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Claudel SE, Chan M, Scammell MK, Waikar SS. Challenges and Opportunities: Studying CKDu in the United States. KIDNEY360 2024; 5:02200512-990000000-00352. [PMID: 38446084 DOI: 10.34067/kid.0000000000000408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/26/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Sophie E Claudel
- Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Maya Chan
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Madeleine K Scammell
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Sushrut S Waikar
- Section of Nephrology, Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Kucirka LM, Angarita AM, Manuck TA, Boggess KA, Derebail VK, Wood ME, Meyer ML, Segev DL, Reynolds ML. Characteristics and Outcomes of Patients With Pregnancy-Related End-Stage Kidney Disease. JAMA Netw Open 2023; 6:e2346314. [PMID: 38064217 PMCID: PMC10709776 DOI: 10.1001/jamanetworkopen.2023.46314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/24/2023] [Indexed: 12/18/2023] Open
Abstract
Importance The incidence of pregnancy-related acute kidney injury is increasing and is associated with significant maternal morbidity including progression to end-stage kidney disease (ESKD). Little is known about characteristics and long-term outcomes of patients who develop pregnancy-related ESKD. Objectives To examine the characteristics and clinical outcomes of patients with pregnancy-related ESKD and to investigate associations between pre-ESKD nephrology care and outcomes. Design, Setting, and Participants This was a cohort study of 183 640 reproductive-aged women with incident ESKD between January 1, 2000, and November 20, 2020, from the US Renal Data System and maternal data from births captured in the US Centers for Disease Control and Prevention publicly available natality data. Data were analyzed from December 2022 to June 2023. Exposure Pregnancy-related primary cause of ESKD, per International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 codes reported at ESKD onset by the primary nephrologist on Centers for Medicare and Medicaid Services form 2728. Main Outcomes Measures Multivariable Cox proportional hazards and competing risk models were constructed to examine time to (1) mortality, (2) access to kidney transplant (joining the waiting list or receiving a live donor transplant), and (3) receipt of transplant after joining the waitlist. Results A total of 341 patients with a pregnancy-related primary cause of ESKD were identified (mean [SD] age 30.2 [7.3]). Compared with the general US birthing population, Black patients were overrepresented among those with pregnancy-related ESKD (109 patients [31.9%] vs 585 268 patients [16.2%]). In adjusted analyses, patients with pregnancy-related ESKD had similar or lower hazards of mortality compared with those with glomerulonephritis or cystic kidney disease (adjusted hazard ratio [aHR], 0.96; 95% CI, 0.76-1.19), diabetes or hypertension (aHR, 0.49; 95% CI, 0.39-0.61), or other or unknown primary causes of ESKD (aHR, 0.60; 95% CI, 0.48-0.75). Despite this, patients with pregnancy-related ESKD had significantly lower access to kidney transplant compared with those with other causes of ESKD, including (1) glomerulonephritis or cystic kidney disease (adjusted subhazard ratio [aSHR], 0.51; 95% CI, 0.43-0.66), (2) diabetes or hypertension (aSHR, 0.81; 95% CI, 0.67-0.98), and (3) other or unkown cause (aSHR, 0.82; 95% CI, 0.67-0.99). Those with pregnancy-related ESKD were less likely to have nephrology care or have a graft or arteriovenous fistula placed before ESKD onset (nephrology care: adjusted relative risk [aRR], 0.47; 95% CI, 0.40-0.56; graft or arteriovenous fistula placed: aRR, 0.31; 95% CI, 0.17-0.57). Conclusion and Relevance In this study, those with pregnancy-related ESKD had reduced access to transplant and nephrology care, which could exacerbate existing disparities in a disproportionately Black population. Increased access to care could improve quality of life and health outcomes among these young adults with high potential for long-term survival.
