1
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Marasa M, Ahram DF, Rehman AU, Mitrotti A, Abhyankar A, Jain NG, Weng PL, Piva SE, Fernandez HE, Uy NS, Chatterjee D, Kil BH, Nestor JG, Felice V, Robinson D, Whyte D, Gharavi AG, Appel GB, Radhakrishnan J, Santoriello D, Bomback A, Lin F, D’Agati VD, Jobanputra V, Sanna-Cherchi S. Implementation and Feasibility of Clinical Genome Sequencing Embedded Into the Outpatient Nephrology Care for Patients With Proteinuric Kidney Disease. Kidney Int Rep 2023; 8:1638-1647. [PMID: 37547535 PMCID: PMC10403677 DOI: 10.1016/j.ekir.2023.05.021] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/01/2023] [Accepted: 05/22/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction The diagnosis and management of proteinuric kidney diseases such as focal segmental glomerulosclerosis (FSGS) are challenging. Genetics holds the promise to improve clinical decision making for these diseases; however, it is often performed too late to enable timely clinical action and it is not implemented within routine outpatient nephrology visits. Methods We sought to test the implementation and feasibility of clinical rapid genome sequencing (GS) in guiding decision making in patients with proteinuric kidney disease in real-time and embedded in the outpatient nephrology setting. Results We enrolled 10 children or young adults with biopsy-proven FSGS (9 cases) or minimal change disease (1 case). The mean age at enrollment was 16.2 years (range 2-30). The workflow did not require referral to external genetics clinics but was conducted entirely during the nephrology standard-of-care appointments. The total turn-around-time from enrollment to return-of-results and clinical decision averaged 21.8 days (12.4 for GS), which is well within a time frame that allows clinically relevant treatment decisions. A monogenic or APOL1-related form of kidney disease was diagnosed in 5 of 10 patients. The genetic findings resulted in a rectified diagnosis in 6 patients. Both positive and negative GS findings determined a change in pharmacological treatment. In 3 patients, the results were instrumental for transplant evaluation, donor selection, and the immunosuppressive treatment. All patients and families received genetic counseling. Conclusion Clinical GS is feasible and can be implemented in real-time in the outpatient care to help guiding clinical management. Additional studies are needed to confirm the cost-effectiveness and broader utility of clinical GS across the phenotypic and demographic spectrum of kidney diseases.
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Affiliation(s)
- Maddalena Marasa
- Division of Nephrology, Department of Medicine, Columbia University, New York, USA
| | - Dina F. Ahram
- Division of Nephrology, Department of Medicine, Columbia University, New York, USA
| | | | - Adele Mitrotti
- Division of Nephrology, Department of Medicine, Columbia University, New York, USA
| | | | - Namrata G. Jain
- Division of Pediatric Nephrology, Department of Pediatrics, Columbia University, New York, USA
| | - Patricia L. Weng
- Division of Pediatric Nephrology, Department of Pediatrics, UCLA Medical Center and UCLA Medical Center-Santa Monica, Los Angeles, California, USA
| | - Stacy E. Piva
- Division of Nephrology, Department of Medicine, Columbia University, New York, USA
| | - Hilda E. Fernandez
- Division of Nephrology, Department of Medicine, Columbia University, New York, USA
| | - Natalie S. Uy
- Division of Pediatric Nephrology, Department of Pediatrics, Columbia University, New York, USA
| | - Debanjana Chatterjee
- Division of Nephrology, Department of Medicine, Columbia University, New York, USA
| | - Byum H. Kil
- Division of Nephrology, Department of Medicine, Columbia University, New York, USA
| | - Jordan G. Nestor
- Division of Nephrology, Department of Medicine, Columbia University, New York, USA
| | | | | | - Dilys Whyte
- Pediatric Specialty Center of Good Samaritan Hospital Medical Center, Babylon, New York, USA
| | - Ali G. Gharavi
- Division of Nephrology, Department of Medicine, Columbia University, New York, USA
| | - Gerald B. Appel
- Division of Nephrology, Department of Medicine, Columbia University, New York, USA
| | - Jai Radhakrishnan
- Division of Nephrology, Department of Medicine, Columbia University, New York, USA
| | - Dominick Santoriello
- Department of Pathology and Cell Biology, Renal Pathology Division, Columbia University Medical Center, New York, USA
| | - Andrew Bomback
- Division of Nephrology, Department of Medicine, Columbia University, New York, USA
| | - Fangming Lin
- Division of Pediatric Nephrology, Department of Pediatrics, Columbia University, New York, USA
| | - Vivette D. D’Agati
- Department of Pathology and Cell Biology, Renal Pathology Division, Columbia University Medical Center, New York, USA
| | - Vaidehi Jobanputra
- The New York Genome Center, New York, USA
- Department of Pathology and Cell Biology, Columbia University, New York, USA
| | - Simone Sanna-Cherchi
