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Matarneh AS, Salameh O, Sardar S, Karasinski A, Channapragada T, Abdulbasit M, Washburn E, Ghahramani N. A rare case of non-lupus full house nephropathy in a transplanted kidney, case report. Clin Case Rep 2024; 12:e8886. [PMID: 38707603 PMCID: PMC11066189 DOI: 10.1002/ccr3.8886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 05/07/2024] Open
Abstract
Key Clinical Message Non-lupus full house nephropathy is a rare entity that is still poorly understood. It can complicate post-transplant kidneys and result in a de novo process. Treatment is difficult but can be possibly achieved with optimization of immune suppression. Abstract Non-lupus full house nephropathy is a rare entity with an unclear incidence. It describes the kidney biopsy findings of positive deposits for IgG, IgA, IgM, C3, and C1q on immunofluorescence in the absence of the classical diagnostic features of systemic lupus nephritis. This disease entity is becoming more recognized but further studies are still needed to evaluate the incidence, etiologies, and management of this condition. Transplant glomerulopathy is a major cause for renal graft loss. It can present with a wide variety of manifestations; it can cause AKI, CKD, or glomerular inflammations through an immune complex or autoimmune-mediated damage.
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Affiliation(s)
- Ahmad Samir Matarneh
- Department of NephrologyPenn State Milton S Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Omar Salameh
- Department of Internal MedicinePenn State Milton S Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Sundus Sardar
- Department of NephrologyPenn State Milton S Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Amanda Karasinski
- Department of NephrologyPenn State Milton S Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Theja Channapragada
- Department of Internal MedicinePenn State Milton S Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Muhammad Abdulbasit
- Department of NephrologyPenn State Milton S Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Erik Washburn
- Department of PathologyPenn State Milton S Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Nasrollah Ghahramani
- Department of NephrologyPenn State Milton S Hershey Medical CenterHersheyPennsylvaniaUSA
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Zhang Y, Ghahramani N, Razjouyan H, Ba DM, Chinchilli VM. The association between proton pump inhibitor use and risk of post-hospitalization acute kidney injury: a multicenter prospective matched cohort study. BMC Nephrol 2023; 24:150. [PMID: 37237361 DOI: 10.1186/s12882-023-03211-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/22/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Proton Pump Inhibitors (PPI) are among the most commonly used drugs to treat acid-related gastrointestinal disorders in the USA. Although PPI use has been linked to acute interstitial nephritis, the side effects of post-hospitalization acute kidney injury (AKI) and the progression of kidney disease still are controversial. We conducted a matched cohort study to examine the associations between PPI use and the side effects, especially in post-hospitalization AKI. METHODS We investigated 340 participants from the multicenter, prospective, matched-cohort ASSESS-AKI study, which enrolled participants from December 2009 to February 2015. After the baseline index hospitalization, follow-up visits were conducted every six months, and included a collection of self-reported PPI use by participants. Post-hospitalization AKI was defined as the percentage increase from the nadir to peak inpatient SCr value was ≥ 50% and/or absolute increase ≥ 0.3 mg/dL in peak inpatient serum creatinine compared with baseline outpatient serum creatinine. We applied a zero-inflated negative binomial regression model to test the relationship between PPI use and post-hospitalization AKI. Stratified Cox proportional hazards regression models also were conducted to examine the association between PPI use and the risk of progression of kidney disease. RESULTS After controlling for demographic variables, baseline co-morbidities and drug use histories, there was no statistically significant association between PPI use and risk of post-hospitalization AKI (risk ratio [RR], 0.91; 95% CI, 0.38 to 1.45). Stratified by AKI status at baseline, no significant relationships were confirmed between PPI use and the risk of recurrent AKI (RR, 0.85; 95% CI, 0.11 to 1.56) or incidence of AKI (RR, 1.01; 95% CI, 0.27 to 1.76). Similar non-significant results also were observed in the association between PPI use and the risk of progression of kidney diseases (Hazard Ratio [HR], 1.49; 95% CI, 0.51 to 4.36). CONCLUSION PPI use after the index hospitalization was not a significant risk factor for post-hospitalization AKI and progression of kidney diseases, regardless of the AKI status of participants at baseline.
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Affiliation(s)
- Yue Zhang
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Hershey, PA, 17033, USA.
| | - Nasrollah Ghahramani
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Hershey, PA, 17033, USA
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Hadie Razjouyan
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Djibril M Ba
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Hershey, PA, 17033, USA
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Hershey, PA, 17033, USA
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Taghrir MH, Akbarialiabad H, Abdollahi A, Ghahramani N, Bastani B, Paydar S, Razani B, Mwangi J, Asadi-Pooya AA, Roozbeh J, Malekmakan L, Kumar M. Inequity and disparities mar existing global research evidence on Long COVID. Glob Health Promot 2022; 30:63-67. [PMID: 35962520 PMCID: PMC10076956 DOI: 10.1177/17579759221113276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Since the pandemic began in December 2019, SARS-Cov2 has accentuated the wide gap and disparities in socioeconomic and healthcare access at individual, community, country, and regional levels. More than two years into the current pandemic, up to three-fourths of the patients are reporting continued signs and symptoms beyond the acute phase of COVID-19, and Long COVID portends to be a major challenge in the future ahead. With a comprehensive overview of the literature, we found that most studies concerning long COVID came from high and upper-middle income countries, and people of low-income and lower-and-middle income regions and vulnerable groups with comorbid conditions have been neglected. Apart from the level of income, there is a significant geographical heterogeneity in investigating the Post-Acute Sequelae of COVID-19 (PASC) or what we call now, long COVID. We believe that these recognizing health disparities is crucial from equity perspective and is the first step toward global health promotion.
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Affiliation(s)
- Mohammad Hossein Taghrir
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Iran
| | - Hossein Akbarialiabad
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Iran
| | - Ashkan Abdollahi
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Iran
| | - Nasrollah Ghahramani
- Division of Nephrology, Department of Medicine, Penn State University College of Medicine, Hershey, USA
| | | | - Shahram Paydar
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Iran
| | - Babak Razani
- Cardiology Division, Department of Medicine, Washington University School of Medicine, St. Louis, USA.,Veterans Affairs St. Louis Healthcare System, John Cochran Division, St. Louis, USA.,Department of Pathology & Immunology, Washington University School of Medicine, St Louis, USA
| | - John Mwangi
- Pulmonary and Critical Care Medicine, Saint Louis University School of Medicine, Saint Louis, USA
| | - Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Iran.,Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, USA
| | - Jamshid Roozbeh
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Iran
| | - Leila Malekmakan
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Iran
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Kenya.,Department of Clinical, Educational and Health Psychology, University College London, UK
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Shen B, Chen C, Chinchilli VM, Ghahramani N, Zhang L, Wang M. Semiparametric marginal methods for clustered data adjusting for informative cluster size with nonignorable zeros. Biom J 2022; 64:898-911. [PMID: 35257406 DOI: 10.1002/bimj.202100161] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 10/26/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022]
Abstract
Clustered or longitudinal data are commonly encountered in clinical trials and observational studies. This type of data could be collected through a real-time monitoring scheme associated with some specific event, such as disease recurrence, hospitalization, or emergency room visit. In these contexts, the cluster size could be informative because of its potential correlation with disease status, since more frequency of observations may indicate a worsening health condition. However, for some clusters/subjects, there are no measures or relevant medical records. Under such circumstances, these clusters/subjects may have a considerably lower risk of an event occurrence or may not be susceptible to such events at all, indicating a nonignorable zero cluster size. There is a substantial body of literature using observations from those clusters with a nonzero informative cluster size only, but few works discuss informative nonignorable zero-sized clusters. To utilize the information from both event-free and event-occurring participants, we propose a weighted within-cluster-resampling (WWCR) method and its asymptotically equivalent method, dual-weighted generalized estimating equations (WWGEE) by adopting the inverse probability weighting technique. The asymptotic properties are rigorously presented theoretically. Extensive simulations and an illustrative example of the Assessment, Serial Evaluation, and Subsequent Sequelae of Acute Kidney Injury (ASSESS-AKI) study are performed to analyze the finite-sample behavior of our methods and to show their advantageous performance compared to the existing approaches.
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Affiliation(s)
- Biyi Shen
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Chixiang Chen
- Division of Biostatistics and Bioinformatics, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vernon M Chinchilli
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | | | - Lijun Zhang
- Institute of Personalized Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Ming Wang
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
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Wen Y, Thiessen-Philbrook H, Moledina DG, Kaufman JS, Reeves WB, Ghahramani N, Ikizler TA, Go AS, Liu KD, Siew ED, Himmelfarb J, Kimmel PL, Hsu CY, Parikh CR. Considerations in Controlling for Urine Concentration for Biomarkers of Kidney Disease Progression After Acute Kidney Injury. Kidney Int Rep 2022; 7:1502-1513. [PMID: 35812275 PMCID: PMC9263319 DOI: 10.1016/j.ekir.2022.03.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/18/2022] [Accepted: 03/28/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction Biomarkers of acute kidney injury (AKI) are often indexed to urine creatinine (UCr) or urine osmolarity (UOsm) to control for urine concentration. We evaluated how these approaches affect the biomarker-outcome association in patients with AKI. Methods The Assessment, Serial Evaluation, and Subsequent Sequelae in Acute Kidney Injury Study was a cohort of hospitalized patients with and without AKI between 2009 and 2015. Using Cox proportional hazards regression, we assessed the associations and predictions (C-statistics) of urine biomarkers with a composite outcome of incident chronic kidney disease (CKD) and CKD progression. We used 4 approaches to account for urine concentration: indexing and adjusting for UCr and UOsm. Results Among 1538 participants, 769 (50%) had AKI and 300 (19.5%) developed composite CKD outcome at median follow-up of 4.7 years. UCr and UOsm during hospitalization were inversely associated with the composite CKD outcome. The associations and predictions with CKD were significantly strengthened after indexing or adjusting for UCr or UOsm for urine kidney injury molecule-1 (KIM-1), interleukin-18 (IL-18), and monocyte chemoattractant protein-1 (MCP-1) in patients with AKI. There was no significant improvement with indexing or adjusting UCr or UOsm for albumin, neutrophil gelatinase-associated lipocalin (NGAL), and chitinase 3-like 1 (YKL-40). Uromodulin's (UMOD) inverse association with the outcome was significantly blunted after indexing but not adjusting for UCr or UOsm. Conclusion UCr and UOsm during hospitalization are inversely associated with development and progression of CKD. Indexing or adjusting for UCr or UOsm strengthened associations and improved predictions for CKD for only some biomarkers. Incorporating urinary concentration should be individualized for each biomarker in research and clinical applications.
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Affiliation(s)
- Yumeng Wen
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Heather Thiessen-Philbrook
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dennis G. Moledina
- Clinical and Translational Research Accelerator, Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - James S. Kaufman
- Division of Nephrology, Department of Medicine, New York University School of Medicine, New York, New York, USA,Department of Medicine, Veterans Affairs New York Harbor Health Care System, New York, New York, USA
| | - W. Brian Reeves
- Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas San Antonio, Texas, USA
| | - Nasrollah Ghahramani
- Division of Nephrology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - T. Alp Ikizler
- Division of Nephrology, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Alan S. Go
- Kaiser Permanente Division of Research, Oakland, California, USA
| | - Kathleen D. Liu
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Eddie D. Siew
- Division of Nephrology, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Jonathan Himmelfarb
- Kidney Research Institute, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Paul L. Kimmel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Chi-yuan Hsu
- Kaiser Permanente Division of Research, Oakland, California, USA,Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Chirag R. Parikh
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,Correspondence: Chirag R. Parikh, Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 416, Baltimore, Maryland 21205, USA.
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Abdollahi A, Ghahramani A, Ghahramani N. Zinc and Kidney Disease: A Review. Iran J Kidney Dis 2022; 16:79-87. [PMID: 35489076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/04/2021] [Accepted: 12/25/2021] [Indexed: 06/14/2023]
Abstract
Zinc is the second most abundant essential trace element in the human body with important regulatory functions in cellular and subcellular levels in several tissues. Zinc deficiency is associated with the development and progression of chronic kidney disease (CKD) and its complications. With the progression of CKD to end-stage kidney disease (ESKD) and initiation of dialysis, zinc is further removed from the body, potentiating the zinc deficiency. Dietary intake plays a major role in zinc-deficiency-related risks and progression of CKD. By taking into account the evidence from clinical studies depicting the mutual correlations between zinc and CKD, and the plausibility based on animal studies, it can be deduced that zinc deficiency has a causative role in CKD and its progression. This review highlights the role of zinc deficiency in kidney disease and the possible indication for supplementation of zinc at various stages of CKD. DOI: 10.52547/ijkd.6702.
