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Territo A, Afferi L, Musquera M, Gaya Sopena JM, Pecoraro A, Campi R, Gallioli A, Etcheverry B, Prudhomme T, Vangeneugden J, Ortved M, Røder A, Zeuschner P, Volpe A, Garcia-Baquero R, Kocak B, Mirza I, Stockle M, Canda E, Fornara P, Rohrsted M, Doumerc N, Decaestecker K, Serni S, Vigues F, Alcaraz A, Breda A. Robot-assisted Kidney Transplantation: The 8-year European Experience. Eur Urol 2025; 87:468-475. [PMID: 39794184 DOI: 10.1016/j.eururo.2024.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Revised: 11/30/2024] [Accepted: 12/13/2024] [Indexed: 01/13/2025]
Abstract
BACKGROUND AND OBJECTIVE Evidence regarding perioperative results and long-term functional outcomes of robotic-assisted kidney transplantation (RAKT) is limited. We evaluated perioperative surgical results and long-term functional outcomes of RAKT in patients receiving kidney transplants from living donors. METHODS This retrospective analysis is based on a prospective multicenter cohort study conducted from July 2015 to October 2023 across ten European centers. A total of 624 patients who underwent heterotopic RAKT from living donors were included, excluding those who received orthotopic RAKT. The primary outcomes measured were long-term renal function, perioperative complications, and survival rates. Renal function was assessed with the estimated glomerular filtration rate (eGFR). The Clavien-Dindo classification (CDC) was used to describe early (within 30 d) and late (from 31 to 90 d) postoperative complications. The probabilities of dialysis, graft nephrectomies, and any-cause mortality during follow-up were reported in terms of the 5-yr cumulative incidence. KEY FINDINGS AND LIMITATIONS A total of 624 patients with a median age of 35 yr (interquartile range [IQR]: 26-52) underwent RAKT. Preemptive RAKT was performed in 52% of cases, and the majority (84%) had the transplant in the right iliac fossa. The median operative time was 210 min (IQR: 180-262), with a rewarming time of 43 min (IQR: 38-50). Intraoperative complications were rare (1.1%), and postoperative graft nephrectomy occurred in 1.9% of patients. High-grade (CDC grade ≥3) early and late postoperative complications were observed in 7.7% and 2.3% of patients, respectively. Rates of incisional hernias, ureteral stenosis, and arterial stenosis were 1.4%, 1.1%, and 0.2%, respectively. The median eGFR values were 19, 52, and 53 ml/min/1.73 m2 on the 1st postoperative day, on the 7th postoperative day, and at 6 mo, respectively. Over a median follow-up of 23 mo (IQR: 6-49), 17 patients received dialysis, 11 patients underwent graft nephrectomy, and four patients died. None of the deaths were due to RAKT. The main limitation is the absence of a comparator group. CONCLUSIONS AND CLINICAL IMPLICATIONS With the largest experience worldwide on RAKT, we confirm the perioperative safety and excellent long-term functional outcomes of this procedure. Given the benefits of a minimally invasive robotic approach, these findings support the broader adoption of RAKT as a viable option for kidney transplantation.
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Affiliation(s)
- Angelo Territo
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Luca Afferi
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Mireia Musquera
- Department of Urology, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Josep Maria Gaya Sopena
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Alessio Pecoraro
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Campi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Begoña Etcheverry
- Department of Urology, Hospital Universitari de Bellvitge, Le'Hospitalet de Llobregat, Barcelona, Spain
| | - Thomas Prudhomme
- Department of Urology and Renal Transplantation, University Hospital of Rangueil, Toulouse, France
| | - Joris Vangeneugden
- Department of Urology, University Hospital Ghent, Ghent, Belgium (ERN eUROGEN accredited center)
| | - Milla Ortved
- Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Andreas Røder
- Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Philip Zeuschner
- Clinic of Urology and Transplantation, Medical Faculty of Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Alessandro Volpe
- Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Rodrigo Garcia-Baquero
- Kidney Transplant Unit, Urology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Burak Kocak
- Koç University Hospital Organ Transplant Center, İstanbul, Turkey; Department of Urology, Koç University School of Medicine, İstanbul, Turkey
| | - Idu Mirza
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Michael Stockle
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Erdem Canda
- Koç University Hospital Organ Transplant Center, İstanbul, Turkey; Department of Urology, Koç University School of Medicine, İstanbul, Turkey
| | - Paolo Fornara
- Clinic of Urology and Transplantation, Medical Faculty of Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Malene Rohrsted
- Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Nicolas Doumerc
- Department of Urology and Renal Transplantation, University Hospital of Rangueil, Toulouse, France
| | - Karel Decaestecker
- Department of Urology, University Hospital Ghent, Ghent, Belgium (ERN eUROGEN accredited center)
| | - Sergio Serni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesc Vigues
- Department of Urology, Hospital Universitari de Bellvitge, Le'Hospitalet de Llobregat, Barcelona, Spain
| | - Antonio Alcaraz
- Department of Urology, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
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Boerstra BA, Pippias M, Kramer A, Dirix M, Daams J, Jager KJ, Hellemans R, Stel VS. The evaluation of kidney transplant candidates prior to waitlisting: a scoping review. Clin Kidney J 2025; 18:sfae377. [PMID: 40008352 PMCID: PMC11852345 DOI: 10.1093/ckj/sfae377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Indexed: 02/27/2025] Open
Abstract
Before patients with kidney failure can undergo kidney transplantation, their suitability is assessed through a transplantation work-up. Variation in the transplantation work-up could contribute to inefficiency and inequality in accessing the transplant waiting list and kidney transplantation. We conducted a scoping review on the evaluation of kidney transplant candidates prior to waitlisting, investigating: (i) content of the transplantation work-up; (ii) contraindications to waitlisting; and (iii) organization of the transplantation work-up. A systematic search was conducted in Ovid Medline and Ovid EMBASE in collaboration with a medical information specialist. Studies investigating practice patterns since 2013 related to the evaluation of adults receiving their first kidney graft from a deceased donor were included. Results from 20 studies showed substantial variation in the evaluation of kidney transplant candidates. The content of the transplantation work-up differed between studied centers, yet common domains included screening for infections, heart disease, peripheral artery disease, and malignancy. Commonly reported contraindications to waitlisting were obesity and age-related factors. However, strict cut-off for BMI and age were used less. The organization of the transplantation work-up differed across studied centers with regard to referral and waitlisting decisions, screening and prioritization, and the setting of the transplantation work-up. Literature on the evaluation of kidney transplant candidates is limited, but our findings suggest substantial variation in pre-waitlisting practices among centers. This may contribute to differences in kidney transplantation access and outcomes between countries. Further research on pre-transplantation practices, specifically regarding the standardization of the transplantation work-up, is needed.