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Affiliation(s)
- Lauren M. Kucirka
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill
| | - Ana M. Angarita
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tracy A. Manuck
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill
- Institute for Environmental Health Solutions, Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Kim A. Boggess
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill
| | - Vimal K. Derebail
- UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina at Chapel Hill
| | - Mollie E. Wood
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill
- Center for Pharmacoepidemiology, University of North Carolina at Chapel Hill
| | - Michelle L. Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill
| | - Dorry L. Segev
- Division of Transplant, Department of Surgery, New York University Langone Medical Center, New York
| | - Monica L. Reynolds
- UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina at Chapel Hill
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Sari O, Bashir AM. Early Change in Platelet Count and MPV Levels of Patients Who Received Hemodialysis for the First Time: Mogadishu Somalia Experience. Int J Clin Pract 2022; 2022:1503227. [PMID: 35832803 PMCID: PMC9262561 DOI: 10.1155/2022/1503227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/14/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Mean platelet volume (MPV) is a marker used to assess the platelet' size and is also an indicator of platelet reactivity and prothrombotic status. OBJECTIVE In this study, we aimed to determine the relationship between MPV and biochemical parameters in patients who had received hemodialysis (HD) for the first time and then in respect of those same patients after their fourth HD. METHOD 151 HD patients were enrolled in this study. Patients were eligible for inclusion if they had received their first HD session during this study protocol. Prehemodialysis blood samples were taken. Most laboratory values, including mean platelet volume (MPV) level and platelets (PLT) count, were measured before the first HD and after the fourth HD session for each patient. RESULTS Among the patients in our study, the mean age profile of the male patients (n = 103; 68.2%) was found to be higher than that of the female patients (n = 48; 31.8%) (53.62 ± 18.19 vs. 46.17 ± 17.9 years) (p = 0.019).In the patients' laboratory results after the fourth HD session, MPV, MPV/Plt, and Na values had increased to those after the first HD session (p < 0.001). When age and gender status were taken into account, the level of weak positive correlation with white blood cell count (WBC), neutrophil, and red cell distribution width (RDW) was found, while the weak negative correlation with platelet to lymphocyte ratio (PLR) was found (p < 0.001). CONCLUSIONS In our study, we found that increase in MPV and MPV/PLT levels was significant in the fourth HD session of patients with CKD. It is also debatable that there are findings indicating an increase in platelet reactivity in the first weeks of the onset of HD. This could be an early indicator of the early prevention of cardiovascular diseases.
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Affiliation(s)
- Oznur Sari
- Department of Internal Medicine, Department of Health Services, General Directorate of Public Hospitals, Ministry of Health, Ankara, Turkey
| | - Ahmed Muhammad Bashir
- Department of Internal Medicine, Mogadishu Somalia Turkey, Recep Tayyip Erdogan, Training and Research Hospital, Mogadishu, Somalia
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Thomas CP, Gupta S, Freese ME, Chouhan KK, Dantuma MI, Holanda DG, Katz DA, Darbro BW, Mansilla MA, Smith RJ. Sequential genetic testing of living-related donors for inherited renal disease to promote informed choice and enhance safety of living donation. Transpl Int 2021; 34:2696-2705. [PMID: 34632641 DOI: 10.1111/tri.14133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 01/09/2023]
Abstract
Living kidney donors (LKDs) with a family history of renal disease are at risk of kidney disease as compared to LKDs without such history suggesting that some LKDs may be pre-symptomatic for monogenic kidney disease. LKDs with related transplant candidates whose kidney disease was considered genetic in origin were selected for genetic testing. In each case, the transplant candidate was first tested to verify the genetic diagnosis. A genetic diagnosis was confirmed in 12 of 24 transplant candidates (ADPKD-PKD1: 6, ALPORT-COL4A3: 2, ALPORT-COL4A5: 1: nephronophthisis-SDCCAG8: 1; CAKUT-HNF1B and ADTKD-MUC1: 1 each) and 2 had variants of unknown significance (VUS) in phenotype-relevant genes. Focused genetic testing was then done in 20 of 34 LKDs. 12 LKDs screened negative for the familial variant and were permitted to donate; seven screened positive and were counseled against donation. One, the heterozygous carrier of a recessive disorder was also cleared. Six of seven LKDs with a family history of ADPKD were under 30 years and in 5, by excluding ADPKD, allowed donation to safely proceed. The inclusion of genetic testing clarified the diagnosis in recipient candidates, improving safety or informed decision-making in LKDs.
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Affiliation(s)
- Christie P Thomas
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.,Department of Pediatrics, University of Iowa, Iowa City, IA, USA.,Veterans Affairs Medical Center, Iowa City, IA, USA
| | - Sonali Gupta
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Margaret E Freese
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Maisie I Dantuma
- Iowa Institute of Human Genetics, University of Iowa, Iowa City, IA, USA
| | | | - Daniel A Katz
- Department of Surgery, University of Iowa, Iowa City, IA, USA
| | - Benjamin W Darbro
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA.,Iowa Institute of Human Genetics, University of Iowa, Iowa City, IA, USA
| | - Maria A Mansilla
- Iowa Institute of Human Genetics, University of Iowa, Iowa City, IA, USA
| | - Richard J Smith
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.,Department of Pediatrics, University of Iowa, Iowa City, IA, USA.,Iowa Institute of Human Genetics, University of Iowa, Iowa City, IA, USA