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Affiliation(s)
- Ashkan Abdollahi
- Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Ghahramani N, Chinchilli VM, Kraschnewski JL, Lengerich EJ, Sciamanna CN. Improving Caregiver Burden by a Peer-Led Mentoring Program for Caregivers of Patients With Chronic Kidney Disease: Randomized Controlled Trial. J Patient Exp 2022; 9:23743735221076314. [PMID: 35111900 PMCID: PMC8801633 DOI: 10.1177/23743735221076314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chronic kidney disease (CKD) is associated with substantial morbidity, mortality, cost, and increased caregiver burden. Peer mentoring (PM) improves multiple outcomes in various chronic diseases. The effect of PM on caregiver burden among caregivers of patients with CKD has not been studied. We conducted a randomized clinical trial to test the effectiveness of a structured PM program on burden of care among caregivers of patients with CKD. We randomized 86 caregivers to receive 6 months of intervention in 1 of 3 groups: (1) face-to-face PM (n = 29); (2) online PM (n = 29); and (3) usual care: textbook-only (n = 28). Peer mentors were caregivers of patients with CKD, who received 16 h of instruction. All participants received a copy of a textbook, which contains detailed information about kidney disease. Participants in the PM groups received FTF or online PM for 6 months. The outcome was time-related change in the Zarit Burden Interview (ZBI) score. There was a statistically significant decrease in the ZBI score (SE: −3.44; CI: −6.31, −0.57 [p = 0.002]) compared with baseline, among the online PM group. Online PM led to decreased caregiver burden among caregivers of patients with CKD. The study was limited to English-speaking subjects with computer literacy.
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Zeng H, Chinchilli VM, Ghahramani N. Causal inference with a mediated proportional hazards regression model. COMMUN STAT-SIMUL C 2021; 53:203-218. [PMID: 38173825 PMCID: PMC10760952 DOI: 10.1080/03610918.2021.2014887] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
Abstract
The natural direct and indirect effects in causal mediation analysis with survival data having one mediator is addressed by VanderWeele (2011) [1]. He derived an approach for (1) an accelerated failure time regression model in general cases and (2) a proportional hazards regression model when the time-to-event outcome is rare. If the outcome is not rare, then VanderWeele (2011) [1] did not derive a simple closed-form expression for the log-natural direct and log-natural indirect effects for the proportional hazards regression model because the baseline cumulative hazard function does not approach zero. We develop two approaches to extend VanderWeele's approach, in which the assumption of a rare outcome is not required. We obtain the natural direct and indirect effects for specific time points through numerical integration after we calculate the cumulative baseline hazard by (1) applying the Breslow method in the Cox proportional hazards regression model to estimate the unspecified cumulative baseline hazard; (2) assuming a piecewise constant baseline hazard model, yielding a parametric model, to estimate the baseline hazard and cumulative baseline hazard. We conduct simulation studies to compare our two approaches with other methods and illustrate our two approaches by applying them to data from the ASsessment, Serial Evaluation, and Subsequent Sequelae in Acute Kidney Injury (ASSESS-AKI) Consortium.
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Affiliation(s)
- Hui Zeng
- Department of Mathematics, College of Mathematics and Physics, Beijing University of Chemical Technology, Beijing, 100029, China
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, 17033, USA
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, 17033, USA
| | - Nasrollah Ghahramani
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, 17033, USA
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Akbarialiabad H, Taghrir MH, Abdollahi A, Ghahramani N, Kumar M, Paydar S, Razani B, Mwangi J, Asadi-Pooya AA, Malekmakan L, Bastani B. Long COVID, a comprehensive systematic scoping review. Infection 2021; 49:1163-1186. [PMID: 34319569 PMCID: PMC8317481 DOI: 10.1007/s15010-021-01666-x] [Citation(s) in RCA: 152] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/10/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To find out what is known from literature about Long COVID until January 30, 2021. METHODS We undertook a four-step search with no language restriction. A preliminary search was made to identify the keywords. A search strategy of all electronic databases resulted in 66 eligible studies. A forward and backward search of the references and citations resulted in additional 54 publications. Non-English language articles were translated using Google Translate. We conducted our scoping review based on the PRISMA-ScR Checklist. RESULTS Of 120 papers, we found only one randomized clinical trial. Of the 67 original studies, 22 were cohort, and 28 were cross-sectional studies. Of the total 120 publications, 49.1% focused on signs and symptoms, 23.3% on management, and 10.8% on pathophysiology. Ten publications focused on imaging studies. The results are also presented extensively in a narrative synthesis in separated sections (nomenclature, diagnosis, pathophysiology, risk factors, signs/symptoms, management). CONCLUSIONS The controversies in its definition have impaired proper recognition and management. The predominant symptoms were: fatigue, breathlessness, arthralgia, sleep difficulties, and chest pain. Recent reports also point to the risk of long-term sequela with cutaneous, respiratory, cardiovascular, musculoskeletal, mental health, neurologic, and renal involvement in those who survive the acute phase of the illness.
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Affiliation(s)
- Hossein Akbarialiabad
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Taghrir
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ashkan Abdollahi
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrollah Ghahramani
- Division of Nephrology, Department of Medicine, Penn State University College of Medicine, Hershey, PA, 17033, USA
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Shahram Paydar
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Babak Razani
- Cardiology Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
- John Cochran Division, Veterans Affairs St. Louis Healthcare System, St. Louis, MO, 63106, USA
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - John Mwangi
- Pulmonary and Critical Care Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Leila Malekmakan
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bahar Bastani
- Professor of Medicine-Nephrology, Saint Louis University School of Medicine, Saint Louis, MO, USA.
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Jain A, Xu R, Venkataramanan R, Farooq U, Butt F, Ghahramani N, Kadry Z. Plasmapheresis Decreases Belatacept Exposure: Requires Consideration for Dose and Frequency Adjustments. Transplantation 2021; 105:e152-e153. [PMID: 34591818 DOI: 10.1097/tp.0000000000003840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ashokkumar Jain
- Department of General Surgery, Division of Transplant Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - Ruichao Xu
- Pharmaceutical Sciences and Pathology, University of Pittsburgh, Pittsburgh, PA
| | | | - Umar Farooq
- Department of Medicine, Division of Nephrology, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - Fauzia Butt
- Department of General Surgery, Division of Transplant Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - Nasrollah Ghahramani
- Department of Medicine, Division of Nephrology, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - Zakiyah Kadry
- Department of General Surgery, Division of Transplant Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA
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11
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Shen B, Chen C, Liu D, Datta S, Ghahramani N, Chinchilli VM, Wang M. Joint modeling of longitudinal data with informative cluster size adjusted for zero-inflation and a dependent terminal event. Stat Med 2021; 40:4582-4596. [PMID: 34057216 PMCID: PMC8579325 DOI: 10.1002/sim.9081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/23/2021] [Accepted: 04/19/2021] [Indexed: 11/08/2022]
Abstract
Repeated measures are often collected in longitudinal follow-up from clinical trials and observational studies. In many situations, these measures are adherent to some specific event and are only available when it occurs; an example is serum creatinine from laboratory tests for hospitalized acute kidney injuries. The frequency of event recurrences is potentially correlated with overall health condition and hence may influence the distribution of the outcome measure of interest, leading to informative cluster size. In particular, there may be a large portion of subjects without any events, thus no longitudinal measures are available, which may be due to insusceptibility to such events or censoring before any events, and this zero-inflation nature of the data needs to be taken into account. On the other hand, there often exists a terminal event that may be correlated with the recurrent events. Previous work in this area suffered from the limitation that not all these issues were handled simultaneously. To address this deficiency, we propose a novel joint modeling approach for longitudinal data adjusting for zero-inflated and informative cluster size as well as a terminal event. A three-stage semiparametric likelihood-based approach is applied for parameter estimation and inference. Extensive simulations are conducted to evaluate the performance of our proposal. Finally, we utilize the Assessment, Serial Evaluation, and Subsequent Sequelae of Acute Kidney Injury (ASSESS-AKI) study for illustration.
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Affiliation(s)
- Biyi Shen
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Chixiang Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Danping Liu
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Somnath Datta
- Department of Biostatistics, University of Florida, Rockville, Florida
| | | | - Vernon M. Chinchilli
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Ming Wang
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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Akbarialiabad H, Bastani B, Taghrir MH, Paydar S, Ghahramani N, Kumar M. Threats to Global Mental Health From Unregulated Digital Phenotyping and Neuromarketing: Recommendations for COVID-19 Era and Beyond. Front Psychiatry 2021; 12:713987. [PMID: 34594251 PMCID: PMC8477163 DOI: 10.3389/fpsyt.2021.713987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
The new era of digitalized knowledge and information technology (IT) has improved efficiency in all medical fields, and digital health solutions are becoming the norm. There has also been an upsurge in utilizing digital solutions during the COVID-19 pandemic to address the unmet mental healthcare needs, especially for those unable to afford in-person office-based therapy sessions or those living in remote rural areas with limited access to mental healthcare providers. Despite these benefits, there are significant concerns regarding the widespread use of such technologies in the healthcare system. A few of those concerns are a potential breach in the patients' privacy, confidentiality, and the agency of patients being at risk of getting used for marketing or data harnessing purposes. Digital phenotyping aims to detect and categorize an individual's behavior, activities, interests, and psychological features to properly customize future communications or mental care for that individual. Neuromarketing seeks to investigate an individual's neuronal response(s) (cortical and subcortical autonomic) characteristics and uses this data to direct the person into purchasing merchandise of interest, or shaping individual's opinion in consumer, social or political decision making, etc. This commentary's primary concern is the intersection of these two concepts that would be an inevitable threat, more so, in the post-COVID era when disparities would be exaggerated globally. We also addressed the potential "dark web" applications in this intersection, worsening the crisis. We intend to raise attention toward this new threat, as the impacts might be more damming in low-income settings or/with vulnerable populations. Legal, health ethics, and government regulatory processes looking at broader impacts of digital marketing need to be in place.
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Affiliation(s)
- Hossein Akbarialiabad
- Research Center for Psychiatry and Behavioral Sciences, Department of Psychiatry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bahar Bastani
- Medicine-Nephrology, Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - Mohammad Hossein Taghrir
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahram Paydar
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrollah Ghahramani
- Division of Nephrology, Department of Medicine, Penn State University College of Medicine, Hershey, PA, United States
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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13
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De Souza LM, Ghahramani N, Abendroth C, Kaur G. Evaluating a Living Donor With Rheumatoid Arthritis for a Recipient With End-Stage Renal Disease From Antineutrophil Cytoplasmic Antibodies Associated Vasculitis. Cureus 2021; 13:e18117. [PMID: 34692328 PMCID: PMC8527875 DOI: 10.7759/cureus.18117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/30/2022] Open
Abstract
A 60-year-old Caucasian female with sero-positive rheumatoid arthritis (RA) was evaluated as a potential kidney donor for her brother-in-law with end-stage kidney disease (ESKD) secondary to c-antineutrophil cytoplasmic antibody (c-ANCA) associated vasculitis (AAV) and membranous nephropathy (MN). With little to no data supporting or contradicting this unique scenario, in addition to the varying viewpoints expressed by the different specialists, our multidisciplinary transplant committee encountered a difficult decision of whether to approve a candidate with RA for a living kidney donation or not. As a result, we carried out a careful literature review addressing aspects of recipients' outcomes following kidney transplants from a living donor with RA, especially when the recipient has AAV, living donor's short- and long-term outcomes post kidney donation, renal disease in AAV and RA, and maintenance of disease remission.
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Affiliation(s)
- Luisa M De Souza
- Medicine, Penn State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA
| | | | | | - Gurwant Kaur
- Nephrology, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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14
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Karimi Z, Masjedi F, Malekmakan L, Doostkam A, Roozbeh J, Ghahramani N. Potential Mechanisms of the SARS-CoV-2-induced AKI Progression to CKD: A Forward-Looking Perspective. Iran J Kidney Dis 2021; 15:243-255. [PMID: 34278995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/30/2021] [Accepted: 05/30/2021] [Indexed: 06/13/2023]
Abstract
Coronavirus disease 2019 (COVID‑19) was identified in December 2019 and is still expanding in most parts of the world. The wide variety of affected organs is likely based upon the shared expression of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) important entry-receptor angiotensin-converting enzyme 2 (ACE2). For this reason, the broad distribution of ACE2 receptors in different tissues plays a crucial role in the multi-organ dysfunction and fatality due to COVID-19. Because of the high prevalence of acute kidney injury (AKI) in patients with COVID-19, we review the molecular understanding into viral infection mechanisms and implications for AKI. Furthermore, mechanisms of the AKI to chronic kidney disease (CKD) progression, such as the relative contribution of immune cell reaction, fibroblasts activation, endothelial dysfunction, and subsequent hypoxia may contribute to the association of AKI with worse outcomes during this virus pandemic. We highlight the state of the knowledge on SARS-CoV-2-dependent mechanisms for AKI and list the potential management choices for the prevention of AKI aggravation and the impending possibility of CKD. Finally, we intend to provide a much better understanding of why Coronavirus induces AKI and its subsequent progression to CKD in the coming years and further discuss the acute and long-term renal consequences.