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Affiliation(s)
- Brittany A Boerstra
- ERA Registry, Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands
- Amsterdam Public Health, Health Behaviours & Chronic Diseases, Amsterdam, The Netherlands
- Amsterdam Public Health, Ageing & Later Life, Amsterdam, The Netherlands
| | - Maria Pippias
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- North Bristol NHS Trust, Renal Unit, Bristol, UK
| | - Anneke Kramer
- ERA Registry, Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Marie Dirix
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Joost Daams
- Medical Library, Research Support, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Kitty J Jager
- ERA Registry, Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands
- Amsterdam Public Health, Ageing & Later Life, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - Rachel Hellemans
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
- Laboratory of Experimental Medicine and Pediatrics (LEMP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vianda S Stel
- ERA Registry, Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands
- Amsterdam Public Health, Ageing & Later Life, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
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Wojtaszek E, Małyszko J, Nazarewski S, Grochowiecki T, Macech M, Głogowski T, Kaszczewski P, Gałązka Z. Effect of Pretransplant Dialysis Method and Vintage on Early Clinical Outcomes of Kidney Transplantation. Transplant Proc 2024; 56:948-952. [PMID: 38729829 DOI: 10.1016/j.transproceed.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Pre-transplantation dialysis duration and modality may affect patients' long-term (mortality and graft failure) and short-term (delayed graft function) outcomes after kidney transplantation. We aimed to assess the impact of the method and duration of dialysis therapy on the graft function in the first 6 months post-transplant. METHODS The analysis included 122 kidney transplant patients (109 from a deceased donor and 13 from a living donor). Before transplantation, 91 were on hemodialysis (HD), 19 were on peritoneal dialysis (PD), and 9 received preemptive transplants. The incidence of delayed graft function (DGF) and creatinine levels at discharge and 6 months after transplantation were assessed. RESULTS PD and HD patients did not differ in age, number of mismatches, and cold ischemia time (CIT), but they had a significantly shorter dialysis vintage (18.3 ± 25.7 vs 39.6 ± 34.3 months, P = .01) and a lower incidence of DGF (5% vs 37%, P = .006). The duration of hospitalization and creatinine concentration at discharge and after 6 months were similar. Preemptively transplanted patients had a significantly shorter CIT (ND vs DO - 576 ± 362 vs 1113 ± 574, P = .01; ND vs HD - 576 ± 362 vs 1025 ± 585 minutes, P = .01). DGF did not occur in any of the patients transplanted preemptively. They had slightly shorter hospitalization times and, compared to HD, better graft function at discharge. After 6 months, creatinine levels were comparable to HD and PD. Patients dialyzed for less than 12 months, regardless of the method, had a lower incidence of DGF. CONCLUSIONS Peritoneal dialysis and a short duration of pre-transplant dialysis may improve the early results of kidney transplantation.
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Affiliation(s)
- Ewa Wojtaszek
- Department of Nephrology, Dialysis & Internal Diseases, The Medical University of Warsaw.
| | - Jolanta Małyszko
- Department of Nephrology, Dialysis & Internal Diseases, The Medical University of Warsaw
| | - Sławomir Nazarewski
- Department of General, Vascular, Endocrine & Transplant Surgery, The Medical University of Warsaw
| | - Tadeusz Grochowiecki
- Department of General, Vascular, Endocrine & Transplant Surgery, The Medical University of Warsaw
| | - Michał Macech
- Department of General, Vascular, Endocrine & Transplant Surgery, The Medical University of Warsaw
| | - Tomasz Głogowski
- Department of Nephrology, Dialysis & Internal Diseases, The Medical University of Warsaw
| | - Piotr Kaszczewski
- Department of General, Vascular, Endocrine & Transplant Surgery, The Medical University of Warsaw
| | - Zbigniew Gałązka
- Department of General, Vascular, Endocrine & Transplant Surgery, The Medical University of Warsaw
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Al-Otaibi T, Nagib AM, Deraz A, Elasawy I, Rida S, Khalid M, Halim MA, Dahab M, Nair P, Almanea O, Gheith OA. Impact of Pretransplant Dialysis Modality on Posttransplant Outcomes: A Single-Center Experience. EXP CLIN TRANSPLANT 2024; 22:200-206. [PMID: 38385398 DOI: 10.6002/ect.mesot2023.p36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
OBJECTIVES It remains unclear whether posttransplant outcomes differ according to the pretransplant dialysis modality (peritoneal dialysis vs hemodialysis). Our aim was to assess posttransplant outcomes in patients with different predialysis modalities. MATERIALS AND METHODS Two thousand two hundred fifty-eight kidney recipients following up in Hamed Alessa Organ transplant center in Kuwait were included and divided into two groups according to pre-transplant dialysis modality: Group 1: those who received hemodialysis (HD) and group 2: those with peritoneal dialysis (PD). Demographics, pretransplant and posttransplant comorbidities, and patient and graft outcomes were studied. RESULTS There were 1956 patients on hemodialysis, and 302 patients were on peritoneal dialysis. Most were male patients (1456 vs 802 female patients), with comparable mean age (P = .34). Chronic glomerulonephritis and diabetic nephropathy represented the most common original kidney disease before transplant (27.6% and 21.4%, respectively), with higher prevalence of glomerulonephritis in group 1 and diabetic nephropathy in group 2 (P = .001). The 2 groups were comparable with regard to immunosuppression (induction and maintenance) (P > .05). Posttransplant diabetes and hypertension were significantly higher in the hemodialysis group (P = .004 and P = 003, respectively). There was no significant difference between the 2 groups with regard to the graft outcome (P = .86). However, patient survival was significantly higher in the hemodialysis group (81.2% vs 64.4%). CONCLUSIONS Compared with peritoneal dialysis, pretransplant hemodialysis is associated with better posttransplant patient survival despite no difference in the graft outcome. Diabetes-related complications could be attributed to such outcomes.
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Affiliation(s)
- Torki Al-Otaibi
- From the Hamed Alessa Organ Transplant Center, Ibn Sina Hospital, Ministry of Health, Kuwait
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Morrison SA, Thanamayooran A, Tennankore K, Vinson AJ. Association Between First Post-operative Day Urine Output Following Kidney Transplantation and Short-Term and Long-Term Outcomes: A Retrospective Cohort Study. Can J Kidney Health Dis 2023; 11:20543581231221630. [PMID: 38161390 PMCID: PMC10757439 DOI: 10.1177/20543581231221630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/05/2023] [Indexed: 01/03/2024] Open
Abstract
Background The relationship between post-operative urine output (UO) following kidney transplantation and long-term graft function has not been well described. Objective In this study, we examined the association between decreased UO on post-operative day 1 (POD1) and post-transplant outcomes. Design This is a retrospective cohort study. Setting Atlantic Canada. Patients Patients from the 4 Atlantic Canadian provinces (Nova Scotia, New Brunswick, Newfoundland, and Prince Edward Island) who received a live or deceased donor kidney transplant from 2006 through 2019 through the multiorgan transplant program at the Queen Elizabeth II Health Sciences Centre (QEII) hospital in Halifax, Nova Scotia. Measurements Using multivariable Cox proportional hazards models, we assessed the association of low POD1 UO (defined as ≤1000 mL) with death-censored graft loss (DCGL). In secondary analyses, we used adjusted logistic regression or Cox models as appropriate to assess the impact of UO on delayed graft function (DGF), prolonged length of stay (greater than the median for the entire cohort), and death. Results Of the 991 patients included, 151 (15.2%) had a UO ≤1000 mL on POD1. Low UO was independently associated with DCGL (hazard ratio [HR] = 4.00, 95% confidence interval [CI] = 95% CI = 1.55-10.32), DGF (odds ratio [OR] = 45.25, 95% CI = 23.00-89.02), and prolonged length of stay (OR = 5.06, 95% CI = 2.95-8.69), but not death (HR = 0.81, 95% CI = 0.31-2.09). Limitations This was a single-center, retrospective, observational study and therefore has inherent limitations of generalizability, data collection, and residual confounding. Conclusions Overall, reduced post-operative UO following kidney transplantation is associated with an increased risk of DCGL, DGF, and prolonged hospital length of stay.
