Baskent University School of Medicine Adana Turgut Noyan Teaching and Research Center, Adana, Turkey
| | - Dilek Torun
- Department of Nephrology, Baskent University School of Medicine Adana Turgut Noyan Teaching and Research Center, Adana, Turkey
| | - Hasan Micozkadioglu
- Department of Nephrology, Baskent University School of Medicine Adana Turgut Noyan Teaching and Research Center, Adana, Turkey
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10
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Ivory SE, Polkinghorne KR, Khandakar Y, Kasza J, Zoungas S, Steenkamp R, Roderick P, Wolfe R. Predicting 6-month mortality risk of patients commencing dialysis treatment for end-stage kidney disease. Nephrol Dial Transplant 2018; 32:1558-1565. [PMID: 28073820 DOI: 10.1093/ndt/gfw383] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 09/26/2016] [Indexed: 11/13/2022] Open
Abstract
Background There is evidence that end-stage kidney disease patients who are older or with more comorbidity may have a poor trade-off between benefits of dialysis and potential harms. We aimed to develop a tool for predicting patient mortality in the early stages of receiving dialysis. Methods In 23 658 patients aged 15+ years commencing dialysis between 2000 and 2009 in Australia and New Zealand a point score tool was developed to predict 6-month mortality based on a logistic regression analysis of factors available at dialysis initiation. Temporal validation used 2009-11 data from Australia and New Zealand. External validation used the UK Renal Registry. Results Within 6 months of commencing dialysis 6.1% of patients had died. A small group (4.7%) of patients had a high predicted mortality risk (>20%), as predicted by the point score tool. Predictive variables were: older age, underweight, chronic lung disease, coronary artery disease, peripheral vascular disease, cerebrovascular disease (particularly for patients <60 years of age), late referral to nephrologist care and underlying cause of renal disease. The new point score tool outperformed existing models, and had an area under the receiver operating characteristic curve of 0.755 on temporal validation with acceptable calibration and 0.713 on external validation with poor calibration. Conclusion Our point score tool for predicting 6-month mortality in patients at dialysis commencement has sufficient prognostic accuracy to use in Australia and New Zealand for prognosis and identification of high risk patients who may be given appropriate supportive care. Use in other countries requires further study.
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Affiliation(s)
- Sara E Ivory
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kevan R Polkinghorne
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Nephrology, Monash Health, Monash Medical Centre, Clayton, Victoria, Australia
| | - Yeasmin Khandakar
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jessica Kasza
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sophia Zoungas
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, Victoria, Australia
| | | | - Paul Roderick
- Academic Unit of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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11
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Ramspek CL, Voskamp PW, van Ittersum FJ, Krediet RT, Dekker FW, van Diepen M. Prediction models for the mortality risk in chronic dialysis patients: a systematic review and independent external validation study. Clin Epidemiol 2017; 9:451-464. [PMID: 28919820 PMCID: PMC5593395 DOI: 10.2147/clep.s139748] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE In medicine, many more prediction models have been developed than are implemented or used in clinical practice. These models cannot be recommended for clinical use before external validity is established. Though various models to predict mortality in dialysis patients have been published, very few have been validated and none are used in routine clinical practice. The aim of the current study was to identify existing models for predicting mortality in dialysis patients through a review and subsequently to externally validate these models in the same large independent patient cohort, in order to assess and compare their predictive capacities. METHODS A systematic review was performed following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. To account for missing data, multiple imputation was performed. The original prediction formulae were extracted from selected studies. The probability of death per model was calculated for each individual within the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD). The predictive performance of the models was assessed based on their discrimination and calibration. RESULTS In total, 16 articles were included in the systematic review. External validation was performed in 1,943 dialysis patients from NECOSAD for a total of seven models. The models performed moderately to well in terms of discrimination, with C-statistics ranging from 0.710 (interquartile range 0.708-0.711) to 0.752 (interquartile range 0.750-0.753) for a time frame of 1 year. According to the calibration, most models overestimated the probability of death. CONCLUSION Overall, the performance of the models was poorer in the external validation than in the original population, affirming the importance of external validation. Floege et al's models showed the highest predictive performance. The present study is a step forward in the use of a prediction model as a useful tool for nephrologists, using evidence-based medicine that combines individual clinical expertise, patients' choices, and the best available external evidence.