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Affiliation(s)
| | | | | | | | - Jamshid Roozbeh
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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15
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MacLaughlin HL, Pike M, Selby NM, Siew E, Chinchilli VM, Guide A, Stewart TG, Himmelfarb J, Go AS, Parikh CR, Ghahramani N, Kaufman J, Ikizler TA, Robinson-Cohen C. Body mass index and chronic kidney disease outcomes after acute kidney injury: a prospective matched cohort study. BMC Nephrol 2021; 22:200. [PMID: 34049502 PMCID: PMC8161937 DOI: 10.1186/s12882-021-02400-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/06/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) and obesity are independent risk factors for chronic kidney disease (CKD). This study aimed to determine if obesity modifies risk for CKD outcomes after AKI. METHODS This prospective multisite cohort study followed adult survivors after hospitalization, with or without AKI. The primary outcome was a combined CKD event of incident CKD, progression of CKD and kidney failure, examined using time-to-event Cox proportional hazards models, adjusted for diabetes status, age, pre-existing CKD, cardiovascular disease status and intensive care unit admission, and stratified by study center. Body mass index (BMI) was added as an interaction term to examine effect modification by body size. RESULTS The cohort included 769 participants with AKI and 769 matched controls. After median follow-up of 4.3 years, among AKI survivors, the rate of the combined CKD outcome was 84.7 per1000-person-years with BMI ≥30 kg/m2, 56.4 per 1000-person-years with BMI 25-29.9 kg/m2, and 72.6 per 1000-person-years with BMI 20-24.9 kg/m2. AKI was associated with a higher risk of combined CKD outcomes; adjusted-HR 2.43 (95%CI 1.87-3.16), with no evidence that this was modified by BMI (p for interaction = 0.3). After adjustment for competing risk of death, AKI remained associated with a higher risk of the combined CKD outcome (subdistribution-HR 2.27, 95%CI 1.76-2.92) and similarly, there was no detectable effect of BMI modifying this risk. CONCLUSIONS In this post-hospitalization cohort, we found no evidence for obesity modifying the association between AKI and development or progression of CKD.
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Affiliation(s)
- Helen L MacLaughlin
- Queensland University of Technology, School of Exercise and Nutrition Sciences, Victoria Park Road, Kelvin Grove, QLD, Australia.
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
| | - Mindy Pike
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nicholas M Selby
- Centre for Kidney Research and Innovation, University of Nottingham, Derby, UK
| | - Edward Siew
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Vernon M Chinchilli
- Division of Biostatistics and Informatics, Pennsylvania State University, Hershey, PA, USA
| | - Andrew Guide
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Thomas G Stewart
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Alan S Go
- Kaiser Permanente Northern California, Oakland, CA, USA
- University of California, San Francisco, San Francisco, CA, USA
| | - Chirag R Parikh
- Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nasrollah Ghahramani
- Division of Nephrology, Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - James Kaufman
- Renal Section, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, NY, USA
| | - T Alp Ikizler
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
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16
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Nwanji V, Ghahramani A, Dauleh M, Ghahramani N. Knowledge about Benefits of Kidney Transplantation: A Survey of Dialysis Patients. Ann Urol Nehrol 2021; 2:550. [PMID: 34368803 PMCID: PMC8341390] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Knowledge about benefits of kidney transplantation (KT) is an important determinant of the patients' decision to pursue KT. We investigated factors associated with End Stage Renal Disease (ESRD) patients' knowledge about KT benefits. METHODS We randomly invited 1,400 dialysis patients to complete a survey about benefits of KT. Using multivariate analysis, we calculated odds ratios for the probability of choosing the correct responses. RESULTS Of 673 participants, 17.6% agreed with benefit of KT for older patients, 36.5% agreed with benefit of KT for diabetic patients, and 31.5% agreed with benefit of pre-emptive KT. Non-white (OR: 0.68) and older (OR: 0.65) participants were less likely to agree with the survival benefit of KT. Older participants were less likely to agree with benefit of KT for older (OR: 0.64), and diabetic patients (OR: 0.54). Participants with less than high school education were less likely to agree with benefit of pre-emptive KT (OR: 0.58). Participants with a previous KT were more likely to agree with benefit of KT for older (OR: 2.32), and diabetic patients (OR: 2.50), and with the benefit of pre-emptive KT (OR: 2.34). Participants who had received 3 or more modes of education about KT were more likely to agree with benefit of KT for diabetic patients (OR: 2.04), and with benefit of pre-emptive KT (OR:1.67). CONCLUSIONS Dialysis patients have limited knowledge about benefits of KT. Previous KT, exposure to 3 or more modes of KT education, and education attainment are significant contributors to knowledge about KT benefits.
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Ghahramani N, Chinchilli VM, Kraschnewski JL, Lengerich EJ, Sciamanna CN. Effect of Peer Mentoring on Quality of Life among CKD Patients: Randomized Controlled Trial. Kidney Dis (Basel) 2021; 7:323-333. [PMID: 34395547 DOI: 10.1159/000514477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/14/2021] [Indexed: 11/19/2022]
Abstract
Introduction CKD is associated with decreased quality of life (QOL). Peer mentoring (PM) leads to improved QOL in various chronic diseases. The effectiveness of PM on QOL of patients with CKD has not been previously studied. We conducted a randomized clinical trial to test the effectiveness of face-to-face (FTF) and online mentoring by trained peers, compared with usual care, on CKD patients' QOL. Methods We randomized 155 patients in one of 3 groups: (1) FTF PM (n = 52), (2) online PM (n = 52), and (3) textbook only (n = 51). Peer mentors were patients with CKD, who received formal training through 16 h of instruction. Participants in all 3 groups received a copy of an informational textbook about CKD. Participants assigned to PM received either 6 months of FTF or online PM. The outcomes included time-related changes in domain scores of the Kidney Disease Quality of Life (KDQOL)-36 for each of the groups over the 18-month study period. Results Compared with baseline, online PM led to improved scores in domains of the KDQOL-36 at 18 months: Effects of Kidney Disease (p = 0.01), Burden of Kidney Disease (p = 0.01), Symptoms and Problems of Kidney Disease (p = 0.006), SF-12 Physical Composite Summary (p = 0.001), and SF-12 Mental Composite Summary (p < 0.001). There were no statistically significant changes from baseline in domain scores of KDQOL-36 within the FTF PM and textbook-only groups. Conclusions Among patients with CKD, online PM led to increased scores in domains of the KDQOL-36 at 18 months. The study was limited to English-speaking subjects with computer literacy and internet access.
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Affiliation(s)
| | - Vernon M Chinchilli
- Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| | | | - Eugene J Lengerich
- Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
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18
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Kostic S, Hauke T, Ghahramani N, Filipovic N, Vukojevic K. Expression pattern of apoptosis-inducing factor in the kidneys of streptozotocin-induced diabetic rats. Acta Histochem 2020; 122:151655. [PMID: 33171392 DOI: 10.1016/j.acthis.2020.151655] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND It is believed that tubulo-interstitial fibrosis and atrophy in diabetic patients are directly associated with the progression of chronic kidney disease, CKD. AIF is one of the crucial factors responsible for mitochondrial apoptosis, however, it can also promote cell survival independently from its role in apoptosis, and therefore can be potentially used as a tool in prevention of the onset of CKD in diabetic patients. Our aim was to investigate the significance of AIF expression in the development of CKD by observing the expression of AIF in 2 weeks' and 2 months' kidneys of diabetic rats compared to their controls. METHODS Male Sprague-Dawley rats were treated with 55 mg/kg streptozotocin (model of type 1 diabetes mellitus; DM group) or citrate buffer (control). After 2 weeks and 2 months kidney samples were collected and analysed in different renal areas. RESULTS Characteristic morphologic changes were found between the 2 months' control and 2 months' diabetic groups. Those changes, including fibrosis and possible replacement of podocytes with connective tissue were mainly present in the glomeruli. AIF expression was seen in the both cortex, and in the collecting ducts of the medulla. Strong intensity of AIF expression was seen in proximal and distal convoluted tubules in both diabetic groups. In the control groups the glomeruli showed no AIF staining but moderate staining was seen in both diabetic groups. Overall, the percentage of AIF positive cells in the glomeruli was the lowest. The greatest rise in cell positivity was displayed from the 2 weeks' control group to 2 weeks' diabetes group (38 %) in glomeruli. The cell positivity of the 2 weeks' diabetic group is significantly reduced to 18 % in the 2 months' diabetic group in glomeruli. A similar pattern was seen in the proximal tubular cells (92 % positivity 2 weeks diabetic groups; 89 % positivity 2 months diabetic groups), as well as in the distal tubules. The highest percentage of AIF positive cells was seen in the collecting ducts, more than 80 % in all groups. CONCLUSIONS Our study provides insight into AIF expression pattern during short term diabetes model, confirming possible dual role of AIF, not only in apoptosis but also in cell function and homeostasis, and proving AIF as potential therapeutic target and marker of advancement of CKD.
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MESH Headings
- Animals
- Apoptosis/drug effects
- Apoptosis Inducing Factor/genetics
- Apoptosis Inducing Factor/metabolism
- Diabetes Mellitus, Experimental/chemically induced
- Diabetes Mellitus, Experimental/genetics
- Diabetes Mellitus, Experimental/metabolism
- Diabetes Mellitus, Experimental/pathology
- Diabetic Nephropathies/genetics
- Diabetic Nephropathies/metabolism
- Diabetic Nephropathies/pathology
- Fibrosis
- Gene Expression Regulation
- Glomerular Mesangium/metabolism
- Glomerular Mesangium/pathology
- Kidney Tubules, Collecting/metabolism
- Kidney Tubules, Collecting/pathology
- Kidney Tubules, Distal/metabolism
- Kidney Tubules, Distal/pathology
- Kidney Tubules, Proximal/metabolism
- Kidney Tubules, Proximal/pathology
- Male
- Nephritis, Interstitial/genetics
- Nephritis, Interstitial/metabolism
- Nephritis, Interstitial/pathology
- Podocytes/metabolism
- Podocytes/pathology
- Rats
- Rats, Sprague-Dawley
- Streptozocin/administration & dosage
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Affiliation(s)
- Sandra Kostic
- Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Soltanska 2, 21000, Split, Croatia.
| | - Tim Hauke
- Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Soltanska 2, 21000, Split, Croatia
| | - Nasrollah Ghahramani
- Penn State College of Medicine Division of Nephrology, Hershey, PA 17033, United States
| | - Natalija Filipovic
- Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Soltanska 2, 21000, Split, Croatia
| | - Katarina Vukojevic
- Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Soltanska 2, 21000, Split, Croatia
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Akbarialiabad H, Kavousi S, Ghahramani A, Bastani B, Ghahramani N. COVID-19 and maintenance hemodialysis: a systematic scoping review of practice guidelines. BMC Nephrol 2020; 21:470. [PMID: 33172405 PMCID: PMC7653213 DOI: 10.1186/s12882-020-02143-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/30/2020] [Indexed: 12/23/2022] Open
Abstract
Background Coronavirus Disease 2019 (COVID-19) has substantially impacted the provision of medical services. During the pandemic, many medical services, including facilities providing care to patients with end stage renal disease faced challenges in safeguarding patients and staff while providing clinical care. This study aims to identify the extent, range, and nature of articles related to COVID-19 and maintenance hemodialysis to understand the research gaps and propose recommendations for future research. Methods Using the terms: “Dialysis” OR “RRT” OR “Renal replacement therapy” AND “SARS-COV-2” OR “COVID-19” OR “novel coronavirus” OR “2019-nCov”, we performed a multi-step systematic search of the literature in the English language in Pubmed, Scopus, Embase, and Web of Science published from December 1, 2019, to May 13, 2020. Two authors separately screened the title and abstracts of the documents and ruled out irrelevant articles. We obtained a full report of the papers that met our inclusion criteria and screened the full texts. We conducted a descriptive analysis of the characteristics of the included articles and performed a narrative synthesis of the results. We conducted this scoping review in accordance with the PRISMA-ScR Checklist. Results We included 22 articles in this scoping review. Perspectives (n = 9), editorials (n = 4), and case series (n = 5) were the most common types of articles. Most articles were from Italy and the United States. Seventeen (77.3%) of the articles focused on the topic of recommendation for outpatient hemodialysis units. While many of the recommendations overlapped in several articles, there were also many unique recommendations. Conclusions most of the articles are based on single-center experience, which spontaneously developed best practices. Many of these practices have formed the basis for policies and guidelines that will guide future prevention of infection and management of patients with End Stage Renal Disease (ESRD) and COVID-19.
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Affiliation(s)
- Hossein Akbarialiabad
- Shiraz University of Medical Sciences, Shiraz Medical School, Zand Street, Shiraz, 7134845794, Iran
| | - Shahin Kavousi
- Shiraz University of Medical Sciences, Shiraz Medical School, Zand Street, Shiraz, 7134845794, Iran
| | - Aria Ghahramani
- Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA
| | - Bahar Bastani
- Medicine-Nephrology, Saint Louis University School of Medicine, 3635 Vista Ave, St Louis, MO, 63110, USA
| | - Nasrollah Ghahramani
- Medicine and Public Health Sciences, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA.