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Affiliation(s)
- Steven A. Morrison
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Aran Thanamayooran
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Karthik Tennankore
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Amanda J. Vinson
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Lalani HS, Ganguly A, Brown LS, Smartt J, Johnson DH, Bhavan KP, Saxena R. Physician Knowledge and Attitudes Toward the Adoption of Peritoneal Dialysis in the Treatment of Patients With End-Stage Kidney Disease. Cureus 2022; 14:e32708. [PMID: 36686081 PMCID: PMC9848698 DOI: 10.7759/cureus.32708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Hemodialysis (HD) is a significant contributor to Medicare spending. Peritoneal dialysis (PD) is a lower-cost dialysis modality with non-inferior clinical outcomes. Recent initiatives at the federal level have emphasized shifting dialysis from in-center to home modalities, namely, PD. Such policy has been slow to impact the distribution of HD and PD due to multiple barriers, including at the provider level. Previous research has characterized the role of patient knowledge gaps and preferences in the under-utilization of PD. We sought to understand physician knowledge and attitudes toward PD to elucidate provider-level barriers to PD adoption. Methods We conducted a 10-question survey assessing physician comfort level, perceived knowledge, and objective knowledge of HD and PD that was distributed among the internal medicine faculty at the University of Texas Southwestern Medical Center, Dallas, TX. The survey respondents included nephrologists and non-nephrologists. Demographic information of respondents was collected. Survey responses were summarized and stratified by medical specialty. All statistical tests used 0.05 as the statistical significance level. Results Among 391 survey recipients, there were 83 respondents (21.2%). The mean age of respondents was 43 and 54% were women. With regard to specialty, 88% of respondents were non-nephrologists and 12% were nephrologists. All respondents reported an increased level of comfort and experience caring for patients receiving HD compared to PD. Regardless of specialty, respondents had a high incorrect response rate with regard to contraindications to PD. While nephrologists reported high perceived knowledge regarding PD, objective assessments revealed knowledge gaps with regard to PD candidacy. Non-nephrologists reported lower perceived knowledge but scored better on objective knowledge assessments regarding medical contraindications to PD. Both specialty groups held misconceptions regarding psychosocial barriers to PD. Discussion This physician survey demonstrated overall decreased confidence in knowledge and experience in the care of patients receiving PD compared to HD. Knowledge assessments revealed discordance between perceived knowledge and objective knowledge with regard to contraindications to PD. These findings highlight ongoing misconceptions across medical specialties regarding the applicability of PD. These findings demonstrate the need for increased training on PD candidacy among nephrologists and non-nephrologists alike. These findings demonstrate the need for education and advocacy around PD for providers to effectively meet federal priorities advocating for shifting dialysis to the home. Conclusion This study demonstrates the impact of physician knowledge and attitudes toward PD in the under-utilization of PD as a dialysis modality. These findings demonstrate a need for increased provider education around PD candidacy and the benefits of shifting dialysis care to the home. Novel models of dissemination are needed to increase the adoption of PD and meet federal policy goals of shifting dialysis care to home-based modalities.
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Affiliation(s)
- Hussain S Lalani
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Internal Medicine, Brigham and Women's Hospital, Boston, USA
| | - Anisha Ganguly
- Center of Innovation and Value, Parkland Health, Dallas, USA
- Department of General Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA
| | - Larry S Brown
- Department of Biostatistics, Parkland Health, Dallas, USA
| | - Jillian Smartt
- Center of Innovation and Value, Parkland Health, Dallas, USA
| | - David H Johnson
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA
| | - Kavita P Bhavan
- Center of Innovation and Value, Parkland Health, Dallas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA
| | - Ramesh Saxena
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA
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Ngamvichchukorn T, Ruengorn C, Noppakun K, Thavorn K, Hutton B, Sood MM, Knoll GA, Nochaiwong S. Association Between Pretransplant Dialysis Modality and Kidney Transplant Outcomes: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2237580. [PMID: 36264575 PMCID: PMC9585427 DOI: 10.1001/jamanetworkopen.2022.37580] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IMPORTANCE The benefits and disadvantages of different pretransplant dialysis modalities and their posttransplant outcomes remain unclear in contemporary kidney transplant care. OBJECTIVE To summarize the available evidence of the association of different pretransplant dialysis modalities, including hemodialysis and peritoneal dialysis (PD), with posttransplant outcomes. DATA SOURCES MEDLINE, Embase, PubMed, Cochrane Library, Scopus, CINAHL, and gray literature were searched from inception to March 18, 2022 (updated to April 1, 2022), for relevant studies and with no language restrictions. STUDY SELECTION Randomized clinical trials and nonrandomized observational (case-control and cohort) studies that investigated the association between pretransplant dialysis modality and posttransplant outcomes regardless of age or donor sources (living or deceased) were abstracted independently by 2 reviewers. DATA EXTRACTION AND SYNTHESIS Following Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology reporting guidelines, 2 reviewers independently extracted relevant information using a standardized approach. Random-effects meta-analysis was used to estimate pooled adjusted hazard ratio (HR) or odds ratio and 95% CI. MAIN OUTCOMES AND MEASURES Primary outcomes included all-cause mortality, overall graft failure, death-censored graft failure, and delayed graft function. Secondary outcomes included acute rejection, graft vessel thrombosis, oliguria, de novo heart failure, and new-onset diabetes after transplant. RESULTS The study analyzed 26 nonrandomized studies (1 case-control and 25 cohort), including 269 715 patients (mean recipient age range, 14.5-67.0 years; reported proportions of female individuals, 29.4%-66.9%) whose outcomes associated with pretransplant hemodialysis vs pretransplant PD were compared. No significant difference, with very low certainty of evidence, was observed between pretransplant PD and all-cause mortality (13 studies; n = 221 815; HR, 0.92 [95% CI, 0.84-1.01]; P = .08) as well as death-censored graft failure (5 studies; n = 96 439; HR, 0.98 [95% CI, 0.85-1.14]; P = .81). However, pretransplant PD was associated with a lower risk for overall graft failure (10 studies; n = 209 287; HR, 0.96 [95% CI, 0.92-0.99]; P = .02; very low certainty of evidence) and delayed graft function (6 studies; n = 47 118; odds ratio, 0.73 [95% CI, 0.70-0.76]; P < .001; low certainty of evidence). Secondary outcomes were inconclusive due to few studies with available data. CONCLUSIONS AND RELEVANCE Results of the study suggest that pretransplant PD is a preferred dialysis modality option during the transition to kidney transplant. Future studies are warranted to address shared decision-making between health care professionals, patients, and caregivers as well as patient preferences.