- Division of Nephrology, Department of Medicine, Columbia University, New York, USA
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Husain SA, King KL, Owen-Simon NL, Fernandez HE, Ratner LE, Mohan S. Access to kidney transplantation among pediatric candidates with prior solid organ transplants in the United States. Pediatr Transplant 2022; 26:e14303. [PMID: 35615911 PMCID: PMC9378581 DOI: 10.1111/petr.14303] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 03/30/2022] [Accepted: 04/24/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric kidney transplant candidates require timely access to transplant to optimize growth and neurodevelopmental outcomes. We studied access to transplant for pediatric candidates with prior organ transplants. METHODS We used US registry data to identify pediatric kidney transplant candidates added to the waiting list 2015-2019 and used competing risk regression to study the association between prior transplant status and probability of receiving a kidney transplant, treating wait-list removal and death as competing events. RESULTS Of 4962 pediatric kidney transplant candidates included, 89% had no prior transplant and 11% had received a prior organ transplant (kidney 87%, liver 5%, heart 5%). Prior transplant recipients were older at listing (median 15 vs. 12 years) and more likely to have PRA≥98% (22% vs. 0.3%) (both p < .001). There was no significant difference in the proportion of candidates from each group who were preemptively wait-listed. Unadjusted competing risk regression showed a lower risk of kidney transplant after wait-listing among candidates with prior organ transplant (HR 0.52, 95%CI 0.47-0.59, p < .001). This association remained significant after adjusting for candidate characteristics (HR 0.73, 95%CI 0.63-0.83, p < .001). Among deceased donor kidney recipients, median KDPI was similar between groups, but recipients with prior transplants were more likely to receive kidneys from donors with hypertension (4% vs. 1%, p = .01) and donors after cardiac death (11% vs. 4%, p < .001). CONCLUSIONS Pediatric kidney transplant candidates with prior organ transplants have reduced access to transplant after wait-listing. Allocation system changes are needed to improve timely access to transplant for this vulnerable group.
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Affiliation(s)
- S. Ali Husain
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, NY
- The Columbia University Renal Epidemiology (CURE) Group, New York, NY
| | - Kristen L. King
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, NY
- The Columbia University Renal Epidemiology (CURE) Group, New York, NY
| | - Nina L. Owen-Simon
- Department of Surgery, Columbia University College of Physicians & Surgeons, New York, New York
| | - Hilda E. Fernandez
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, NY
- Department of Pediatrics, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, NY
| | - Lloyd E. Ratner
- Department of Surgery, Columbia University College of Physicians & Surgeons, New York, New York
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, NY
- The Columbia University Renal Epidemiology (CURE) Group, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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3
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Rosen RJ, Fernandez HE, Shirazian S, Moses AA. The authors reply:. Kidney Int 2022; 101:1085-1086. [DOI: 10.1016/j.kint.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 10/18/2022]
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Abstract
Pediatric kidney transplant recipients are distinguished from adult recipients by the need for many decades of graft function, the potential effect of CKD on neurodevelopment, and the changing immune environment of a developing human. The entire life of an individual who receives a transplant as a child is colored by their status as a transplant recipient. Not only must these young recipients negotiate all of the usual challenges of emerging adulthood (transition from school to work, romantic relationships, achieving independence from parents), but they must learn to manage a life-threatening medical condition independently. Regardless of the age at transplantation, graft failure rates are higher during adolescence and young adulthood than at any other age. All pediatric transplant recipients must pass through this high-risk period. Factors contributing to the high graft failure rates in this period include poor adherence to treatment, potentially exacerbated by the transfer of care from pediatric- to adult-oriented care providers, and perhaps an increased potency of the immune response. We describe the characteristics of pediatric kidney transplant recipients, particularly those factors that may influence their care throughout their lives. We also discuss the risks associated with the transition from pediatric- to adult-oriented care and provide some suggestions to optimize the transition to adult-oriented transplant care and long-term outcomes.