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20
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Hansrivijit P, Puthenpura MM, Ghahramani N, Thongprayoon C, Cheungpasitporn W. Bidirectional association between chronic kidney disease and sleep apnea: a systematic review and meta-analysis. Int Urol Nephrol 2020; 53:1209-1222. [PMID: 33155087 DOI: 10.1007/s11255-020-02699-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/27/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Previous data have suggested a link between chronic kidney disease (CKD) and sleep apnea (SA). However, the prevalence and risk association of both disease entities are not uniformly described. METHODS Ovid MEDLINE, EMBASE, and the Cochrane Library were searched for eligible publications that included patients aged ≥ 18 years diagnosed with CKD or SA. Included studies were divided into two cohorts: (1) a cohort of CKD or end-stage kidney disease (ESKD) patients reporting the prevalence of SA or odds ratio (OR) for SA (CKD cohort) and (2) a cohort of SA patients reporting the prevalence of CKD/ESKD or OR for CKD/ESKD (SA cohort). RESULTS CKD cohort: Of 16 studies (n = 340,587), the pooled estimated prevalence of SA among CKD/ESKD patients was 47.5% (95% CI 28.8-66.9). The pooled adjusted OR for SA among CKD/ESKD patients was 1.961 (95% CI 1.702-2.260). Male sex, history of diabetes, and lower BMI were associated with increased prevalence of SA. SA cohort: Of 12 studies (n = 3,103,074), the pooled prevalence of CKD/ESKD among patients with SA was 8.2% (95% CI 4.7-13.7), whereas the pooled adjusted OR for CKD/ESKD among patients with SA was 2.088 (95% CI 1.777-2.452). Increasing age, higher BMI, male sex, white race, and history of diabetes were associated with higher prevalence of CKD/ESKD. CONCLUSION There was a bidirectional association between CKD/ESKD and SA. Interventions aiming to prevent the progression of either CKD or SA are important.
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Affiliation(s)
- Panupong Hansrivijit
- Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, 504 S. Front St, Suite 3C, Harrisburg, PA, 17104, USA.
| | - Max M Puthenpura
- Drexel University College of Medicine, Philadelphia, PA, 19129, USA
| | - Nasrollah Ghahramani
- Division of Nephrology, Department of Medicine, Penn State University College of Medicine, Hershey, PA, 17033, USA
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, 55905, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, 39216, USA
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21
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Hansrivijit P, Yarlagadda K, Cheungpasitporn W, Thongprayoon C, Ghahramani N. Hypoalbuminemia is associated with increased risk of acute kidney injury in hospitalized patients: A meta-analysis. J Crit Care 2020; 61:96-102. [PMID: 33157311 DOI: 10.1016/j.jcrc.2020.10.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022]
Abstract
PURPOSES Previous systematic review suggested that hypoalbuminemia is associated with increased risk of acute kidney injury (AKI). However, pooled sample size was small, and there was no universal definition for AKI. MATERIALS AND METHODS vid MEDLINE, EMBASE, the Cochrane Library and Database of Abstracts of Reviews of Effects (DARE) were search up to December 2019. Inclusion criteria include: observational studies, age ≥ 18 years, non-end-stage kidney disease, AKI, or mortality are outcomes of interest. Only articles utilizing multivariate analysis were included. RESULTS A total of 39 studies were included in hypoalbuminemia and AKI cohort (n = 168,740), and 15 studies were included in mortality cohort (n = 5693). Each 1.0 g/dL decrement of serum albumin was associated with increased AKI (OR 1.685; 95% CI, 1.302-2.179). The risk remained significant across sensitivity analyses. Furthermore, subgroup analyses showed that age ≥ 70 years and baseline serum albumin level > 3.2 g/dL were significant risk factors for AKI. In mortality cohort, patients with AKI and hypoalbuminemia had significantly higher death (OR 1.183; 95% CI, 1.085-1.288). However, there was potential publication bias to this analysis. CONCLUSIONS Hypoalbuminemia is associated with AKI in hospitalized patients. However, the effect on mortality is subjected to publication bias.
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Affiliation(s)
| | - Keerthi Yarlagadda
- Department of Internal Medicine, UPMC Pinnacle, Harrisburg, PA 17104, USA.
| | - Wisit Cheungpasitporn
- Division of Nephrology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
| | - Nasrollah Ghahramani
- Division of Nephrology, Department of Medicine, Penn State University College of Medicine, Hershey, PA 17033, USA.
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Hansrivijit P, Yarlagadda K, Cheungpasitporn W, Thongprayoon C, Ghahramani N. HYPOALBUMINEMIA, AN INDEPENDENT RISK FACTOR FOR ACUTE KIDNEY INJURY IN HOSPITALIZED PATIENTS: A META-ANALYSIS. Chest 2020. [DOI: 10.1016/j.chest.2020.08.616] [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: 10/23/2022] Open
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23
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Hansrivijit P, Qian C, Boonpheng B, Thongprayoon C, Vallabhajosyula S, Cheungpasitporn W, Ghahramani N. Incidence of acute kidney injury and its association with mortality in patients with COVID-19: a meta-analysis. J Investig Med 2020; 68:1261-1270. [PMID: 32655013 PMCID: PMC7371487 DOI: 10.1136/jim-2020-001407] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 12/15/2022]
Abstract
Acute kidney injury (AKI) is a complication of COVID-19. However, the incidence of AKI in COVID-19 varies among studies. Thus, we aimed to evaluate the pooled incidence of AKI and its association with mortality in patients with COVID-19 using a meta-analysis. We search Ovid MEDLINE, EMBASE, and the Cochrane Library for eligible publications reporting the clinical characteristics of patients with COVID-19 without language restriction. Incidence of AKI and mortality were reported. Meta-regression was used to describe the association between outcomes. From 26 studies (n=5497), the pooled incidence of AKI in patients with COVID-19 was 8.4% (95% CI 6.0% to 11.7%) with a pooled incidence of renal replacement therapy of 3.6% (95% CI 1.8% to 7.1%). The incidence of AKI was higher in critically ill patients (19.9%) compared with hospitalized patients (7.3%). The pooled estimated odds ratio for mortality from AKI was 13.33 (95% CI 4.05 to 43.91). No potential publication bias was detected. By using meta-regression analyses, the incidence of AKI was positively associated with mortality after adjusted for age and sex (Q=26.18; p=0.02). Moreover, age (p<0.01), diabetes (p=0.02), hypertension (p<0.01) and baseline serum creatinine levels (p=0.04) were positively associated with AKI incidence in adjusted models. In conclusion, AKI is present in 8.3% of overall patients with COVID-19 and in 19.9% of critically ill patients with COVID-19. Presence of AKI is associated with 13-fold increased risk of mortality. Age, diabetes, hypertension, and baseline serum creatinine levels are associated with increased AKI incidence.
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Affiliation(s)
- Panupong Hansrivijit
- Department of Internal Medicine, UPMC Pinnacle Harrisburg, Harrisburg, Pennsylvania, USA
| | - Chenchen Qian
- Department of Internal Medicine, UPMC Pinnacle Harrisburg, Harrisburg, Pennsylvania, USA
| | - Boonphiphop Boonpheng
- Division of Nephrology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | | | | | - Wisit Cheungpasitporn
- Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Nasrollah Ghahramani
- Division of Nephrology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
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Hansrivijit P, Oli S, Khanal R, Ghahramani N, Thongprayoon C, Cheungpasitporn W. Mediterranean diet and the risk of chronic kidney disease: A systematic review and meta-analysis. Nephrology (Carlton) 2020; 25:913-918. [PMID: 32852121 DOI: 10.1111/nep.13778] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/24/2020] [Accepted: 08/17/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Mediterranean diet has been shown to be associated with lower risk of cardiovascular disease. However, its association with chronic kidney disease (CKD) remains inconclusive as the results were not consistent among population-based studies. This study aims to assess the association between Mediterranean diet adherence and CKD prevention. METHODS We performed a systematic review and meta-analysis of studies describing the risk for CKD in community-dwelling subjects ≥18 years of age. Mediterranean diet adherence was assessed by standardized food frequency questionnaires. The search was conducted through MEDLINE, EMBASE and Cochrane Library. RESULTS Of 168 citations, a total of nine (n = 19 151) and four studies (n = 8467) were included in the systematic review and meta-analysis, respectively. Only studies adopting Mediterranean Diet Scale (MDS) were included in the analysis. The mean score was 3.8 ± 0.3 points. With the mean follow-up duration of 20.6 ± 7.0 years, the pooled odds ratio (OR) for CKD was 0.901 (95% confidence interval [CI] 0.868-0.935) for each 1-point increment of MDS. The incidence of CKD was 0.026 events per person-year (95% CI 0.008-0.045). Moreover, male sex was associated with the incidence of CKD in an adjusted meta-regression analysis. In contrast, there was no significant association between age, black race, smoking, diabetes, hypertension estimated glomerular filtration rate and total daily energy intake vs CKD incidence. CONCLUSION Adherence to Mediterranean diet by a 1-point increment of MDS was associated with 10% lower risk of CKD. However, there were insufficient data on patients with pre-existing CKD or dialysis.
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Affiliation(s)
- Panupong Hansrivijit
- Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, Pennsylvania, USA
| | - Sharad Oli
- Department of Internal Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - Resha Khanal
- Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, Pennsylvania, USA
| | - Nasrollah Ghahramani
- Division of Nephrology, Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Hansrivijit P, Yarlagadda K, Puthenpura MM, Ghahramani N, Thongprayoon C, Vaitla P, Cheungpasitporn W. A meta-analysis of clinical predictors for renal recovery and overall mortality in acute kidney injury requiring continuous renal replacement therapy. J Crit Care 2020; 60:13-22. [PMID: 32731101 DOI: 10.1016/j.jcrc.2020.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/03/2020] [Accepted: 07/12/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To determine clinical predictors for continuous renal replacement therapy (CRRT) discontinuation in patients with acute kidney injury (AKI). MATERIALS AND METHODS Ovid MEDLINE, EMBASE, and Cochrane Library were searched. The protocol is registered on researchregistry.com (reviewregistry909). Our criteria included non-end-stage kidney disease adults who required CRRT for AKI. Renal recovery was defined by CRRT discontinuation. Risk of bias was assessed using ROBINS-I tool. RESULTS We classified our analyses into renal recovery cohort and overall mortality cohort. All studies were observational. For renal recovery cohort, increasing urine output at time of CRRT discontinuation, elevated initial SOFA score and serum creatinine at CRRT initiation were predictive of renal recovery with OR 1.021 (95%CI = 1.011-1.031), 0.869 (95%CI = 0.811-0.932) and 0.995 (95%CI = 0.996-0.999), respectively. For overall mortality cohort, age and presence of sepsis were significantly associated with overall mortality with OR of 1.028 (95%CI = 1.008-1.048) and 2.160 (95%CI = 0.973-1.932), respectively. CONCLUSIONS Urine output at CRRT discontinuation, lower initial SOFA score, and lower serum creatinine levels at CRRT initiation were associated with higher likelihood of renal recovery. Increasing age and the presence of sepsis were associated with increased overall mortality from AKI on CRRT. However, there were limited data on co-morbidities which might preclude their inclusion in our analysis.
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Affiliation(s)
- Panupong Hansrivijit
- Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA 17104, USA.
| | - Keerthi Yarlagadda
- Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA 17104, USA.
| | - Max M Puthenpura
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA 19129, USA.
| | - Nasrollah Ghahramani
- Division of Nephrology, Department of Medicine, Penn State University College of Medicine, Hershey, PA 17033, USA.
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
| | - Pradeep Vaitla
- Division of Nephrology, University of Mississippi Medical Center, Jackson, MS 39216, USA.
| | - Wisit Cheungpasitporn
- Division of Nephrology, University of Mississippi Medical Center, Jackson, MS 39216, USA
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Hansrivijit P, Ghahramani N. Combined rituximab and plasmapheresis or plasma exchange for focal segmental glomerulosclerosis in adult kidney transplant recipients: a meta-analysis. Int Urol Nephrol 2020; 52:1377-1387. [DOI: 10.1007/s11255-020-02462-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/31/2020] [Indexed: 12/21/2022]
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Hansrivijit P, Cheungpasitporn W, Thongprayoon C, Ghahramani N. Rituximab therapy for focal segmental glomerulosclerosis and minimal change disease in adults: a systematic review and meta-analysis. BMC Nephrol 2020; 21:134. [PMID: 32293308 PMCID: PMC7160971 DOI: 10.1186/s12882-020-01797-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/06/2020] [Indexed: 12/12/2022] Open
Abstract
Background Use of rituximab (RTX) for focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) is widely described in children. Clinical evidence in adults is limited. The objective of this study was to determine the treatment outcomes of RTX in adults with FSGS and MCD. Methods Ovid MEDLINE, SCOPUS, and Cochrane Database of Systematic Reviews were searched up to September 2019. Out of 699 studies, we included 16 studies describing the treatment outcomes of rituximab in adult patients with FSGS or MCD. Results were reported in remission rate and relapse rate. Serious adverse events were also reported. Results A total of 16 studies were included in our review and analysis. All studies were observational studies and included a total of 221 patients (23.1% FSGS, 76.9% MCD). Mean follow-up duration was 26.3 ± 12.8 months. From the analysis of five studies with FSGS patients (n = 51), the overall remission rate and relapse rate of RTX therapy was 53.6% (95% CI, 15.8–87.6%) and 47.3% (95% CI, 25.4–70.2%), respectively. Complete remission occurred in 42.9%. In contrast, from the analysis of 11 studies with MCD patients (n = 170), the overall remission rate and relapse rate of RTX therapy was 80.3% (95% CI, 68.5–88.5%) and 35.9% (95% CI, 25.1–48.4), respectively. Complete remission occurred in 74.7%. Subgroup analyses showed that overall remission and relapse were not different after adjusted for study year and RTX dose for both FSGS and MCD. Incidence of serious adverse events was 0.092 events/year. Conclusions Rituximab may be considered as an additional treatment to the standard therapy for adult patients with FSGS and MCD. Remissions and relapses are similar between FSGS and MCD. Serious adverse effects of rituximab were uncommon. We encourage further randomized controlled trials to confirm the efficacy of rituximab therapy in these patients.