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Affiliation(s)
- Tanun Ngamvichchukorn
- Division of Nephrology, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Chidchanok Ruengorn
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Kajohnsak Noppakun
- Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kednapa Thavorn
- Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Manish M. Sood
- Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Greg A. Knoll
- Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Surapon Nochaiwong
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
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8
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Dirix M, Philipse E, Vleut R, Hartman V, Bracke B, Chapelle T, Roeyen G, Ysebaert D, Van Beeumen G, Snelders E, Massart A, Leyssens K, Couttenye MM, Abramowicz D, Hellemans R. Timing of the pre-transplant workup for renal transplantation: is there room for improvement? Clin Kidney J 2022; 15:1100-1108. [PMID: 35664264 PMCID: PMC9155241 DOI: 10.1093/ckj/sfac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Indexed: 11/15/2022] Open
Abstract
Background Since patient survival after kidney transplantation is significantly improved with a shorter time on dialysis, it is recommended to start the transplant workup in a timely fashion. Methods This retrospective study analyses the chronology of actions taken during the care for patients with chronic kidney disease (CKD) stage 5 who were waitlisted for a first kidney transplant at the Antwerp University Hospital between 2016 and 2019. We aimed to identify risk factors for a delayed start of the transplant workup (i.e. after dialysis initiation) and factors that prolong its duration. Results Of the 161 patients included, only 43% started the transplant workup before starting dialysis. We identified the number of hospitalization days {odds ratio [OR] 0.79 [95% confidence interval (CI) 0.69-0.89]; P < 0.001}, language barriers [OR 0.20 (95% CI 0.06-0.61); P = 0.005] and a shorter nephrology follow-up before CKD stage 5 [OR 0.99 (95% CI 1.0-0.98); P = 0.034] as factors having a significant negative impact on the probability of starting the transplant screening before dialysis. The workup took a median of 8.6 months (interquartile range 5-14) to complete. The number of hospitalization days significantly prolonged its duration. Conclusion The transplant workup was often started too late and the time needed to complete it was surprisingly long. By starting the transplant workup in a timely fashion and reducing the time spent on the screening examinations, we should be able to register patients on the waiting list before or at least at the start of dialysis. We believe that such an internal audit could be of value for every transplant centre.
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Affiliation(s)
- Marie Dirix
- Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
| | - Ester Philipse
- Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
| | - Rowena Vleut
- Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
| | - Vera Hartman
- Department of Hepatobiliary, Transplantation and Endocrine Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Bart Bracke
- Department of Hepatobiliary, Transplantation and Endocrine Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Thierry Chapelle
- Department of Hepatobiliary, Transplantation and Endocrine Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Geert Roeyen
- Department of Hepatobiliary, Transplantation and Endocrine Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Dirk Ysebaert
- Department of Hepatobiliary, Transplantation and Endocrine Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Gerda Van Beeumen
- Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
- Department of Hepatobiliary, Transplantation and Endocrine Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Erik Snelders
- Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
| | - Annick Massart
- Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
| | - Katrien Leyssens
- Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
| | - Marie M Couttenye
- Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
| | - Daniel Abramowicz
- Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
| | - Rachel Hellemans
- Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
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9
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Gardezi AI, Aziz F, Parajuli S. The Role of Peritoneal Dialysis in Different Phases of Kidney Transplantation. KIDNEY360 2022; 3:779-787. [PMID: 35721606 PMCID: PMC9136899 DOI: 10.34067/kid.0000482022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/23/2022] [Indexed: 04/28/2023]
Abstract
The utilization of peritoneal dialysis (PD) has been increasing in the past decade owing to various government initiatives and recognition of benefits such as better preservation of residual renal function, quality of life, and lower cost. The Advancing American Kidney Health initiative aims to increase the utilization of home therapies such as PD and kidney transplantation to treat end stage kidney disease (ESKD). A natural consequence of this development is that more patients will receive PD, and many will eventually undergo kidney transplantation. Therefore, it is important to understand the effect of pretransplant PD on posttransplant outcomes such as delayed graft function (DGF), rejection, thrombosis, graft, and patient survival. Furthermore, some of these patients may develop DGF, which raises the question of the utility of PD during DGF and its risks. Although transplant is the best renal replacement therapy option, it is not everlasting, and many transplant recipients must go on dialysis after allograft failure. Can PD be a good option for these patients? This is another critical question. Furthermore, a significant proportion of nonrenal solid organ transplant recipients develop ESKD. Is PD feasible in this group? In this review, we try to address all of these questions in the light of available evidence.
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Affiliation(s)
- Ali I. Gardezi
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Fahad Aziz
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sandesh Parajuli
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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10
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Impact of the Type of Dialysis on Time to Transplantation: Is It Just a Matter of Immunity? J Clin Med 2022; 11:jcm11041054. [PMID: 35207326 PMCID: PMC8874533 DOI: 10.3390/jcm11041054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/11/2022] [Accepted: 02/16/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Renal transplantation represents the therapeutic gold standard in patients with end stage renal disease (ESRD). Still the role of pre-transplant dialysis in affecting time to transplantation has yet to be determined. We wanted to verify whether the type of renal replacement therapy (hemodialysis vs. peritoneal dialysis) affects time to transplantation and to identify clinical features related to the longer time to transplantation. Methods: We performed a retrospective single-center observational study on patients who had received a transplant in the Bologna Transplant Unit from 1991 to 2019, described through the analysis of digital transplant list documents for sex, age, body mass index (BMI), blood group, comorbidities, underlying disease, serology, type of dialysis, time to transplantation, Panel Reactive Antibodies (PRA) max, number of preformed anti Human Leukocyte Antigens (HLA) antibodies. A p-value < 0.05 was considered statistically significant. Results: In the 1619 patients analyzed, we observed a significant difference in time to transplant, PRA max and Preformed Antibodies Number between patients who received Hemodialysis (HD) and Peritoneal dialysis (PD). Then we performed a multiple regression analysis with all the considered factors in order to identify features that support these differences. The clinical variables that independently and directly correlate with longer time to transplantation are PRA max (p < 0.0001), Antibodies number (p < 0.0001) and HD (p < 0.0001); though AB blood group (p < 0.0001), age (p < 0.003) and PD (p < 0.0001) inversely correlate with time to transplantation. Conclusions: In our work, PD population received renal transplants in a shorter period of time compared to HD and turned out to be less immunized. Considering immunization, the type of dialysis impacts both on PRA max and on anti HLA antibodies.
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11
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Nardelli L, Scalamogna A, Messa P, Gallieni M, Cacciola R, Tripodi F, Castellano G, Favi E. Peritoneal Dialysis for Potential Kidney Transplant Recipients: Pride or Prejudice? MEDICINA (KAUNAS, LITHUANIA) 2022; 58:214. [PMID: 35208541 PMCID: PMC8875254 DOI: 10.3390/medicina58020214] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 12/28/2022]
Abstract
Kidney transplantation (KT) is recognized as the gold-standard of treatment for patients with end-stage renal disease. Additionally, it has been demonstrated that receiving a pre-emptive KT ensures the best recipient and graft survivals. However, due to an overwhelming discrepancy between the organs available and the patients on the transplant waiting list, the vast majority of transplant candidates require prolonged periods of dialysis before being transplanted. For many years, peritoneal dialysis (PD) and hemodialysis (HD) have been considered competitive renal replacement therapies (RRT). This dualistic vision has recently been questioned by evidence suggesting that an individualized and flexible approach may be more appropriate. In fact, tailored and cleverly planned changes between different RRT modalities, according to the patient's needs and characteristics, are often needed in order to achieve the best results. While home HD is still under scrutiny in this particular setting, current data seems to favor the use of PD over in-center HD in patients awaiting a KT. In this specific population, the demonstrated advantages of PD are superior quality of life, longer preservation of residual renal function, lower incidence of delayed graft function, better recipient survival, and reduced cost.