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Affiliation(s)
- Hilda E. Fernandez
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Bethany J. Foster
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada,Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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5
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Abstract
Advances in the use of ultrasonography can enhance our ability to better characterize acute kidney injury (AKI). AKI is a clinical syndrome characterized by a rapid decrease in kidney excretory function with the accumulation of products of nitrogen metabolism and other clinically unmeasured waste products, and may proceed to include clinical manifestations including decreased urine output, development of metabolic acidosis, and electrolyte abnormalities [1]. The Kidney Disease Improving Global Outcomes (KDIGO) criteria defines AKI (Table 1). Staging severity of AKI guides the physician in respect to medical management and prognosis. The overall incidence of AKI is around 20% of patients hospitalized worldwide, and around 50% in intensive care unit (ICU) patients [2, 3]. AKI has been found to have increasing morbidity and mortality, no matter the cause of admission, as well as an in-hospital mortality of close to 50% [4]. In a large study of 8 ICUs over 8 years, Kellum et al. found that AKI was associated with increasing mortality rate with worsening AKI stage. A decrease in urine output alone, without an increase in serum creatinine, was associated with decreased 1-year survival [5]. Recurrent AKI has also been associated with increased mortality, further demonstrating the importance of detecting, monitoring, and diagnosing AKI [6].
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Affiliation(s)
- Andrew A Moses
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University New York, NY
| | - Hilda E Fernandez
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University New York, NY
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6
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Husain SA, Tsapepas D, Paget KF, Chang JH, Crew RJ, Dube GK, Fernandez HE, Morris HK, Mohan S, Cohen DJ. Postvaccine Anti-SARS-CoV-2 Spike Protein Antibody Development in Kidney Transplant Recipients. Kidney Int Rep 2021; 6:1699-1700. [PMID: 33907723 PMCID: PMC8062410 DOI: 10.1016/j.ekir.2021.04.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 12/21/2022] Open
Affiliation(s)
- Syed Ali Husain
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | | | - Kathryn F Paget
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Jae-Hyung Chang
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - R John Crew
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Geoffrey K Dube
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Hilda E Fernandez
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Heather K Morris
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - David J Cohen
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
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7
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Vasylyeva TL, Page-Hefley S, Almaani S, Ayoub I, Batson A, Hladunewich M, Howard N, Fernandez HE, O'Shaughnessy M, Reynolds ML, Wadhwani S, Zee J, Smoyer WE, Wenderfer SE, Twombley KE. Evaluation of the Reproductive Care Provided to Adolescent Patients in Nephrology Clinics: A Pediatric Nephrology Research Consortium Study. Kidney Int Rep 2021; 6:1411-1415. [PMID: 34013118 PMCID: PMC8116773 DOI: 10.1016/j.ekir.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Tetyana L Vasylyeva
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
| | - Shyanne Page-Hefley
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
| | - Salem Almaani
- Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Isabelle Ayoub
- Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Abigail Batson
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
| | - Michelle Hladunewich
- Division of Nephrology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Noel Howard
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
| | - Hilda E Fernandez
- Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Michelle O'Shaughnessy