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Affiliation(s)
- Panupong Hansrivijit
- Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, 504 S. Front St, Suite 3C, Harrisburg, PA, 17104, USA.
| | - Wisit Cheungpasitporn
- Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, 55905, USA
| | - Nasrollah Ghahramani
- Division of Nephrology, Department of Medicine, Penn State University College of Medicine, Hershey, PA, 17033, USA
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Hsu CY, Chinchilli VM, Coca S, Devarajan P, Ghahramani N, Go AS, Hsu RK, Ikizler TA, Kaufman J, Liu KD, Parikh CR, Reeves WB, Wurfel M, Zappitelli M, Kimmel PL, Siew ED. Post-Acute Kidney Injury Proteinuria and Subsequent Kidney Disease Progression: The Assessment, Serial Evaluation, and Subsequent Sequelae in Acute Kidney Injury (ASSESS-AKI) Study. JAMA Intern Med 2020; 180:402-410. [PMID: 31985750 PMCID: PMC6990681 DOI: 10.1001/jamainternmed.2019.6390] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
IMPORTANCE Among patients who had acute kidney injury (AKI) during hospitalization, there is a need to improve risk prediction such that those at highest risk for subsequent loss of kidney function are identified for appropriate follow-up. OBJECTIVE To evaluate the association of post-AKI proteinuria with increased risk of future loss of renal function. DESIGN, SETTING, AND PARTICIPANTS The Assessment, Serial Evaluation, and Subsequent Sequelae in Acute Kidney Injury (ASSESS-AKI) Study was a multicenter prospective cohort study including 4 clinical centers in North America included 1538 patients enrolled 3 months after hospital discharge between December 2009 and February 2015. EXPOSURES Urine albumin-to-creatinine ratio (ACR) quantified 3 months after hospital discharge. MAIN OUTCOMES AND MEASURES Kidney disease progression defined as halving of estimated glomerular filtration rate (eGFR) or end-stage renal disease. RESULTS Of the 1538 participants, 769 (50%) had AKI durring hospitalization. The baseline study visit took place at a mean (SD) 91 (23) days after discharge. The mean (SD) age was 65 (13) years; the median eGFR was 68 mL/min/1.73 m2; and the median urine ACR was 15 mg/g. Overall, 547 (37%) study participants were women and 195 (13%) were black. After a median follow-up of 4.7 years, 138 (9%) participants had kidney disease progression. Higher post-AKI urine ACR level was associated with increased risk of kidney disease progression (hazard ratio [HR], 1.53 for each doubling; 95% CI, 1.45-1.62), and urine ACR measurement was a strong discriminator for future kidney disease progression (C statistic, 0.82). The performance of urine ACR was stronger in patients who had had AKI than in those who had not (C statistic, 0.70). A comprehensive model of clinical risk factors (eGFR, blood pressure, and demographics) including ACR provided better discrimination for predicting kidney disease progression after hospital discharge among those who had had AKI (C statistic, 0.85) vs those who had not (C statistic, 0.76). In the entire matched cohort, after taking into account urine ACR, eGFR, demographics, and traditional chronic kidney risk factors determined 3 months after discharge, AKI (HR, 1.46; 95% CI, 0.51-4.13 for AKI vs non-AKI) or severity of AKI (HR, 1.54; 95% CI, 0.50-4.72 for AKI stage 1 vs non-AKI; HR, 0.56; 95% CI, 0.07-4.84 for AKI stage 2 vs non-AKI; HR, 2.24; 95% CI, 0.33-15.29 for AKI stage 3 vs non-AKI) was not independently associated with more rapid kidney disease progression. CONCLUSIONS AND RELEVANCE Proteinuria level is a valuable risk-stratification tool in the post-AKI period. These results suggest there should be more widespread and routine quantification of proteinuria after hospitalized AKI.
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Affiliation(s)
- Chi-Yuan Hsu
- Division of Nephrology, University of California School of Medicine, San Francisco, San Francisco.,Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey
| | - Steven Coca
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Prasad Devarajan
- Cincinnati Children's Hospital, Division of Nephrology and Hypertension, University of Cincinnati, Cincinnati, Ohio
| | - Nasrollah Ghahramani
- Division of Nephrology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey
| | - Alan S Go
- Division of Nephrology, University of California School of Medicine, San Francisco, San Francisco.,Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Raymond K Hsu
- Division of Nephrology, University of California School of Medicine, San Francisco, San Francisco
| | - T Alp Ikizler
- Vanderbilt Center for Kidney Disease, Division of Nephrology & Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James Kaufman
- Renal Section, Veterans Affairs New York Harbor Health Care System, New York University School of Medicine, New York
| | - Kathleen D Liu
- Division of Nephrology, University of California School of Medicine, San Francisco, San Francisco
| | - Chirag R Parikh
- Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - W Brian Reeves
- University of Texas, Long School of Medicine, San Antonio
| | - Mark Wurfel
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle
| | - Michael Zappitelli
- Hospital for Sick Children, Division of Nephrology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Paul L Kimmel
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Edward D Siew
- Vanderbilt Center for Kidney Disease, Division of Nephrology & Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee.,Tennessee Valley Health Services, Nashville Veterans Affairs Hospital, Nashville, Tennessee
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Bartolomeo K, Lipinski M, Romeu J, Ghahramani N. A Survey of Nephrologists Regarding Their Communication with Transplant Centers. Int J Organ Transplant Med 2020; 11:95-100. [PMID: 32913584 PMCID: PMC7471615] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND Patients with end-stage renal disease (ESRD) undergo a transition of care between their primary nephrologist and the transplant center during evaluation for kidney transplantation. Due to medical complexity, high hospitalization rate, and involvement of multiple medical stakeholders, transitions of medical care among patients with ESRD are likely to be associated with suboptimal care and medical errors. Provider-to-provider communication improves outcomes among ESRD patients transitioning between dialysis and transplant. There is little data analyzing proper transition of care between the nephrologist and the transplant center (TC). OBJECTIVE Using survey methodology, we examined nephrologists' current practice and experience regarding patient-related communication with the TC. METHODS From among 822 nephrologists who were following at least 20 ESRD patients, we randomly selected 252 nephrologists to participate in the study. The survey consisted of 102 multiple choice and Likert-style items probing perceptions about various aspects of transplant, including communication between TC and nephrologist. Responses from 216 participants who submitted complete responses were included in the final analysis. RESULTS Depending on the phase of transplant, nephrologist-TC communication varied between 50%-81% of nephrologists. Factors associated with higher likelihood of nephrologist-TC communication included attending transplant-related educational activity, practicing in a group with more than 5 nephrologists, and having more than 50 patients on dialysis. The majority of nephrologists indicated satisfaction with access to an attending physician in the TC, receiving timely and adequate information from the TC about their patients. Factors associated with higher likelihood of nephrologist satisfaction regarding communication with the TC included attending national nephrology meetings, medical directorship of a dialysis unit, fellowship training at an institution with an on-site transplant program, and availability of more than 2 transplant centers within 50 miles. CONCLUSION There is a lack of evidence-based guidelines for patient transfer of care between nephrologists and transplant centers during various phases of transplant referral, evaluation and post-transplant care. We found that the likelihood of the nephrologists' communication with the transplant center and their satisfaction with the communication are related to their training, participation in continuing educational meetings, their practice location and size, and the overall composition of their patient population.
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Affiliation(s)
- K. Bartolomeo
- Department of Medicine, Pennsylvania State University College of Medicine, USA
| | - M. Lipinski
- Department of Medicine, Pennsylvania State University College of Medicine, USA
| | - J. Romeu
- Department of Medicine, Pennsylvania State University College of Medicine, USA
| | - N. Ghahramani
- Department of Medicine, Pennsylvania State University College of Medicine, USA
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Bartolomeo K, (Tandon) Gandhir A, Lipinski M, Romeu J, Ghahramani N. Factors Considered by Nephrologists in Excluding Patients from Kidney Transplant Referral. Int J Organ Transplant Med 2019; 10:101-107. [PMID: 31497272 PMCID: PMC6716219] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Provider perceptions about patient candidacy for kidney transplant (KT) are potentially significant contributors to disparities in KT. OBJECTIVE To examine nephrologists' perceptions about factors that are important in excluding patients from KT referral, and to analyze the association between these perceptions and nephrologists' demographic and practice characteristics.Methods: Invitations were sent to 3180 nephrologists. Among those who consented, 822 fulfilled the inclusion criteria, and 250 were randomly invited to complete a questionnaire about perceptions of factors essential in deciding not to refer patients for KT. RESULTS Responses from 216 participants with complete responses were analyzed. The 3 most common reasons for excluding patients were "patient's inadequate social support" (44%), "limited understanding of the process due to patient's inadequate education" (32%), and "patient's age above 65" (26%). Nephrologists practicing in rural settings were more likely to consider inadequate support and limited education of patients as reasons not to refer for KT. In multivariate analysis, physicians with 2 or fewer transplant centers within 50 miles were more likely to report inadequate social support (OR: 3.15, 95% CI: 1.59-6.24) and age greater than 65 years (OR: 1.88, 95% CI: 1.01-3.49) as reasons to exclude patients from KT referral. Nephrologists whose practice included patients majority of whom had not completed high school were more likely to consider limited understanding due to inadequate education as an important reason to exclude patients from KT (OR: 3.31, 95% CI: 1.60-6.86). CONCLUSION Patient's social support, understanding, and age were the most common factors regarded by nephrologists as important in not referring patients for KT evaluation. Practice location, particularly rural setting, proximity to a transplant center, and the education level of a nephrologist's patient population were important determinants of referral for KT.
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Affiliation(s)
- K. Bartolomeo
- Division of Nephrology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - A. (Tandon) Gandhir
- Division of Nephrology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - M. Lipinski
- Division of Nephrology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - J. Romeu
- Division of Nephrology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - N. Ghahramani
- Division of Nephrology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
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Farooq U, Tober A, Chinchilli V, Reeves WB, Ghahramani N. Definition, Management, and Outcomes of Acute Kidney Injury: An International Survey of Nephrologists. Kidney Dis (Basel) 2017; 3:120-126. [PMID: 29344507 DOI: 10.1159/000478264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/07/2017] [Indexed: 12/23/2022]
Abstract
Background Acute kidney injury (AKI) is a complex disease burdened by uncertainties of definition, management strategies, and prognosis. This study explores the relationship between demographic characteristics of nephrologists and their perceptions about the definition, management, and follow-up of AKI. Methods We developed a Web-based survey, the International Survey on Acute Kidney Injury (ISAKI), consisting of 29 items in 4 categories: (1) demographic and practice characteristics, (2) definition of AKI, (3) management of renal replacement therapy (RRT) in AKI, and (4) sequelae of AKI. A multivariable stepwise logistic regression model was used to examine relationships between the dependent variables and the demographic characteristics of the respondents. Results Responses from 743 nephrologists from 90 countries were analyzed. The majority (60%) of respondents reported using RIFLE and/or AKIN criteria regularly to define AKI, although US nephrologists were less likely to do so (OR: 0.58; 95% CI: 0.42-0.85). The most common initial RRT modality was intermittent hemodialysis (63.5%), followed by continuous RRT (23.8%). Faculty affiliation was associated with a higher likelihood of using a dialysis schedule of ≥4 times a week (OR: 1.75; 95% CI: 1.20-2.55). The respondents believed that a single episode of AKI increases the likelihood of development of chronic kidney disease (CKD) (55%), subsequent AKI (36%), and rapid progression of preexisting CKD (87%). US nephrologists were less likely to recommend follow-up after resolution of AKI (OR: 0.15; 95% CI: 0.07-0.33). Conclusions Our findings highlight the need for a widely accepted consensus definition of AKI, a uniform approach to management, and improved follow-up after resolution of AKI episodes.