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Affiliation(s)
- Luca Nardelli
- Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.N.); (A.S.); (P.M.); (F.T.); (G.C.)
| | - Antonio Scalamogna
- Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.N.); (A.S.); (P.M.); (F.T.); (G.C.)
| | - Piergiorgio Messa
- Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.N.); (A.S.); (P.M.); (F.T.); (G.C.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Maurizio Gallieni
- Department of Biomedical and Clinical Sciences, Università di Milano, 20157 Milan, Italy;
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, 20157 Milan, Italy
| | - Roberto Cacciola
- Department of Surgical Sciences, Università di Tor Vergata, 00133 Rome, Italy;
| | - Federica Tripodi
- Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.N.); (A.S.); (P.M.); (F.T.); (G.C.)
| | - Giuseppe Castellano
- Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.N.); (A.S.); (P.M.); (F.T.); (G.C.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Evaldo Favi
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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12
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Vernooij RWM, Law W, Peters SAE, Canaud B, Davenport A, Grooteman MPC, Kircelli F, Locatelli F, Maduell F, Morena M, Nubé MJ, Ok E, Torres F, Woodward M, Blankestijn PJ, Bots ML. The probability of receiving a kidney transplantation in end-stage kidney disease patients who are treated with haemodiafiltration or haemodialysis: a pooled individual participant data from four randomised controlled trials. BMC Nephrol 2021; 22:70. [PMID: 33632160 PMCID: PMC7905891 DOI: 10.1186/s12882-021-02265-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/29/2021] [Indexed: 01/08/2023] Open
Abstract
Background Due to a critical shortage of available kidney grafts, most patients with Stage 5 Chronic Kidney Disease (CKD5) require bridging dialysis support. It remains unclear whether treatment by different dialysis modalities changes the selection and/or preparation of a potential transplant candidate. Therefore, we assessed whether the likelihood of receiving kidney transplant (both living or deceased kidney donors) differs between haemodialysis (HD) and online haemodiafiltration (HDF) in patients with CKD5D. Methods Individual participant data from four randomised controlled trials comparing online HDF with HD were used. Information on kidney transplant was obtained during follow-up. The likelihood of receiving a kidney transplant was compared between HD and HDF, and evaluated across different subgroups: age, sex, diabetes, history of cardiovascular disease, albumin, dialysis vintage, fistula, and level of convection volume standardized to body surface area. Hazard ratios (HRs), with corresponding 95% confidence intervals (95% CI), comparing the effect of online HDF versus HD on the likelihood of receiving a kidney transplant, were estimated using Cox proportional hazards models with a random effect for study. Results After a median follow-up of 2.5 years (Q1 to Q3: 1.9–3.0), 331 of the 1620 (20.4%) patients with CKD5D received a kidney transplant. This concerned 22% (n = 179) of patients who were treated with online HDF compared with 19% (n = 152) of patients who were treated with HD. No differences in the likelihood of undergoing a kidney transplant were found between the two dialysis modalities in both the crude analyse (HR: 1.07, 95% CI: 0.86–1.33) and adjusted analysis for age, sex, diabetes, cardiovascular history, albumin, and creatinine (HR: 1.15, 95%-CI: 0.92–1.44). There was no evidence for a differential effect across subgroups based on patient- and disease-characteristics nor in different categories of convection volumes. Conclusions Treatment with HD and HDF does not affect the selection and/or preparation of CKD5D patients for kidney transplant given that the likelihood of receiving a kidney transplant does not differ between the dialysis modalities. These finding persisted across a variety of subgroups differing in patient and disease characteristics and is not affected by the level of convection volume delivered during HDF treatment sessions.
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Affiliation(s)
- Robin W M Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Way Law
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands.,Wai-ping Law, Renal unit, Department of medicine, Queen Elizabeth Hospital, Hong Kong, PR China
| | - Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,The George Institute for Global Health, School of Public Health, Imperial College, London, UK.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Bernard Canaud
- Global Medical Office, Fresenius Medical Care Deutschland, Bad Homburg, Germany.,Montpellier University, School of Medicine, Montpellier, France
| | - Andrew Davenport
- University College London, Centre for Nephrology, Royal Free Hospital, London, UK
| | - Muriel P C Grooteman
- Department of Nephrology and Amsterdam Cardiovascular Sciences (ACS), Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands
| | - Fatih Kircelli
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Francesco Locatelli
- Department of Nephrology, Alessandro Manzoni Hospital, past director, Lecco, Italy
| | | | - Marion Morena
- PhyMedExp, University of Montpellier, INSERM, CNRS, Biochemistry/Hormonology department, University Hospital Center of Montpellier, Montpellier, France
| | - Menso J Nubé
- Department of Nephrology and Amsterdam Cardiovascular Sciences (ACS), Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands
| | - Ercan Ok
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | - Ferran Torres
- Biostatistics Unit, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Medical Statistics core facility, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - Mark Woodward
- The George Institute for Global Health, School of Public Health, Imperial College, London, UK.,The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Peter J Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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13
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Changes in body composition in peritoneal dialysis patients after kidney transplantation. Int Urol Nephrol 2021; 53:383-390. [PMID: 33387221 DOI: 10.1007/s11255-020-02713-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Serial follow-up data of body composition from peritoneal dialysis (PD) initiation until 1 year after kidney transplantation (KT) would be useful in identifying pathologic or physiologic changes, related to each modality or during the exchange of the modality. METHODS Body composition analysis was performed 1 month after PD initiation, repeated annually, immediately before KT, 1 month and 1 year after KT (n = 43). Body composition analysis was performed using a bioimpedance analysis (BIA) machine. The body composition parameters measured using BIA included the water contents, fat mass index (FMI), appendicular muscle mass index (aMMI), and bone mineral content (BMC). RESULTS The aMMI values 1 month and 1 year after PD initiation, immediately before KT, and 1 month and 1 year after KT were 7.6 ± 1.5, 7.8 ± 1.4, 8.0 ± 1.4, 6.8 ± 0.9, and 7.0 ± 1.0 kg/m2, respectively. The aMMI increased during the first year of PD (P = 0.029) and was maintained during the remaining period of PD (P = 0.413). The value decreased during the first month after KT (P < 0.001) and recovered during the first year after KT (P = 0.010). FMI increased during the first year of PD (P < 0.001) and was maintained during the remaining period of PD (P = 0.214). The value increased during the first year of KT (P < 0.001). BMC was stable during the PD period but decreased after KT. Body waters were maintained during PD and decreased after KT. The presence of low muscle mass (LMM) 1 month after PD initiation or 1 month after KT, was associated with development of LMM 1 year after KT. CONCLUSION Our study showed that body composition was significantly changed during the first year after PD or the first month after KT, as evidenced by a decrease in aMMI and BMC and an increase in FMI. Adequate interventions provided at these two points might help maintain proper body composition.