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Affiliation(s)
- Chava L Ramspek
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden
| | - Pauline Wm Voskamp
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden
| | | | - Raymond T Krediet
- Department of Nephrology, Academic Medical Center, Amsterdam, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden
| | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden
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Haapio M, Helve J, Grönhagen-Riska C, Finne P. One- and 2-Year Mortality Prediction for Patients Starting Chronic Dialysis. Kidney Int Rep 2017; 2:1176-1185. [PMID: 29270526 PMCID: PMC5733880 DOI: 10.1016/j.ekir.2017.06.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 05/24/2017] [Accepted: 06/20/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction Mortality risk of patients with end-stage renal disease (ESRD) is highly elevated. Methods to estimate individual mortality risk are needed to provide individualized care and manage expanding ESRD populations. Many mortality prediction models exist but have shown deficiencies in model development (data comprehensiveness, validation) and in practicality. Therefore, our aim was to design 2 easy-to-apply prediction models for 1- and 2-year all-cause mortality in patients starting long-term renal replacement therapy (RRT). Methods We used data from the Finnish Registry for Kidney Diseases with complete national coverage of RRT patients. Model training group included all incident adult patients who started long-term dialysis in Finland in 2000 to 2008 (n = 4335). The external validation cohort consisted of those who entered dialysis in 2009 to 2012 (n = 1768). Logistic regression with stepwise variable selection was used for model building. Results We developed 2 prognostic models, both of which only included 6 to 7 variables (age at RRT start, ESRD diagnosis, albumin, phosphorus, C-reactive protein, heart failure, and peripheral vascular disease) and showed sufficient discrimination (c-statistic 0.77 and 0.74 for 1- and 2-year mortality, respectively). Due to a significantly lower mortality in the newer cohort, the models, to a degree, overestimated mortality risk. Discussion Mortality prediction algorithms could be more widely implemented into management of ESRD patients. The presented models are practical with only a limited number of variables and fairly good performance.
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Affiliation(s)
- Mikko Haapio
- Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Correspondence: Mikko Haapio, Helsinki University Hospital, P.O. Box 372, FI-00029 HUS, Finland.Helsinki University HospitalP.O. Box 372FI-00029 HUSFinland
| | - Jaakko Helve
- Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Patrik Finne
- Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Finnish Registry for Kidney Diseases, Helsinki, Finland
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13
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Kaboré R, Haller MC, Harambat J, Heinze G, Leffondré K. Risk prediction models for graft failure in kidney transplantation: a systematic review. Nephrol Dial Transplant 2017; 32:ii68-ii76. [DOI: 10.1093/ndt/gfw405] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 10/03/2016] [Indexed: 01/01/2023] Open
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14
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Koopman JJE, Kramer A, van Heemst D, Åsberg A, Beuscart JB, Buturović-Ponikvar J, Collart F, Couchoud CG, Finne P, Heaf JG, Massy ZA, De Meester JMJ, Palsson R, Steenkamp R, Traynor JP, Jager KJ, Putter H. Measuring senescence rates of patients with end-stage renal disease while accounting for population heterogeneity: an analysis of data from the ERA-EDTA Registry. Ann Epidemiol 2016; 26:773-779. [PMID: 27665405 DOI: 10.1016/j.annepidem.2016.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 08/05/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Although a population's senescence rate is classically measured as the increase in mortality rate with age on a logarithmic scale, it may be more accurately measured as the increase on a linear scale. Patients on dialysis, who suffer from accelerated senescence, exhibit a smaller increase in their mortality rate on a logarithmic scale, but a larger increase on a linear scale than patients with a functioning kidney transplant. However, this comparison may be biased by population heterogeneity. METHODS Follow-up data on 323,308 patients on dialysis and 91,679 patients with a functioning kidney transplant were derived from the ERA-EDTA Registry. We measured the increases in their mortality rates using Gompertz frailty models that allow individual variation in this increase. RESULTS According to these models, the senescence rate measured as the increase in mortality rate on a logarithmic scale was smaller in patients on dialysis, while the senescence rate measured as the increase on a linear scale was larger in patients on dialysis than patients with a functioning kidney transplant. CONCLUSIONS Also when accounting for population heterogeneity, a population's senescence rate is more accurately measured as the increase in mortality rate on a linear scale than a logarithmic scale.
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Affiliation(s)
- Jacob J E Koopman
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
| | - Anneke Kramer
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Diana van Heemst
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Anders Åsberg
- Norwegian Renal Registry, Department of Transplant Medicine, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Jean-Baptiste Beuscart
- University of Lille, EA2694, Santé publique: épidémiologie et qualité des soins, Lille, France; CHU Lille, Geriatric Department, Lille, France
| | - Jadranka Buturović-Ponikvar
- Department of Nephrology, Ljubljana University Medical Center, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Frederic Collart
- Department of Nephrology and Dialysis, Brugmann University Hospital, Brussels, Belgium
| | - Cécile G Couchoud
- Renal Epidemiology and Information Network (REIN) Registry, French Biomedical Agency, Saint-Denis-la-Plaine, France
| | - Patrik Finne
- Finnish Registry for Kidney Diseases, Helsinki, Finland; Department of Nephrology, Helsinki University Central Hospital, Helsinki, Finland
| | - James G Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Hospital, University of Paris Ouest-Versailles-St-Quentin-en-Yvelines, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, Research Centre in Epidemiology and Population Health (CESP), Villejuif, France
| | - Johan M J De Meester
- Department of Nephrology, Dialysis, and Hypertension, AZ Nikolaas, Sint-Niklaas, Belgium
| | - 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
| | | | - Jamie P Traynor
- The Scottish Renal Registry, Information Services Division Scotland, Glasgow, UK
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Hein Putter
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
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Abstract
BACKGROUND Currently, potential kidney transplant patients more often suffer from comorbidities. The Charlson Comorbidity Index (CCI) was developed in 1987 and is the most used comorbidity score. We questioned to what extent number and severity of comorbidities interfere with graft and patient survival. Besides, we wondered whether the CCI was best to study the influence of comorbidity in kidney transplant patients. METHODS In our center, 1728 transplants were performed between 2000 and 2013. There were 0.8% cases with missing values. Nine pretransplant comorbidity covariates were defined: cardiovascular disease, cerebrovascular accident, peripheral vascular disease, diabetes mellitus, liver disease, lung disease, malignancy, other organ transplantation, and human immunodeficiency virus positivity. The CCI used was unadjusted for recipient age. The Rotterdam Comorbidity in Kidney Transplantation score was developed, and its influence was compared to the CCI. Kaplan-Meier analysis and multivariable Cox proportional hazards analysis, corrected for variables with a known significant influence, were performed. RESULTS We noted 325 graft failures and 215 deaths. The only comorbidity covariate that significantly influenced graft failure censored for death was peripheral vascular disease. Patient death was significantly influenced by cardiovascular disease, other organ transplantation, and the total comorbidity scores. Model fit was best with the Rotterdam Comorbidity in Kidney Transplantation score compared to separate comorbidity covariates and the CCI. In the population with the highest comorbidity score, 50% survived more than 10 years. CONCLUSIONS Despite the negative influence of comorbidity, patient survival after transplantation is remarkably good. This means that even patients with extensive comorbidity should be considered for transplantation.