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Affiliation(s)
- Umar Farooq
- Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Aaron Tober
- Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Vernon Chinchilli
- Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - W Brian Reeves
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Cukor D, Cohen LM, Cope EL, Ghahramani N, Hedayati SS, Hynes DM, Shah VO, Tentori F, Unruh M, Bobelu J, Cohen S, Dember LM, Faber T, Fischer MJ, Gallardo R, Germain MJ, Ghahate D, Grote N, Hartwell L, Heagerty P, Kimmel PL, Kutner N, Lawson S, Marr L, Nelson RG, Porter AC, Sandy P, Struminger BB, Subramanian L, Weisbord S, Young B, Mehrotra R. Patient and Other Stakeholder Engagement in Patient-Centered Outcomes Research Institute Funded Studies of Patients with Kidney Diseases. Clin J Am Soc Nephrol 2016; 11:1703-1712. [PMID: 27197911 PMCID: PMC5012486 DOI: 10.2215/cjn.09780915] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Including target populations in the design and implementation of research trials has been one response to the growing health disparities endemic to our health care system, as well as an aid to study generalizability. One type of community-based participatory research is "Patient Centered-Research", in which patient perspectives on the germane research questions and methodologies are incorporated into the study. The Patient-Centered Outcomes Research Institute (PCORI) has mandated that meaningful patient and stakeholder engagement be incorporated into all applications. As of March 2015, PCORI funded seven clinically-focused studies of patients with kidney disease. The goal of this paper is to synthesize the experiences of these studies to gain an understanding of how meaningful patient and stakeholder engagement can occur in clinical research of kidney diseases, and what the key barriers are to its implementation. Our collective experience suggests that successful implementation of a patient- and stakeholder-engaged research paradigm involves: (1) defining the roles and process for the incorporation of input; (2) identifying the particular patients and other stakeholders; (3) engaging patients and other stakeholders so they appreciate the value of their own participation and have personal investment in the research process; and (4) overcoming barriers and challenges that arise and threaten the productivity of the collaboration. It is our hope that the experiences of these studies will further interest and capacity for incorporating patient and stakeholder perspectives in research of kidney diseases.
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Affiliation(s)
- Daniel Cukor
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Tandon A, Wang M, Roe KC, Patel S, Ghahramani N. Nephrologists' likelihood of referring patients for kidney transplant based on hypothetical patient scenarios. Clin Kidney J 2016; 9:611-5. [PMID: 27478607 PMCID: PMC4957715 DOI: 10.1093/ckj/sfw031] [Citation(s) in RCA: 12] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/08/2016] [Indexed: 01/04/2023] Open
Abstract
Background There is wide variation in referral for kidney transplant and preemptive kidney transplant (PKT). Patient characteristics such as age, race, sex and geographic location have been cited as contributing factors to this disparity. We hypothesize that the characteristics of nephrologists interplay with the patients' characteristics to influence the referral decision. In this study, we used hypothetical case scenarios to assess nephrologists' decisions regarding transplant referral. Methods A total of 3180 nephrologists were invited to participate. Among those interested, 252 were randomly selected to receive a survey in which nephrologists were asked whether they would recommend transplant for the 25 hypothetical patients. Logistic regression models with single covariates and multiple covariates were used to identify patient characteristics associated with likelihood of being referred for transplant and to identify nephrologists' characteristics associated with likelihood of referring for transplant. Results Of the 252 potential participants, 216 completed the survey. A nephrologist's affiliation with an academic institution was associated with a higher likelihood of referral, and being ‘>10 years from fellowship’ was associated with lower likelihood of referring patients for transplant. Patient age <50 years was associated with higher likelihood of referral. Rural location and smoking history/chronic obstructive pulmonary disease were associated with lower likelihood of being referred for transplant. The nephrologist's affiliation with an academic institution was associated with higher likelihood of referring for preemptive transplant, and the patient having a rural residence was associated with lower likelihood of being referred for preemptive transplant. Conclusions The variability in transplant referral is related to patients' age and geographic location as well as the nephrologists' affiliation with an academic institution and time since completion of training. Future educational interventions should emphasize the benefits of kidney transplant and PKT for all population groups regardless of geographic location and age and should target nephrologists in non-academic settings who are 10 or more years from their fellowship training.
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Affiliation(s)
- Ankita Tandon
- Department of Medicine , Pennsylvania State University College of Medicine , Hershey , PA , USA
| | - Ming Wang
- Department of Public Health Sciences , Pennsylvania State University College of Medicine , Hershey , PA , USA
| | - Kevin C Roe
- Division of Nephrology, Department of Medicine , Pennsylvania State University College of Medicine , Hershey , PA , USA
| | - Surju Patel
- Division of Nephrology, Department of Medicine , Pennsylvania State University College of Medicine , Hershey , PA , USA
| | - Nasrollah Ghahramani
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA; Division of Nephrology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
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Ghahramani N. Potential impact of peer mentoring on treatment choice in patients with chronic kidney disease: a review. Arch Iran Med 2015; 18:239-43. [PMID: 25841945 DOI: 015184/aim.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chronic kidney disease (CKD) and the resultant end stage renal disease (ESRD) are associated with significant mortality, morbidity, and cost for the individual patient and society. CKD is among the major contributors to years of life lost (YLL) due to premature mortality. Also, while the disability adjusted life years (DALY) for many conditions decreased between 1990 and 2010, the DALY for CKD has increased by 69%. In addition to the physical disability, CKD is associated with high prevalence (27.9%) of major depressive episodes, associated with limitations of employment, and a significant negative effect on quality of life (QOL). A major determinant of QOL is satisfaction with treatment choice. There is consensus among investigators that patients who are actively engaged in their own care experience improved health outcomes. The shared decision making (SDM) approach allows patients and providers the opportunity to work in partnership to make decisions that are congruent with the patient's values, preferences, and distinct situations. SDM has been associated with improved outcomes among patients with various chronic disease states. Mentoring, particularly by trained peers, has been used as an approach to enhance SDM in several chronic conditions, including cancer and cardiovascular disease. In this review, we will focus on care of patients with CKD as a model for the study of the impact of peer mentoring on SDM and choice of treatment for ESRD.
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Affiliation(s)
- Nasrollah Ghahramani
- Associate Professor of Medicine and Public Health Sciences, Pennsylvania State University, College of Medicine, Division of Nephrology, 500 University Drive, Mail Code H040, Hershey, PA 17033, USA.
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Ghahramani N, Sanati-Mehrizy A, Wang C. Perceptions of patient candidacy for kidney transplant in the United States: a qualitative study comparing rural and urban nephrologists. EXP CLIN TRANSPLANT 2015; 12:9-14. [PMID: 24471717 DOI: 10.6002/ect.2013.0183] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To explore different perceptions of urban and rural nephrologists regarding patient suitability for transplant. MATERIALS AND METHODS We conducted 4 focus groups, each consisting of 4 to 6 nephrologists practicing in either a rural (n=9) or an urban setting (n=11). A topic guide was developed and modified according to pilot testing. Broadly stated, open ended queries probed perceptions about the ideal or suboptimal candidates for transplant, perceived barriers to transplant, views regarding providing information to patients, and strategies that could improve transplant rates. At the sessions, all audio was recorded and professionally transcribed. Responses were pooled, de-identified, and analyzed using qualitative thematic content analysis. RESULTS In considering candidacy, urban participants mentioned "age, " "compliance, " and "functional status "; "support " was a more-prevalent theme among rural nephrologists. Urban physicians discussed the expected effect of a transplant on a subject 's quality of life. As barriers to transplant, "evaluation time " was mentioned by urban groups only, and "distance to transplant center " was suggested by rural nephrologists only. To improve transplant rates, urban nephrologists suggested strategies that would increase the donor pool. Rural nephrologists, on the other hand, suggested a collaboration between nephrologists and the transplant center, "limiting listing eligibility " and "financial assistance. " Rural nephrologists suggested providing comparisons of modalities and information about selecting subjects. CONCLUSIONS This qualitative study underscores geographic differences in perceptions of nephrologists regarding patient candidacy for kidney transplant, perceived barriers to kidney transplant, and proposed strategies to increase rates of kidney transplant. These differences are potential contributors to geographic variations in referring patients for kidney transplant.
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Affiliation(s)
- Nasrollah Ghahramani
- Department of Medicine, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033,USA
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Ghahramani N, Wang C, Sanati-Mehrizy A, Tandon A. Perception about transplant of rural and urban patients with chronic kidney disease; a qualitative study. Nephrourol Mon 2014; 6:e15726. [PMID: 24783174 PMCID: PMC3997949 DOI: 10.5812/numonthly.15726] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 11/05/2013] [Accepted: 01/27/2014] [Indexed: 11/16/2022] Open
Abstract
Background: Chronic kidney disease (CKD) is a worldwide public health problem with increasing incidence and prevalence and associated expenses. Objectives: To explore different perceptions of rural and urban patients with chronic kidney disease (CKD) about kidney transplant. Patients and Methods: We conducted four focus groups, each including 5 or 6 patients with stage 5 CKD or end stage renal disease living in a rural or urban area. Open-ended questions probed patient familiarity with kidney transplant, perceptions of benefits of kidney transplant, perceived barriers to kidney transplant, and views about living donation. All the sessions were recorded and professionally transcribed. Responses were pooled, de-identified, and analyzed using qualitative thematic content analysis. Results: Urban patients were more likely to receive supplementary information and being strongly encouraged by their nephrologists to seek transplant. All participants acknowledged “independence” as the main advantage of transplantation. Increased freedom to travel and improved life expectancy were mentioned only among the urban groups. The main themes in all groups regarding perceived barriers to transplant were the tedious pre-transplant testing and workup expenses. Among rural groups, there was a perception that distance from transplant centers impedes transplant evaluation. Religious reasons favoring and opposing transplant were mentioned by participants in a rural group. Some members contended that since illness is God’s will, we should not change it. Others in the same group argued that “God is not ready for us to give up”. Praise and gratitude for the living donor were expressed in all groups, but concerns about donor’s outcome were discussed only within the rural groups. In discussing preference about known or anonymous donors, members of an urban group mentioned favoring an anonymous donor, citing unease with a sense of life-long indebtedness. Conclusions: Observed differences in perceptions among rural and urban patients about aspects of transplant may contribute to geographic disparities in transplant. The findings could be helpful to guide future individualized, culturally sensitive educational interventions about transplant for patients with CKD.
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Affiliation(s)
- Nasrollah Ghahramani
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, USA
- Corresponding author: Nasrollah Ghahramani, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, USA. Tel: +1-7175318156, Fax: +1-7175316776, E-mail:
| | - Chloe Wang
- Pennsylvania State University College of Medicine, Hershey, USA
| | | | - Ankita Tandon
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, USA
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Ghahramani N, Karparvar Z, Ghahramani M, Shadrou S. International survey of nephrologists' perceptions and attitudes about rewards and compensations for kidney donation. Nephrol Dial Transplant 2014; 28:1610-21. [PMID: 23780679 DOI: 10.1093/ndt/gft079] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Payment for organ donation, whether in the form of incentives, rewards or compensation is highly debated and has been denounced by many professional and legislative bodies. Despite the passionate discussion in the literature, there is very limited data on attitudes and perceptions of physicians about providing rewards or compensation to organ donors. We investigated the relationship between demographic and practice characteristics of nephrologists and their perceptions and attitudes about rewards and compensations for organ donation. METHODS Using a web-based survey, we explored the views of nephrologists around the world about rewards and compensations for kidney donation. The relationship between attitudes and demographic characteristics of 1280 nephrologists from 74 countries was examined by univariate and multivariable analyses. RESULTS Seventy-five percent agreed with donor health insurance, 26% favored direct financial compensation and 31% agreed with financial rewards for unrelated donors. Sixty-six percent believed that rewards will lead to increased donation. Seventy-three percent indicated that rewards will lead to exploitation of the poor and 78% agreed with legislation prohibiting organ sales. Thirty-seven percent believed that rewards will negatively impact deceased-donor transplantation. Nephrologists from India/Pakistan and the Middle East had more favorable views about rewards, while respondents from Latin America and Europe, older than 50, female nephrologists and those practicing in rural areas had less favorable views. CONCLUSIONS We conclude that a minority of nephrologists favor rewards for donation, many agree with some compensation and a considerable majority favor donor health insurance. Perceptions of nephrologists about rewards and compensation are influenced by age, sex, urban versus rural location and geographic region of practice.
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Affiliation(s)
- Nasrollah Ghahramani
- Pennsylvania State University College of Medicine, Division of Nephrology, Hershey, PA, USA.