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14
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Etta P. Automated peritoneal dialysis is a superior option for the management of postrenal transplant delayed graft function. INDIAN JOURNAL OF TRANSPLANTATION 2020. [DOI: 10.4103/ijot.ijot_43_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Balzer MS, Pankow S, Claus R, Dumann E, Ruben S, Haller H, Einecke G. Pretransplant dialysis modality and long‐term patient and kidney allograft outcome: a 15‐year retrospective single‐centre cohort study. Transpl Int 2019; 33:376-390. [DOI: 10.1111/tri.13552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/02/2019] [Accepted: 11/03/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Michael S. Balzer
- Department of Nephrology and Hypertension Hannover Medical School Hannover Germany
| | - Stephanie Pankow
- Department of Nephrology and Hypertension Hannover Medical School Hannover Germany
| | - Robert Claus
- Department of Nephrology and Hypertension Hannover Medical School Hannover Germany
| | - Eva Dumann
- Department of Nephrology and Hypertension Hannover Medical School Hannover Germany
| | - Stephan Ruben
- Department of Pediatric Kidney, Liver and Metabolic Diseases Hannover Medical School Hannover Germany
| | - Hermann Haller
- Department of Nephrology and Hypertension Hannover Medical School Hannover Germany
| | - Gunilla Einecke
- Department of Nephrology and Hypertension Hannover Medical School Hannover Germany
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16
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Jain D, Haddad DB, Goel N. Choice of dialysis modality prior to kidney transplantation: Does it matter? World J Nephrol 2019. [DOI: 10.5527/wjn.v8.i1.0000] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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17
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Jain D, Haddad DB, Goel N. Choice of dialysis modality prior to kidney transplantation: Does it matter? World J Nephrol 2019; 8:1-10. [PMID: 30705867 PMCID: PMC6354079 DOI: 10.5527/wjn.v8.i1.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/05/2018] [Accepted: 01/09/2019] [Indexed: 02/06/2023] Open
Abstract
The population of patients with end stage renal disease (ESRD) is increasing, lengthening waiting lists for kidney transplantation. Majority of the patients are not able to receive a kidney transplant in timely manner even though it is well established that patient survival and quality of life after kidney transplantation is far better when compared to being on dialysis. A large number of patients who desire a kidney transplant ultimately end up needing some form of dialysis therapy. Most of incident ESRD patients choose hemodialysis (HD) over peritoneal dialysis (PD) as the modality of choice in the United States, even though studies have favored PD as a better choice of pre-transplant dialysis modality than HD. PD is largely underutilized in the United States due to variety of reasons. As a part of the decision making process, patients are often educated how the choice regarding modality of dialysis would fit into their life but it is not clear and not usually discussed, how it can affect eventual kidney transplantation in the future. In this article we would like to discuss ESRD demographics and outcomes, modality of dialysis and kidney transplant related events. We have summarized the data comparing PD and HD as the modality of dialysis and its impact on allograft and recipient outcomes after kidney transplantation.
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Affiliation(s)
- Deepika Jain
- Nephrology and Internal Medicine, New Jersey Kidney Care, Jersey city, NJ 07305, United States
| | - Danny B Haddad
- Nephrology and Internal Medicine, New Jersey Kidney Care, Jersey city, NJ 07305, United States
- Department of Internal Medicine, Division of Nephrology, RWJ-Jersey City Medical Center, Jersey city, NJ 07305, United States
| | - Narender Goel
- Nephrology and Internal Medicine, New Jersey Kidney Care, Jersey city, NJ 07305, United States
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18
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Lin HT, Liu FC, Lin JR, Pang ST, Yu HP. Impact of the pretransplant dialysis modality on kidney transplantation outcomes: a nationwide cohort study. BMJ Open 2018; 8:e020558. [PMID: 29866727 PMCID: PMC5988177 DOI: 10.1136/bmjopen-2017-020558] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Most patients with uraemia must undergo chronic dialysis while awaiting kidney transplantation; however, the role of the pretransplant dialysis modality on the outcomes of kidney transplantation remains obscure. The objective of this study was to clarify the associations between the pretransplant dialysis modality, namely haemodialysis (HD) or peritoneal dialysis (PD), and the development of post-transplant de novo diseases, allograft failure and all-cause mortality for kidney-transplant recipients. DESIGN Retrospective nationwide cohort study. SETTING Data retrieved from the Taiwan National Health Insurance Research Database. PARTICIPANTS The National Health Insurance database was explored for patients who received kidney transplantation in Taiwan during 1998-2011 and underwent dialysis >90 days before transplantation. OUTCOME MEASURES The pretransplant characteristics, complications during kidney transplantation and post-transplant outcomes were statistically analysed and compared between the HD and PD groups. Cox regression analysis was used to evaluate the HR of the dialysis modality on graft failure and all-cause mortality. The primary outcomes were long-term post-transplant death-censored allograft failure and all-cause mortality started after 90 days of kidney transplantation until the end of follow-up. The secondary outcomes were events during kidney transplantation and post-transplant de novo diseases adjusted by propensity score in log-binomial model. RESULTS There were 1812 patients included in our cohort, among which 1209 (66.7%) and 603 (33.3%) recipients received pretransplant HD and PD, respectively. Recipients with chronic HD were generally older and male, had higher risks of developing post-transplant de novo ischaemic heart disease, tuberculosis and hepatitis C after adjustment. Pretransplant HD contributed to higher graft failure in the multivariate analysis (HR 1.38, p<0.05) after adjustment for the recipient age, sex, duration of dialysis and pretransplant diseases. There was no significant between-group difference in overall survival. CONCLUSIONS Pretransplant HD contributed to higher risks of death-censored allograft failure after kidney transplantation when compared with PD.
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Affiliation(s)
- Huan-Tang Lin
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Fu-Chao Liu
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jr-Rung Lin
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Clinical Informatics and Medical Statistics Research Center, Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan
| | - See-Tong Pang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Urology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Huang-Ping Yu
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Anesthesiology, Xiamen Changgung Hospital, Taoyuan, Taiwan
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19
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Davidson I, Gallieni M, Saxena R, Dolmatch B. A Patient Centered Decision Making Dialysis Access Algorithm. J Vasc Access 2018. [DOI: 10.1177/112972980700800201] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Much controversy surrounds the establishment of proper planning, placement and management (the best practice pattern) of dialysis access. These include the dialysis type and modality selection, timing of access placement and who places the access. The lack of and the difficulty of performing randomized studies with multiple confounding factors, in an extremely heterogeneous and rapidly changing ESRD population demographics, only partly explains the dialysis access conundrum. Add to this the rapidly developing and competing technologies, the wide spectrum of the professional experience, bias and socio-economic forces to make the ESRD problems as multivariate and complex as life itself. This overview describes a dialysis access algorithm approach to the patient needing renal replacement therapy, considering long-term improved patient outcome as the ultimate objective.