- Department of Renal Medicine, University College Cork and Cork University Hospital, Wilton, Cork, Ireland
| | - Monica L Reynolds
- Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Shikha Wadhwani
- Division of Nephrology and Hypertension, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jarcy Zee
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - William E Smoyer
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA.,Division of Nephrology and Hypertension, Center for Clinical and Translational Research, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Scott E Wenderfer
- Department of Pediatrics-Renal, Baylor College of Medicine, Houston, Texas, USA
| | - Katherine E Twombley
- Division of Nephrology, Department of Pediatric, Medical University of South Carolina, Charleston, South Carolina, USA
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8
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Chang JH, Diop M, Burgos YL, Blackstock DM, Fernandez HE, Morris HK, Dube GK, Crew RJ, Mohan S, Husain SA, Cohen DJ, Tsapepas DS. Telehealth in outpatient management of kidney transplant recipients during COVID-19 pandemic in New York. Clin Transplant 2020; 34:e14097. [PMID: 32940919 DOI: 10.1111/ctr.14097] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/06/2020] [Accepted: 09/10/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Jae-Hyung Chang
- Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Mohamed Diop
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | | | - Hilda E Fernandez
- Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Heather K Morris
- Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Geoffrey K Dube
- Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Russell John Crew
- Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.,Columbia University Renal Epidemiology (CURE) group, New York, NY, USA
| | - Syed Ali Husain
- Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.,Columbia University Renal Epidemiology (CURE) group, New York, NY, USA
| | - David J Cohen
- Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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9
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Fernandez HE, Amaral S, Shaw PA, Doyle AM, Bloom RD, Palmer JA, Baluarte HJ, Furth SL. The effect of transfer to adult transplant care on kidney function and immunosuppressant drug level variability in pediatric kidney transplant recipients. Pediatr Transplant 2019; 23:e13527. [PMID: 31209988 DOI: 10.1111/petr.13527] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 03/30/2019] [Accepted: 05/12/2019] [Indexed: 11/29/2022]
Abstract
Adolescent age at time of transplant has been recognized as a risk factor for renal allograft loss. Increased risk for graft failure may persist from adolescence to young adulthood. Transfer of care is hypothesized as a risk factor for non-adherence and graft loss. We explored whether kidney allograft function declined at an accelerated rate after transfer of care to adult transplant centers and whether coefficient of variation of tacrolimus (CV TAC) trough levels predicted allograft loss. Single-center, retrospective chart review was performed for pediatric kidney transplant recipients who received transplants between 1999 and 2011. Change in eGFR pre- and post-transfer was performed via a linear mixed-effects model. CV TAC was calculated in transplant recipients with TAC data pre- and post-transfer. t test was performed to determine the difference between means of CV TAC in subjects with and without allograft loss following transfer of care. Of the 138 subjects who transferred to adult care, 47 subjects with data pre- and post-transfer demonstrated a decrease in the rate of eGFR decline post-transfer from 8.0 mL/min/1.73 m2 per year to 2.1 mL/min/1.73 m2 per year, an ~80% decrease in eGFR decline post-transfer (P = 0.01). Twenty-four subjects had CV TAC data pre- and post-transfer of care. Pretransfer CV TAC for subjects with allograft loss post-transfer was significantly higher than in subjects without allograft loss (49% vs 26%, P < 0.05). Transfer of care was not independently associated with acceleration in eGFR decline. CV TAC may aid in identifying patients at risk for allograft loss post-transfer.