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Yildirim T, Yilmaz R, Altindal M, Turkmen E, Arici M, Altun B, Erdem Y, Guliyev O, Erkmen Uyar M, Tutal E, Bal Z, Sezer S, Erkmen Uyar M, Bal U, Bal Z, Tutal E, Say n B, Guliyev O, Erdemir B, Sezer S, O'Rourke-Potowki A, Gauge N, Penny H, Cronin A, Frame S, Goldsmith DJ, Yagan JA, Chandraker A, Velickovic Radovanovic RM, Catic Djordjevic A, Mitic B, Stefanovic N, Cvetkovic T, Serpieri N, Grosjean F, Sileno G, Torreggiani M, Esposito V, Mangione F, Abelli M, Castoldi F, Catucci D, Esposito C, Dal Canton A, Vatazin AV, Zulkarnaev AB, Borst C, Liu Y, Thoning J, Tepel M, Libetta C, Margiotta E, Borettaz I, Canevari M, Martinelli C, Lainu E, Abelli M, Meloni F, Sepe V, Dal Canton A, Miguel Costa R, Vasquez Martul E, Reboredo J, Rivera C, Simonato F, Tognarelli G, Daidola G, Gallo E, Burdese M, Cantaluppi V, Biancone L, Segoloni GP, Burdese M, Priora M, Messina M, Tamagnone M, Daidola G, Linsalata A, Lavacca A, Biancone L, Segoloni G, Zuidema W, Erdman R, van de Wetering J, Dor F, Roodnat J, Massey E, Timmerman L, IJzermans J, Weimar W, Goldsmith DJ, Sibley-Allen C, Hilton R, Moghul M, Burnapp L, Blake G, Koo TY, Park JS, Park HC, Kim GH, Lee CH, Oh IH, Kang CM, Hwang JK, Park SC, Choi BS, Chun HJ, Kim JI, Yang CW, Moon IS, Van Laecke S, Van Biesen W, Nagler EV, Taes Y, Peeters P, Vanholder R, Pruthi R, Ravanan R, Casula A, Harber M, Roderick P, Fogarty D, Cho A, Shin JH, Jang HR, Lee JE, Huh W, Kim DJK, Oh HY, Kim YG, Sancho Calabuig A, Gavela Martinez E, Kanter Berga J, Beltran Catalan S, Avila Bernabeu AI, Pallardo Mateu LM, Gonzalez E, Polanco N, Molina M, Gutierrez E, Garcia Puente L, Sevillano A, Morales E, Praga M, Andres A, Banasik M, Boratynska M, Koscielska-Kasprzak K, Bartoszek D, Myszka M, Zmonarski S, Nowakowska B, Wawrzyniak E, Halon A, Chudoba P, Klinger M, Rojas-Rivera J, Gonzalez E, Polanco N, Morales E, Andres A, Morales JM, Egido J, Praga M, Kopecky CM, Haidinger M, Kaltenecker C, Antlanger M, Marsche G, Holzer M, Kovarik J, Werzowa J, Hecking M, Saemann MD, Hwang JK, Kim JM, Koh ES, Chung BH, Park SC, Choi BS, Kim JI, Yang CW, Kim YS, Moon IS, Banasik M, Boratynska M, Koscielska-Kasprzak K, Krajewska M, Mazanowska O, Kaminska D, Bartoszek D, Zabinska M, Halon A, Malkiewicz B, Patrzalek D, Klinger M, Sulowicz J, Szostek S, Wojas-Pelc A, Ignacak E, Sulowicz W, Bellizzi V, Calella P, Cupisti A, Capitanini A, D'Alessandro C, Giannese D, Camocardi A, Conte G, Barsotti M, Bilancio G, Luciani R, Locsey L, Seres I, Kovacs D, Asztalos L, Paragh G, Wohlfahrtova M, Balaz P, Rokosny S, Wohlfahrt P, Bartonova A, Viklicky O, Kers J, Geskus RB, Meijer LJ, Bemelman F, ten Berge IJM, Florquin S, Hwang JC, Jiang MY, Lu YH, Weng SF, Testa A, Porto G, Sanguedolce M, Spoto B, Parlongo R, Pisano A, Enia G, Tripepi G, Zoccali C, Zuidema W, Mamode N, Lennerling A, Citterio F, Massey E, Van Assche K, Sterckx S, Frunza M, Jung H, Pascalev A, Johnson R, Loven C, Weimar W, Dor F, Soleymanian T, Keyvani H, Jazayeri SM, Fazeli Z, Ghamari S, Mahabadi M, Chegeni V, Najafi I, Ganji MR, Meys KME, Groothoff JW, Jager K, Schaefer F, Tonshoff B, Mota C, Cransberg K, van Stralen K, Gurluler E, Gures N, Alim A, Gurkan A, Cakir U, Berber I, Van Laecke S, Caluwe R, Nagler E, Van Biesen W, Peeters P, Van Vlem B, Vanholder R, Sulowicz J, Wojas-Pelc A, Ignacak E, Betkowska-Prokop A, Kuzniewski M, Krzanowski M, Sulowicz W, Masson I, Flamant M, Maillard N, Cavalier E, Moranne O, Alamartine E, Mariat C, Delanaye P, Canas Sole LL, Iglesias Alvarez E, Pastor MCMC, Moreno Flores FF, Abujder VV, Graterol FF, Bonet Sol JJ, Lauzurica Valdemoros RR, Yoshikawa M, Kitamura K, Nakai K, Goto S, Fujii H, Ishimura T, Takeda M, Fujisawa M, Nishi S, Prasad N, Gurjer D, Bhadauria D, Gupta A, Sharma R, Kaul A, Cybulla M, West M, Nicholls K, Torras J, Sunder-Plassmann G, Feriozzi S, Lo S, Wong PYH, Ip D, Wong CK, Chow VCC, Mo SKL, Molnar M, Ujszaszi A, Czira ME, Novak M, Mucsi I, Cruzado JM, Coelho S, Porta N, Bestard O, Melilli E, Taco O, Rivas I, Grinyo J, Pouteau LM, N'Guyen JM, Hami A, Hourmant M, Ghahramani N, Karparvar Z, Shadrou S, Ghahramani M, Fauvel JP, Hadj-Aissa A, Buron F, Morelon E, Ducher M, Heine C, Glander P, Neumayer HH, Budde K, Liefeldt L, Montero N, Webster AC, Royuela A, Zamora J, Crespo M, Pascual J, Adema AY, van Dorp WTH, Mallat MJK, de Fijter HW, Kim YS, Hong YA, Chung BH, Park CW, Yang CW, Kim YS, Choi BS, Suleymanlar G, Uzundurukan Z, Kapuagas A, Sencan I, Akdag R, Pascual J, Torio A, Mas V, Perez-Saez MJ, Mir M, Faura A, Montes-Ares O, Checa MD, Crespo M, Sawinski D, Trofe-Clark J, Sparkes T, Patel P, Goral S, Bloom R, Kim HJ, Park SJ, Kim TH, Kim YW, Kim YH, Kang SW, Abdel Halim M, Gheith O, Al-Otaibi T, Mosaad A, Awadeen W, Said T, Nair P, Nampoory MRN. Transplantation: clinical studies - A. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft123] [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: 11/14/2022] Open
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Ismail-Beigi F, Ghahramani N. Impact of quality mentorship on achievements of Shiraz Medical School in the 1970s and the role of Professors Khosrow Nasr and Asghar Rastegar. Arch Iran Med 2013; 16:251-253. [PMID: 23496373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Faramarz Ismail-Beigi
- Departments of Medicine and Biochemistry, Case Western Reserve University, Cleveland, OH, USA
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Spatz C, Saadulla L, Lapsiwala A, Parhizgar A, Ghahramani N. Effect of renin-angiotensin-aldosterone system blockade therapy on incidence of contrast-induced nephropathy in patients with chronic kidney disease. Iran J Kidney Dis 2012; 6:432-436. [PMID: 23146980 PMCID: PMC3596166] [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] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 07/06/2012] [Accepted: 07/06/2012] [Indexed: 06/01/2023]
Abstract
INTRODUCTION The incidence of contrast-induced nephropathy (CIN) ranges between 10% and 50% among high-risk patients. Whether medications that affect rennin-angiotensin-aldosterone system (RAAS) have any impact on the development of CIN remains uncertain. MATERIALS AND METHODS We performed a retrospective study of patients with CKD stages 3 and 4 who were either on or off RAAS blockade therapy at the time of coronary angiography. Development of CIN was defined by a 25% increase of serum creatinine from baseline or an increase in serum creatinine by 0.5 mg/dL from baseline. Serum creatinine values were recorded before contrast exposure and for 5 days after coronary angiography. RESULTS A total of 178 patients with CKD who had coronary angiography during the study period were included, of whom 62 (35%) were on ACE inhibitors, 12 (7%) were on ARBs, and 1 (1%) was on combination of ACE inhibitors and ARBs. The estimated glomerular filtration rate was 44.0 ± 11.5 mL/min. The odds ratio of acute kidney failure on day 5 was 0.73 (95% confidence interval, 0.31 to 1.69) for the ACE inhibitors and 0.46 (95% confidence interval, 0.06 to 3.70) for ARBs. Multivariable analysis revealed the findings to be independent of demographic variables, comorbidities, type of contrast medium, and the prophylactic strategies. CONCLUSIONS Patients on RAAS blockade therapy before contrast exposure did not have an increased incidence of CIN. There was also no increased incidence of CIN with ACE inhibitors or ARBs in the subgroups at higher risk, such as those with diabetes mellitus.
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Affiliation(s)
- Christin Spatz
- Division of Nephrology, Department of Medicine, Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
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Abstract
Paying for kidney or other organ donation has lead to heated debates about donor and recipient welfare. Many have argued that paying for donation leads to coercion and exploitation of the poor, and, in the end, produces more harm than good. Others have said that payment helps the poor, and we should all have sovereignty over our bodies and, thus, should be allowed to donate for remuneration. Although World Health Organizations and governments in many countries have now banned the process of paying for donation, there is still ongoing payment legally and illegally. Thus, this timely set of three articles from Iran, Pakistan, and the Philippines, where paid donation has been extensively performed, will allow the reader to decide for themselves whether the benefits and/or harms of this practice are now clear.
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Douthitt L, Bezinover D, Uemura T, Kadry Z, Shah R, Ghahramani N, Janicki P. Perioperative Use of Continuous Renal Replacement Therapy for Orthotopic Liver Transplantation. Transplant Proc 2012; 44:1314-7. [DOI: 10.1016/j.transproceed.2012.01.142] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 11/30/2011] [Accepted: 01/10/2012] [Indexed: 10/28/2022]
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Rawal BB, Shadrou S, Abubacker F, Ghahramani N. A Systematic Review and Meta-analysis of Prophylactic versus Pre-emptive Strategies for Preventing Cytomegalovirus Infection in Renal Transplant Recipients. Int J Organ Transplant Med 2012; 3:10-7. [PMID: 25013618 PMCID: PMC4089275] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND In kidney transplant (KT) recipients, CMV infection poses significant morbidity and mortality. Both prophylactic and pre-emptive approaches for preventing CMV infection have been utilized. OBJECTIVE To compare the effectiveness of routine prophylaxis vs. pre-emptive treatment for preventing CMV disease after KT. METHODS We conducted a systematic review and meta-analysis comparing the effectiveness of routine prophylaxis vs. pre-emptive treatment for preventing CMV disease after KT. Combining 4 comprehensive search terms (CMV, renal transplant, prophylaxis, pre-emptive); we searched PubMed, EMBASE, ISI Web of Science, and Cochrane Central Register from inception through January 2011. We also evaluated studies referenced in review articles and abstracts from meetings of major nephrology and transplant societies (2009-2011). Two authors independently extracted data and assessed methodological criteria. The primary outcome was the pooled estimate of the odds ratio (OR) of developing CMV infection. Secondary outcomes included OR of acute rejection, OR of graft loss and OR of death within first year of KT. Comprehensive Meta-analysis V2 software was used for data analysis. RESULTS Analysis of 9 randomized controlled trials (991 patients; ganciclovir=5, valganciclovir=4) with CMV infection as an outcome revealed the OR of CMV infection to be 0.34 (95% CI: 0.25-0.46, p=0.008) for the prophylactic vs. the pre-emptive groups. The OR of acute rejection (7 studies; 1358 patients) was 0.52 (95% CI: 0.41-0.67, p=0.001) with prophylactic approach compared to pre-emptive treatment; graft loss (7 studies; OR 0.52 [95% CI: 0.34-1.12, p=0.32] and mortality (6 studies; OR 0.84 [95% CI: 0.62-1.23, p=0.23]) were similar between the two groups. CONCLUSIONS Prophylactic approach is superior to pre-emptive approach in preventing CMV infection within the first year of kidney transplant. The risk of developing acute rejection is also lower with prophylactic approach in the first year of transplant but there is no significant difference in graft loss or mortality with either approach.