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Hemke AC, Heemskerk MBA, van Diepen M, Dekker FW, Hoitsma AJ. Improved Mortality Prediction in Dialysis Patients Using Specific Clinical and Laboratory Data. Am J Nephrol 2015; 42:158-67. [PMID: 26406283 DOI: 10.1159/000439181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 07/29/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Risk prediction models can be used to inform patients undergoing renal replacement therapy about their survival chances. Easily available predictors such as registry data are most convenient, but their predictive value may be limited. We aimed to improve a simple prediction model based on registry data by incrementally adding sets of clinical and laboratory variables. METHODS Our data set includes 1,835 Dutch patients from the Netherlands Cooperative Study on the Adequacy of Dialysis. The potential survival predictors were categorized on availability. The first category includes easily available clinical data. The second set includes laboratory values like albumin. The most laborious category contains glomerular filtration rate (GFR) and Kt/V. Missing values were substituted using multiple imputation. Within 1,225 patients, we recalibrated the registry model and subsequently added parameter sets using multivariate Cox regression analyses with backward selection. On the other 610 patients, calibration and discrimination (C-index, integrated discrimination improvement (IDI) index and net reclassification improvement (NRI) index) were assessed for all models. RESULTS The recalibrated registry model showed adequate calibration and discrimination (C-index=0.724). Adding easily available parameters resulted in a model with 10 predictors, with similar calibration and improved discrimination (C-index=0.784). The IDI and NRI indices confirmed this, especially for short-term survival. Adding laboratory values resulted in an alternative model with similar discrimination (C-index=0.788), and only the NRI index showed minor improvement. Adding GFR and Kt/V as candidate predictors did not result in a different model. CONCLUSION A simple model based on registry data was enhanced by adding easily available clinical parameters.
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Affiliation(s)
- Aline C Hemke
- Dutch Transplant Foundation, Organ Centre, Leiden, The Netherlands
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Association of Relapse with Renal Outcomes under the Current Therapy Regimen for IgA Nephropathy: A Multi-Center Study. PLoS One 2015; 10:e0137870. [PMID: 26371477 PMCID: PMC4570760 DOI: 10.1371/journal.pone.0137870] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 08/22/2015] [Indexed: 11/21/2022] Open
Abstract
Background and Objectives Renal relapse is a very common manifestation of IgA nephropathy (IgAN). The clinical characteristics and long-term outcomes of this condition have not yet been carefully explored. Design and Patients Patients with biopsy-proven IgAN between January 2005 and December 2010 from three medical centers in China was a primary cohort of patients. From January 2010 to April 2012, data of an independent cohort of IgAN patients from Ren Ji Hospital, Shanghai, China was collected using the same inclusion and exclusion criteria. These patients formed the validation cohort of this study. Results Of the patients with biopsy-proven IgAN from three medical centers, 489 patients achieved remission within 6 months following the therapy. Additionally, 76 (15.5%) of these patients experienced a relapse after achieving remission. During the median follow-up period of 66 months, 6 patients (1.4%) in the non-relapse group experienced renal deterioration, compared with 22 patients (29.6%) in the relapse group. Our study indicated that each 1-mmHg increase in the baseline diastolic blood pressure (DBP) was associated with a 4.5% increase in the risk of renal relapse; additionally, the male patients had a 3.324-fold greater risk of relapse compared with the female patients according to the adjusted multivariate Cox analysis. The nomogram was based on 489 patients achieved remission. The predictive accuracy and discriminative ability of the nomogram were determined by concordance index (C-index) and calibration curve. The results were validated using bootstrap resampling on the validation cohort. Conclusions This study demonstrated that renal relapse is a potential predictor of prognostic outcomes in patients under the current therapeutic regimens for IgAN. And male patients with higher diastolic blood pressure had a greater risk of experiencing relapse.
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