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Affiliation(s)
- I. Davidson
- Division of Transplant, Department of Surgery, Parkland Memorial Hospital, University of Texas Southwestern Medical Center, Dallas - USA
| | - M. Gallieni
- Renal Unit San Paolo Hospital, University of Milan - Italy
| | - R. Saxena
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas - USA
| | - B. Dolmatch
- Division of Interventional Radiology, University of Texas Southwestern Medical Center, Dallas - USA
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20
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Dębska-Ślizień A, Bobkowska-Macuk A, Bzoma B, Moszkowska G, Milecka A, Zadrożny D, Wołyniec W, Chamienia A, Lichodziejewska-Niemierko M, Król E, Śledziński Z, Rutkowski B. Paired Analysis of Outcomes After Kidney Transplantation in Peritoneal and Hemodialysis Patients. Transplant Proc 2018; 50:1646-1653. [PMID: 29961550 DOI: 10.1016/j.transproceed.2018.02.104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/09/2018] [Accepted: 02/23/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND The impact of dialysis modality before kidney transplantation (hemodialysis or peritoneal dialysis) on outcomes is not clear. In this study we retrospectively analyzed the impact of dialysis modality on posttransplant follow-up. METHODS To minimize donor bias, a paired kidney analysis was applied. One hundred thirty-three pairs of peritoneal dialysis (PD) and hemodialysis (HD) patients were transplanted at our center between 1994 and 2016. Those who received kidneys from the same donor were included in the study. HD patients were significantly older (44 vs 48 years), but the Charlson Comorbidity Index was similar (3.12 vs 3.46) in both groups. The groups did not differ significantly with respect to immunosuppressive protocols and number of mismatches (2.96 vs 2.95). RESULTS One-year patient (98% vs 96%) and graft (90% vs 93%) survival was similar in the PD and HD patient groups. The Kaplan-Meier curves of the patients and graft survival did not differ significantly. Delayed graft function (DGF) and acute rejection (AR) occurred significantly more often in the HD recipients. Graft vessel thrombosis resulting in graft loss occurred in 9 PD (6.7%) and 4 HD (3%) patients (P > .05). Serum creatinine concentration and estimated glomerular filtration rate (using the Modification of Diet in Renal Disease guidelines) showed no difference at 1 month, 1 year, and at final visit. On multivariate analysis, factors significantly associated with graft loss were graft vessel thrombosis, DGF, and graft function 1 month after transplantation. On univariate analysis, age, coronary heart disease, and graft loss were associated with death. Among these factors, only coronary heart disease (model 1) and graft loss were significant predictors of death on multivariate analysis. CONCLUSION The long-term outcome for renal transplantation is similar in patients with PD and HD. These groups differ in some aspects, however, such as susceptibility to vascular thrombosis in PD patients, and to DGF and AR in HD patients.
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Affiliation(s)
- A Dębska-Ślizień
- Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdansk, Gdansk, Poland.
| | - A Bobkowska-Macuk
- Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
| | - B Bzoma
- Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
| | - G Moszkowska
- Department of Clinical Immunology and Transplantology, Medical University of Gdansk, Gdansk, Poland
| | - A Milecka
- Department of General, Endocrine, and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland
| | - D Zadrożny
- Department of General, Endocrine, and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland
| | - W Wołyniec
- Department of Occupational, Metabolic and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
| | - A Chamienia
- Kidney Transplant Regional Waiting List, Medical University of Gdansk, Gdansk, Poland; Department of General Nursing, Faculty of Medical Sciences, Medical University of Gdansk, Gdansk, Poland
| | | | - E Król
- Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Z Śledziński
- Department of General, Endocrine, and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland
| | - B Rutkowski
- Department of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
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21
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See EJ, Hawley CM, Cho Y, Toussaint ND, Agar JW, Pascoe EM, Lim WH, Francis RS, Collins MG, Johnson DW. Comparison of graft and patient outcomes following kidney transplantation in extended hour and conventional haemodialysis patients. Nephrology (Carlton) 2018; 24:111-120. [PMID: 29316017 DOI: 10.1111/nep.13221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2018] [Indexed: 11/29/2022]
Abstract
AIM Differences in early graft function between kidney transplant recipients previously managed with either haemodialysis (HD) or peritoneal dialysis are well described. However, only two single-centre studies have compared graft and patient outcomes between extended hour and conventional HD patients, with conflicting results. METHODS This study compared the outcomes of all extended hour (≥24 h/week) and conventional HD patients transplanted in Australia and New Zealand between 2000 and 2014. The primary outcome was delayed graft function (DGF), defined in an ordinal manner as either a spontaneous fall in serum creatinine of less than 10% within 24 h, or the need for dialysis within 72 h following transplantation. Secondary outcomes included the requirement for dialysis within 72 h post-transplant, acute rejection, estimated glomerular filtration rate at 12 months, death-censored graft failure, all-cause and cardiovascular mortality, and a composite of graft failure and mortality. RESULTS A total of 4935 HD patients (378 extended hour HD, 4557 conventional HD) received a kidney transplant during the study period. Extended hour HD was associated with an increased likelihood of DGF compared with conventional HD (adjusted proportional odds ratio 1.33; 95% confidence interval 1.06-1.67). There was no significant difference between extended hour and conventional HD in terms of any of the secondary outcomes. CONCLUSION Compared to conventional HD, extended hour HD was associated with DGF, although long-term graft and patient outcomes were not different.
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Affiliation(s)
- Emily J See
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Carmel M Hawley
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, Brisbane, Queensland, Australia
| | - Yeoungjee Cho
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, Brisbane, Queensland, Australia
| | - Nigel D Toussaint
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia.,Department of Nephrology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - John Wm Agar
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia.,Department of Nephrology, University Hospital Geelong, Geelong, Victoria, Australia
| | - Elaine M Pascoe
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, Brisbane, Queensland, Australia
| | - Wai H Lim
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia.,Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Ross S Francis
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Michael G Collins
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia.,Department of Nephrology, Auckland City Hospital, Auckland, New Zealand
| | - David W Johnson
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, Brisbane, Queensland, Australia
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22
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Pampa-Saico S, Caravaca-Fontán F, Burguera-Vion V, Nicolás VD, Yerovi-León E, Jimenez-Álvaro S, Fernández-Rodríguez A, Marcén R, Rivera-Gorrín M. Outcomes of Peritoneal Dialysis Catheter Left In Place after Kidney Transplantation. Perit Dial Int 2017; 37:651-654. [PMID: 29123003 DOI: 10.3747/pdi.2017.00031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
No clear consensus has been reached regarding the optimal time to remove the peritoneal dialysis catheter (PDC) after kidney transplantation (KT). This retrospective observational study, conducted in a single peritoneal dialysis (PD) unit including all PD patients who received a KT between 1995 - 2015, was undertaken to evaluate the clinical outcomes and potential complications associated with a PDC left in place after KT. Of the 132 PD patients who received a KT, 20 were excluded from the study. Of the remaining, 112 (85%) patients with functioning KT were discharged with their PDC left in place and had it removed in a mean interval of 5 ± 3 months after KT, after achieving optimal graft function. During this follow-up period, 7 patients (6%) developed exit-site infection and there were 2 cases (2%) of peritonitis; all of them were successfully treated. Delayed PDC removal after KT is associated with low complication rates, although regular examination is needed so that mild infections can be detected early and therapy promptly instituted.