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Affiliation(s)
- Hilda E Fernandez
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Sandra Amaral
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, and University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pamela A Shaw
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alden M Doyle
- Division of Nephrology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Roy D Bloom
- Renal Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jo Ann Palmer
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hobart J Baluarte
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan L Furth
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, and University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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10
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Ashoor IF, Mansfield SA, O'Shaughnessy MM, Parekh RS, Zee J, Vasylyeva TL, Kogon AJ, Sethna CB, Glenn DA, Chishti AS, Weaver DJ, Helmuth ME, Fernandez HE, Rheault MN. Prevalence of Cardiovascular Disease Risk Factors in Childhood Glomerular Diseases. J Am Heart Assoc 2019; 8:e012143. [PMID: 31286821 PMCID: PMC6662122 DOI: 10.1161/jaha.119.012143] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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] [Indexed: 12/21/2022]
Abstract
Background Cardiovascular disease is a major cause of morbidity and mortality in children with chronic kidney disease. We sought to determine the prevalence of cardiovascular risk factors in children with glomerular disease and to describe current practice patterns regarding risk factor identification and management. Methods and Results Seven-hundred sixty-one children aged 0 to 17 years with any of 4 biopsy-confirmed primary glomerular diseases (minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, and IgA nephropathy/vasculitis) were enrolled at a median of 16 months from glomerular disease diagnosis in the multicenter prospective Cure Glomerulonephropathy Network study. Prevalence of traditional (hypertension, hypercholesterolemia, and obesity) and novel (proteinuria, prematurity, and passive smoke exposure) cardiovascular risk factors were determined at enrollment and compared across glomerular disease subtypes. Frequency of screening for dyslipidemia and prescribing of lipid-lowering or antihypertensive medications were compared across glomerular disease subtype, steroid exposure, and remission status groups. Compared with the general population, all traditional risk factors were more frequent: among those screened, 21% had hypertension, 51% were overweight or obese, and 71% had dyslipidemia. Children who were not in remission at enrollment were more likely to have hypertension and hypercholesterolemia. Fourteen percent of hypertensive children were not receiving antihypertensives. Only 49% underwent screening for dyslipidemia and only 9% of those with confirmed dyslipidemia received lipid-lowering medications. Conclusions Children with primary glomerular diseases exhibit a high frequency of modifiable cardiovascular risk factors, particularly untreated dyslipidemia. Lipid panels should be routinely measured to better define the burden of dyslipidemia in this population. Current approaches to screening for and treating cardiovascular risk factors are not uniform, highlighting a need for evidence-based, disease-specific guidelines.
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Affiliation(s)
- Isa F Ashoor
- 1 Louisiana State University Health Sciences Center New Orleans LA
| | | | | | - Rulan S Parekh
- 4 Division of Nephrology Department of Pediatrics and Medicine Hospital for Sick Children University Health Network, and University of Toronto Toronto Canada
| | - Jarcy Zee
- 2 Arbor Research Collaborative for Health Ann Arbor MI
| | | | - Amy J Kogon
- 6 Children's Hospital of Philadelphia Philadelphia PA
| | | | - Dorey A Glenn
- 8 University of North Carolina at Chapel Hill School of Medicine Chapel Hill NC
| | | | - Donald J Weaver
- 10 Levine Children's Hospital at Carolinas Medical Center Charlotte NC
| | | | - Hilda E Fernandez
- 11 Columbia University College of Physicians and Surgeons New York NY
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11
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Fernandez HE, Chiles MC, Pereira M, Husain SA, Miko B, Baral P, Dale LA, Patel S, Runge B, Tsapepas D, Sandoval PR, Ratner LE, Cohen DJ, Mohan S. Outcomes for potential kidney transplant recipients offered public health service increased risk kidneys: A single-center experience. Clin Transplant 2018; 32:e13427. [PMID: 30329179 DOI: 10.1111/ctr.13427] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 09/25/2018] [Accepted: 10/08/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Discard rate of Public Health Service Increased Risk (PHS-IR) organs is high despite the absence of worse kidney transplant outcomes. METHODS We conducted a retrospective, single-center study of PHS-IR kidney offers made to kidney transplant-only potential recipients from 6/2004 to 5/2015. Overall mortality and transplant outcomes between potential recipients were stratified by response to PHS-IR kidney offers. Cox regression and Kaplan-Meier analyses of mortality and allograft failure were performed. RESULTS A total of 2423 potential recipients were offered a PHS-IR kidney, with 1502 transplanted, with or without a PHS-IR kidney. Predictors of accepting a PHS-IR kidney included higher Estimated Post Transplant Survival (EPTS) score, prior kidney transplant, and lower educational achievement on multivariable analysis (P = 0.025, P = 0.004, P = 0.023). A positive response to a PHS-IR kidney was associated with lower risk of mortality (3.63% vs 11.6%; aHR 0.467, P = 0.0008). PHS-IR kidney recipients had decreased risk of allograft loss compared to non-PHS-IR recipients (P = 0.007), though mortality outcomes were not significantly different based on PHS-IR status (P = 0.38). No transmission of HIV, HBV, or HCV occurred from PHS-IR kidney donors in this cohort. CONCLUSIONS Efforts must be made to increase awareness of the beneficial outcomes of PHS-IR organs to maximize appropriate donor allocation.