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Affiliation(s)
| | | | | | - N. Ghahramani
- Correspondence: Nasrollah Ghahramani, MD, MS, FACP
Division of Nephrology, Department of Medicine, Pennsylvania State University, College of Medicine, Mail Code H040, Hershey, PA 17033, USA
Phone: +1-717-531-8156
Fax: +1-717-531-6776
E-mail:
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Hollenbeak CS, Nikkel LE, Schaefer EW, Alemao E, Ghahramani N, Raman JD. Determinants of medicare all-cause costs among elderly patients with renal cell carcinoma. J Manag Care Pharm 2011; 17:610-20. [PMID: 21942302 PMCID: PMC3350946 DOI: 10.18553/jmcp.2011.17.8.610] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Renal cell carcinoma (RCC) is the third most common genitourinary cancer and the most common primary renal neoplasm. Estimates of the economic burden of RCC in the United States range from approximately $400 million (in year 2000 dollars) to $4.4 billion (in year 2005 dollars). Actual costs associated with RCC, particularly for elderly Medicare patients who account for 46% of U.S. patients hospitalized for RCC, are poorly understood. OBJECTIVE To estimate all-cause health care costs associated with RCC using the combined Surveillance Epidemiology and End Results (SEER)-Medicare database. METHODS The sample was limited to non-HMO patients aged 65 years or older who were diagnosed with a first primary RCC (SEER site recode 59, kidney and renal pelvis) between 1995 and 2002. Our final sample included 4,938 patients with RCC and 9,876 non-HMO noncancer comparison group cases without chronic renal disease drawn from the SEER 5% Medicare sample and matched by a propensity score calculated from age, gender, race/ethnicity, and comorbidities. Costs were defined as payments made by Medicare for all-cause medical treatments including inpatient stays, emergency room visits, outpatient procedures, office visits, home health visits, durable medical equipment, and hospice care, but excluding out-patient prescription drugs. Using the method of Bang and Tsiatis (2000), we estimated cumulative costs at 1 and 5 years by estimating average costs for each patient in each month up to 60 months following diagnosis. Total costs were weighted sums of monthly costs, where weights were the inverse probability that the patient was not censored, and inverse probabilities were estimated by Kaplan-Meier estimates of time to censoring. Using the method of Lin (2000), we performed multivariate analyses of costs by fitting each of the 60 monthly costs to linear models that controlled for demographic characteristics and comorbidities. Marginal effects of covariates on 1- and 5-year costs were obtained by summing the coefficients for months 1 through 12 and months 1 through 60, respectively. Confidence intervals were obtained by bootstrapping. RESULTS Patients with RCC and matched comparison group cases had similar demographic characteristics, comorbidities, and chronic conditions. At the start of the fifth year post-diagnosis, there were 1,208 Medicare RCC cases of the original 4,938 (20.8%). Mean costs per patient per month (PPPM) in the first year were $3,673 for patients with RCC and $793 for comparison group patients. PPPM costs were higher for RCC patients with more advanced stage (i.e., regional or distant) disease. Average cumulative total costs for RCC patients were $33,605 per patient in the first year following diagnosis and $59,397 per patient in the first 5 years following diagnosis. Several patient-specific factors were associated with 1- and 5-year costs in multivariate analyses, including age, race/ethnicity, and comorbidities. Among RCC patients, treatment with surgery and radiation was associated with higher costs per patient than treatment with surgery alone at 1 year ($24,556, 95% CI = $16,673-$32,940) and 5 years ($30,540, 95% CI = $17,853-$43,648). RCC patients who received chemotherapy as part of their treatment regimen also had significantly higher costs per patient than those who received surgery alone at 1 year ($15,144, 95% CI = $ 9,979-$20,344) and 5 years ($13,440, 95% CI = $1,257-$27,572). CONCLUSIONS Newly diagnosed RCC is associated with a significant economic burden, which is largely determined by several patient characteristics, disease stage, and treatment choice.
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Affiliation(s)
- Christopher S. Hollenbeak
- Departments of Surgery and Public Health Sciences, Penn State College of Medicine, 600 Centerview Dr., A210, Hershey, PA 17033, USA.
| | - Lucas E. Nikkel
- Departments of Surgery and Public Health Sciences, Penn State College of Medicine, 600 Centerview Dr., A210, Hershey, PA 17033, USA.
| | - Eric W. Schaefer
- Departments of Surgery and Public Health Sciences, Penn State College of Medicine, 600 Centerview Dr., A210, Hershey, PA 17033, USA.
| | - Evo Alemao
- Departments of Surgery and Public Health Sciences, Penn State College of Medicine, 600 Centerview Dr., A210, Hershey, PA 17033, USA.
| | - Nasrollah Ghahramani
- Departments of Surgery and Public Health Sciences, Penn State College of Medicine, 600 Centerview Dr., A210, Hershey, PA 17033, USA.
| | - Jay D. Raman
- Departments of Surgery and Public Health Sciences, Penn State College of Medicine, 600 Centerview Dr., A210, Hershey, PA 17033, USA.
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Ghahramani N, Karparvar ZY, Ghahramani M, Shrivastava P. Nephrologists' perceptions of renal transplant as treatment of choice for end-stage renal disease, preemptive transplant, and transplanting older patients: an international survey. EXP CLIN TRANSPLANT 2011; 9:223-229. [PMID: 21819365 PMCID: PMC3154028] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To explore the relation between nephrologists' characteristics and their views of transplant as the treatment of choice for end-stage renal disease, preemptive transplant, and transplant of older patients. MATERIALS AND METHODS A comprehensive international Web-based survey explored the relation between nephrologists' characteristics and their views of transplant as the treatment of choice for end-stage renal disease, preemptive transplant, and transplant of older patients. RESULTS A total of 1448 nephrologists completed the survey. The majority of respondents agreed with transplant as the treatment of choice for end-stage renal disease (75%), preemptive transplant (71%), and transplant for patients > 60 years of age (59%). The likelihood of agreement was higher among transplant and academic nephrologists, and practice at hospitals with ≥ 50 transplants per year. Urban location and ≥ 10 years in practice were associated with higher likelihood of viewing transplant as treatment of choice and favoring preemptive transplant. CONCLUSIONS Demographic and practice characteristics influence nephrologists' attitudes about transplant as the treatment of choice for end-stage renal disease, preemptive transplant, and transplant as an option for older patients. Detailed studies exploring the determinants of nephrologists' attitudes are likely to identify sources of variations in perceptions of patient suitability for transplant. Our findings underscore the need for continuing educational programs addressing evolving aspects of transplant particularly targeting nephrologists practicing within nonacademic centers and in rural areas.
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Roozbeh J, Shahriyari B, Akmali M, Vessal G, Pakfetrat M, Raees Jalali GA, Afshariani R, Hasheminasab M, Ghahramani N. Comparative effects of silymarin and vitamin E supplementation on oxidative stress markers, and hemoglobin levels among patients on hemodialysis. Ren Fail 2011; 33:118-23. [PMID: 21332331 DOI: 10.3109/0886022x.2010.541579] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The incidence of accelerated atherosclerosis among patients on hemodialysis is very high and oxidative stress (OS) is a potentially major contributor to their morbidity and mortality. OBJECTIVE To evaluate the effects of Silymarin and/or vitamin E on OS markers and hemoglobin levels in patients on hemodialysis. METHODS Eighty patients on hemodialysis were randomized into four groups: Group 1 received silymarin 140 mg 3 times daily; Group 2 received vitamin E 400 IU/day; Group 3 received silymarin 140 mg 3 times daily and vitamin E 400 IU/day; and Group 4 was the control. Samples were obtained at baseline and on day 21 for measurement of malondialdehyde (MDA), red blood cell (RBC) glutathione peroxidase (GPX), and hemoglobin. RESULTS Combination of silymarin and vitamin E led to a reduction in the MDA levels (7.84 ± 1.84 vs. 9.20 ± 2.74 nmol/mL; p = 0.008). There was a significant increase in RBC GPX levels in all treatment groups compared with controls after 3 weeks. This was more pronounced in the group receiving combination compared with the group receiving vitamin E or the control group (5.78 ± 3.51, 4.22 ± 1.63, and 3.16 ± 1.89 IU/grHb, respectively; p < 0.001). There was also a significant increase in mean hemoglobin of all treatment groups compared with the control. CONCLUSIONS Oral supplementation with silymarin and vitamin E leads to reduction in MDA, increase in RBC GPX, and increase in hemoglobin levels in patients with end-stage renal disease. Studies with larger sample sizes and longer follow-up are required to investigate the effect of silymarin on cardiovascular outcomes and erythropoietin requirement.
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Affiliation(s)
- Jamshid Roozbeh
- Division of Nephrology, Department of Medicine, Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
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Ghahramani N, Ahmed F, Al-Laham A, Lengerich EJ. The epidemiological association of altitude with chronic kidney disease: Evidence of protective effect. Nephrology (Carlton) 2011; 16:219-24. [PMID: 21272135 DOI: 10.1111/j.1440-1797.2010.01332.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS We sought to determine the association between living at high altitudes and the estimated glomerular filtration rate (eGFR) and also to determine the prevalence of end-stage renal disease (ESRD) at various altitudes. METHODS In the first part of the study, we used data from the National Health and Nutrition Examination Survey III to examine the association between altitude of residence and eGFR. In the second part, we used the United States Renal Data System to study the association between altitude and prevalence of ESRD. The query revealed an ESRD prevalence of 485,012 for the year 2005. The prevalence rates were merged with the zip codes dataset. RESULTS The mean eGFR was significantly increased at higher altitudes (78.4 ± 21.6 vs 85.4 ± 26.8 mL/min for categories 1 and 5, respectively; P < 0.05). In the analysis of the United States Renal Data System data for prevalence of ESRD, we found a significantly lower prevalence at the altitude of 523 feet and higher. CONCLUSION Using a population-based approach, our study demonstrates an association between altitude and renal function. This association is independent of all factors studied and is reached at approximately 250 feet. There is also a negative association between the prevalence of ESRD and altitude of residence. Further studies are needed to elucidate the pathophysiological basis of these epidemiological findings.
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Affiliation(s)
- Nasrollah Ghahramani
- Pennsylvania State University College of Medicine, Hershey Medical Center, Harrisburg, Pennsylvania, USA.
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Uemura T, Riley TR, Khan A, Hollenbeak C, Schreibman I, Ghahramani N, Reeves B, Domen RE, Zander DS, Kadry Z. Immune functional assay for immunosuppressive management in post-transplant malignancy. Clin Transplant 2011; 25:E32-7. [PMID: 20636411 DOI: 10.1111/j.1399-0012.2010.01303.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Immunosuppression management in post-transplant malignancy is challenging because of a lack of objective immunologic assessment tools. The ImmuKnow assay measures the ATP level from CD4 T cells, quantifying cell-mediated immunity and providing an insight into the immune status of transplant recipients. Its potential use in patients with post-transplant de novo malignancy was evaluated. Thirteen adult transplant patients with de novo malignancy were divided into survivors (n = 9) and non-survivors (n = 4) after malignancy treatment. Tacrolimus and the ImmuKnow levels were monitored before, during, and after malignancy treatment. The ImmuKnow level in non-survivors group was significantly lower before and after malignancy treatment compared to survivors group (p = 0.013 and 0.0014 respectively). In survivor group, the ImmuKnow level was significantly decreased during malignancy treatment (p = 0.019) but recovered to the initial level after the treatment. However, in non-survivor group, the ImmuKnow level remained suppressed throughout the observed period despite a reduction in immunosuppressive drug levels. The ImmuKnow assay can be an objective means evaluating immune status of patients with de novo malignancy. The ImmuKnow assay can express the degree of immune suppression induced by chemotherapeutic or radiation therapy and may be a useful tool in optimizing the timing of re-introduction of immunosuppression after malignancy treatment.
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Affiliation(s)
- Tadahiro Uemura
- Division of Transplantation, Department of Surgery, Penn State Milton S. Hershey Medical Center, College of Medicine, Penn State University, Hershey, PA 17033, USA
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Hychko G, Mirhosseini A, Parhizgar A, Ghahramani N. A Systematic Review and Meta-Analysis of Rituximab in Antibody-mediated Renal Allograft Rejection. Int J Organ Transplant Med 2011; 2:51-6. [PMID: 25013595 PMCID: PMC4089253] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The standard treatment of antibody-mediated rejection (AMR) consists of antilymphocyte antibody, intravenous immunoglobulin, and plasmapheresis. This treatment is associated with a high rate of resistance and refractory AMR. Recent interest has focused on use of rituximab (RTX), a chimeric anti-CD20 monoclonal antibody. OBJECTIVE We conducted a systematic review and meta-analysis of studies of RTX in AMR of the renal allograft. METHODS Combining two comprehensive search themes (AMR and RTX), we searched electronic databases from 1969 through 2010, supplemented by a manual review of abstracts from nephrology and transplant meetings, and reference lists of review articles. All studies evaluating explicit response of patients with AMR to RTX were included. The outcome was pooled odds ratio (OR) of response to RTX. RESULTS A total of 114 studies were identified, 94 of which were excluded on initial screening. Analysis of the 10 studies (249 patients) showed an OR of 3.16 (95% CI: 1.75-5.70) for response to RTX. Reported adverse effects included BK virus nephropathy, cytomegalovirus (CMV) viremia, pneumonia, herpes zoster, and septic shock. CONCLUSION This study suggests that RTX is a reasonable therapeutic option in the treatment of AMR. Further randomized studies are necessary to establish its efficacy and safety.
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Affiliation(s)
| | | | - A. Parhizgar
- Pennsylvania State University College of Medicine, USA
| | - N. Ghahramani
- Pennsylvania State University College of Medicine, USA ,Correspondence: Nasrollah Ghahramani, MD, MS, Assistant Professor of Medicine and Public Health Sciences, Division of Nephrology, Pennsylvania State University, College of Medicine and Milton S. Hershey Medical Center, 500 University Drive, Mail Code H040, Hershey, PA 17033
Tel: +1-717-531-8156
Fax: +1-717-531-6776
E-mail:
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