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Santos M, Yin H, Steffick D, Saran R, Heung M. Predictors of kidney function recovery among incident ESRD patients. BMC Nephrol 2021; 22:142. [PMID: 33879082 PMCID: PMC8059163 DOI: 10.1186/s12882-021-02345-7] [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: 10/16/2020] [Accepted: 04/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background ESRD is considered an irreversible loss of renal function, yet some patients will recover kidney function sufficiently to come off dialysis. Potentially modifiable predictors of kidney recovery, such as dialysis prescription, have not been fully examined. Methods Retrospective cohort study using United States Renal Data System (USRDS) data to identify incident hemodialysis (HD) patients between 2012 and 2016, the first 4 years for which dialysis treatment data is available. The primary outcome was kidney recovery within 1 year of ESRD and HD initiation, defined by a specific recovery code and survival off dialysis for at least 30 days. Patient and treatment characteristics were compared between those that recovered versus those that remained dialysis-dependent. A time-dependent survival model was used to identify independent predictors of kidney recovery. Results During the study period, there were 372,387 incident HD patients with available data, among whom 16,930 (4.5%) recovered to dialysis-independence. Compared to non-recovery, a higher proportion of patients with kidney recovery were of white race, and non-Hispanic ethnicity. Both groups had a similar age distribution. Patients with an acute kidney injury diagnosis as primary cause of ESRD were most likely to recover, but the most common ESRD diagnosis among recovering patients was type 2 diabetes (29.8% of recovery cases). Higher eGFR and lower albumin at ESRD initiation were associated with increased likelihood of recovery. When examining HD ultrafiltration rate (UFR), each quintile above the first quintile was associated with a progressively lower likelihood of recovery (HR 0.45, 95% CI 0.43–0.48 for highest versus lowest quintile, p < 0.001). Conclusions We identified non-modifiable and potentially modifiable factors associated with kidney recovery which may assist clinicians in counseling and monitoring incident ESRD patients with a greater chance to gain dialysis-independence. Clinical trials are warranted to examine the impact of dialysis prescription on subsequent kidney function recovery.
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Affiliation(s)
- Maria Santos
- University of Michigan Medical School, 1500 E. Medical Center Drive, SPC 5364, Ann Arbor, MI, 48109-5364, USA
| | - Huiying Yin
- University of Michigan Kidney Epidemiology and Cost Center, Ann Arbor, USA
| | - Diane Steffick
- University of Michigan Kidney Epidemiology and Cost Center, Ann Arbor, USA
| | - Rajiv Saran
- University of Michigan Medical School, 1500 E. Medical Center Drive, SPC 5364, Ann Arbor, MI, 48109-5364, USA.,University of Michigan Kidney Epidemiology and Cost Center, Ann Arbor, USA.,Department of Medicine, Division of Nephrology, University of Michigan, Ann Arbor, USA
| | - Michael Heung
- University of Michigan Medical School, 1500 E. Medical Center Drive, SPC 5364, Ann Arbor, MI, 48109-5364, USA. .,University of Michigan Kidney Epidemiology and Cost Center, Ann Arbor, USA. .,Department of Medicine, Division of Nephrology, University of Michigan, Ann Arbor, USA.
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Mena-Gutierrez AM, Reeves-Daniel AM, Jay CL, Freedman BI. Practical Considerations for APOL1 Genotyping in the Living Kidney Donor Evaluation. Transplantation 2020; 104:27-32. [PMID: 31449181 DOI: 10.1097/tp.0000000000002933] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Association between the apolipoprotein L1 gene (APOL1) and nephropathy has altered the epidemiology of chronic kidney disease. In addition, donor APOL1 genotypes play important roles in the time to allograft failure in kidneys transplanted from deceased donors and the safety of living kidney donation. METHODS This article reviews genetic testing for inherited kidney disease in living kidney donors to improve donor safety. APOL1 genotyping in donors with recent African ancestry is considered. RESULTS Based on current data, transplant physicians should discuss APOL1 genotyping with potential living kidney donors self-reporting recent African ancestry. Until results from APOL1 Long-term Kidney Transplant Outcomes Network ancillary studies are available, we present practical approaches from our experience for considering APOL1 genotyping in the living donor evaluation. CONCLUSIONS Transplant physicians should inform potential living kidney donors at risk for APOL1-associated nephropathy about the gene and possibility of genetic testing early in the donor evaluation, well before scheduling the donor nephrectomy. Transplant programs must weigh risks of performing a donor nephrectomy in those with 2 APOL1 renal risk variants (high-risk genotypes), particularly younger individuals. Our program counsels kidney donors with APOL1 high-risk genotypes in the same fashion as with risk genotypes in other nephropathy genes. Because most African American kidney donor candidates lacking hypertension, proteinuria and reduced kidney function after workup will not possess APOL1 high-risk genotypes, genetic testing is unlikely to markedly increase donor declines and may reassure donors with regard to their long-term kidney outcomes, potentially increasing the number of African American donors.
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Affiliation(s)
- Alejandra M Mena-Gutierrez
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Amber M Reeves-Daniel
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Colleen L Jay
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC
| | - Barry I Freedman
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
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Murea M, Ma L, Freedman BI. APOL1 and Mortality in Patients on Dialysis. Cardiorenal Med 2019; 9:261-264. [PMID: 31185465 DOI: 10.1159/000501303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/04/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Mariana Murea
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Lijun Ma
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Barry I Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA,
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