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Affiliation(s)
- Hilda E Fernandez
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Mariana C Chiles
- The Columbia University Renal Epidemiology (CURE) Group, New York, New York
| | - Marcus Pereira
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Syed Ali Husain
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Benjamin Miko
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Prativa Baral
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Leigh-Anne Dale
- Division of Transplantation, Department of Surgery, Columbia University Medical Center, New York, New York
| | - Shefali Patel
- Division of Transplantation, Department of Surgery, Columbia University Medical Center, New York, New York
| | - Brian Runge
- Division of Transplantation, Department of Surgery, Columbia University Medical Center, New York, New York
| | - Demetra Tsapepas
- Division of Transplantation, Department of Surgery, Columbia University Medical Center, New York, New York
| | - Pedro Rodrigo Sandoval
- Division of Transplantation, Department of Surgery, Columbia University Medical Center, New York, New York
| | - Lloyd E Ratner
- Division of Transplantation, Department of Surgery, Columbia University Medical Center, New York, New York
| | - David J Cohen
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York.,The Columbia University Renal Epidemiology (CURE) Group, New York, New York.,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
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Rickard DG, Dudovitz RN, Wong MD, Jen HC, Osborn RD, Fernandez HE, Donkor CI. Closing the gap between insecticide treated net ownership and use for the prevention of malaria. Prog Community Health Partnersh 2011; 5:123-31. [PMID: 21623014 DOI: 10.1353/cpr.2011.0018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Malaria is the leading cause of morbidity and mortality in children younger than 5 years old and pregnant women in sub-Saharan Africa. Insecticide-treated nets (ITNs) reduce clinical malaria by more than 50% and all cause mortality in young children by 15% to 30%. However, use of these nets is poor across sub-Saharan Africa, limiting the potential impact of this effective tool in the fight against malaria. OBJECTIVE We sought to improve the use of ITNs using a community-created and -implemented approach, and measure the change in ITN use over the year after implementation. METHODS Using a community-based participatory research approach, we created and implemented an intervention to improve ITN use in a rural village. Our intervention involved providing hands-on instructions and assistance in hanging of nets, in-home small group education, and monthly follow-up by trained community members. ITN use was measured for all individuals in a subset of the community (61 households, 759 individuals) at baseline and at 6 months and 1 year after distribution. RESULTS Rates of individual usage increased significantly from 29% at baseline to 88.7% (p < .001) at 6 months and to 96.6% (p < .001) at 12 months. For children under age 5, usage rates increased from 46% at baseline to 95.7% (p < .001) at 6 months and 95.4% (p < .001) at 12 months. CONCLUSION Our study demonstrates that rapidly achieving and sustaining almost universal ITN usage rates is possible using a community-based approach. Closing the gap between ITN ownership and use will help communities to realize the full potential of ITNs in the prevention of malaria.
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Affiliation(s)
- Diana G Rickard
- Department of Health Services, University of California Los Angeles, USA
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Rickard DG, Dudovitz RN, Wong MD, Jen HC, Osborn RD, Fernandez HE, Donkor CI. Closing the Gap Between Insecticide Treated Net Ownership and Use for the Prevention of Malaria. Prog Community Health Partnersh 2011. [DOI: 10.1353/cpr.2011.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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