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Affiliation(s)
- Saúl Pampa-Saico
- Department of Nephrology, Hospital Universitario Ramón y Cajal (HURyC), Madrid, Spain .,Instituto Ramón y Cajal de Investigación Sanitaria (IRyCis), RedinRenISCIII (ERC 10 RD12/0021/0020), Madrid, Spain
| | - Fernando Caravaca-Fontán
- Department of Nephrology, Hospital Universitario Ramón y Cajal (HURyC), Madrid, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRyCis), RedinRenISCIII (ERC 10 RD12/0021/0020), Madrid, Spain
| | - Víctor Burguera-Vion
- Department of Nephrology, Hospital Universitario Ramón y Cajal (HURyC), Madrid, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRyCis), RedinRenISCIII (ERC 10 RD12/0021/0020), Madrid, Spain
| | - Víctor Diéz Nicolás
- Department of Urology, Hospital Universitario Ramón y Cajal (HURyC), Madrid, Spain
| | - Estefanía Yerovi-León
- Department of Nephrology, Hospital Universitario Ramón y Cajal (HURyC), Madrid, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRyCis), RedinRenISCIII (ERC 10 RD12/0021/0020), Madrid, Spain
| | - Sara Jimenez-Álvaro
- Department of Nephrology, Hospital Universitario Ramón y Cajal (HURyC), Madrid, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRyCis), RedinRenISCIII (ERC 10 RD12/0021/0020), Madrid, Spain
| | - Ana Fernández-Rodríguez
- Department of Nephrology, Hospital Universitario Ramón y Cajal (HURyC), Madrid, Spain.,Facultad de Medicina, Universidad de Alcalá, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRyCis), RedinRenISCIII (ERC 10 RD12/0021/0020), Madrid, Spain
| | - Roberto Marcén
- Department of Nephrology, Hospital Universitario Ramón y Cajal (HURyC), Madrid, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRyCis), RedinRenISCIII (ERC 10 RD12/0021/0020), Madrid, Spain
| | - Maite Rivera-Gorrín
- Department of Nephrology, Hospital Universitario Ramón y Cajal (HURyC), Madrid, Spain.,Facultad de Medicina, Universidad de Alcalá, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRyCis), RedinRenISCIII (ERC 10 RD12/0021/0020), Madrid, Spain
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23
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McKane WS. Should Nephrologists Promote Peritoneal Dialysis as a Bridge to Transplantation? Perit Dial Int 2017; 37:247-249. [PMID: 28512161 DOI: 10.3747/pdi.2016.00269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- William S McKane
- Sheffield Kidney Institute, Northern General Hospital, Sheffield, UK
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24
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Outcomes of Kidney Recipients According to Mode of Pretransplantation Renal Replacement Therapy. Transplant Proc 2017; 48:2461-2463. [PMID: 27742322 DOI: 10.1016/j.transproceed.2016.02.096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 02/02/2016] [Indexed: 02/08/2023]
Abstract
The effects of pretransplantation dialysis modality on graft function are key issues in end-stage renal disease patients. The aim of this study was to evaluate post-transplantation outcomes according to pretransplantation renal replacement therapy modality in deceased-donor kidney transplantation. Among 444 deceased-donor kidney transplant recipients in Severance Hospital between April 1993 and Dec 2014, 275 who maintained a unique dialysis modality (hemodialysis [HD; n = 178] or peritoneal dialysis [PD; n = 97]) until transplantation were enrolled. There were no significant differences in sex, age, human leukocyte antigen mismatch, cold ischemic time, or duration of dialysis between groups. There was also no difference in 5-year graft survival between HD and PD groups (87.7% vs. 82.3%, respectively; P = .148). On multivariate Cox regression for risk factors affecting graft survival, renal replacement therapy modality was not found to be a risk factor. However, the rate of delayed graft function was higher in the HD group than in the PD group (32.0% vs. 19.6%, respectively; P = .028). In addition, graft function at 1 week after transplantation in the PD group was superior to that in the HD group. The pretransplantation dialysis modality was found to affect both delayed graft function and early graft function, although not graft survival.
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25
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Joachim E, Gardezi AI, Chan MR, Shin JI, Astor BC, Waheed S. Association of Pre-Transplant Dialysis Modality and Post-Transplant Outcomes: A Meta-Analysis. Perit Dial Int 2016; 37:259-265. [PMID: 28007762 DOI: 10.3747/pdi.2016.00011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 09/02/2016] [Indexed: 11/15/2022] Open
Abstract
♦ BACKGROUND: It remains unclear whether post-transplant outcomes differ according to the pre-transplant dialysis modality (peritoneal dialysis [PD] versus hemodialysis [HD]). We performed a meta-analysis of studies that assessed either post-transplant mortality, graft survival, or delayed graft function (DGF) in both PD and HD patients. ♦ METHODS: Two independent authors searched English-language literature from January 1, 1980, through August 31, 2014, national conference proceedings, and reference lists. We used combinations of terms related to dialysis (hemodialysis, peritoneal dialysis, or renal replacement therapy), kidney transplant, and outcomes. Studies were included if they measured any of the 3 post-transplant study outcomes in both pre-transplant HD and PD. ♦ RESULTS: A total of 16 studies were included in the final analysis. Of these, 6 studies reported adjusted hazard ratio for mortality, pooled adjusted risk ratio: 0.89 (95% confidence interval [CI] 0.82 - 0.97) in favor of PD (p = 0.006). The same 6 studies reported adjusted hazard ratio for graft survival, pooled adjusted risk ratio: 0.97 (95% CI 0.92 - 1.01, p = 0.16). A total of 13 studies reported unadjusted DGF. Pooled odds ratio: 0.5 (95% CI 0.41 - 0.63) in favor of PD (p < 0.005). Significant heterogeneity observed for all outcomes: I2 = 72.7%, I2 = 59.9%, and I2 = 66.8%, respectively. ♦ CONCLUSIONS: Based on these results, pre-transplant PD is associated with better post-transplant survival than HD. Pre-transplant PD was also associated with decreased risk for DGF compared with HD, although these results were unadjusted. There was no significant difference in graft survival between pre-transplant HD and PD. These results suggest that PD may be the preferred dialysis modality for patients expected to receive a transplant.
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Affiliation(s)
- Emily Joachim
- Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Ali I Gardezi
- Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Micah R Chan
- Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Jung-Im Shin
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Brad C Astor
- Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.,Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Sana Waheed
- Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
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26
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Yoo KD, Kim CT, Kim MH, Noh J, Kim G, Kim H, An JN, Park JY, Cho H, Kim KH, Kim H, Ryu DR, Kim DK, Lim CS, Kim YS, Lee JP. Superior outcomes of kidney transplantation compared with dialysis: An optimal matched analysis of a national population-based cohort study between 2005 and 2008 in Korea. Medicine (Baltimore) 2016; 95:e4352. [PMID: 27537562 PMCID: PMC5370789 DOI: 10.1097/md.0000000000004352] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Data regarding kidney transplantation (KT) and dialysis outcomes are rare in Asian populations. In the present study, we evaluated the clinical outcomes associated with KT using claims data from the Korean national public health insurance program. Among the 35,418 adult patients with incident dialysis treated between 2005 and 2008 in Korea, 1539 underwent KT. An optimal balanced risk set matching was attempted to compare the transplant group with the control group in terms of the overall survival and major adverse cardiac event-free survival. Before matching, the dialysis group was older and had more comorbidities. After matching, there were no differences in age, sex, dialysis modalities, or comorbidities. Patient survival was significantly better in the transplant group than in the matched control group (P < 0.001). In addition, the transplant group showed better major adverse cardiac event-free survival than the dialysis group (P < 0.001; hazard ratio, 0.49; 95% confidence interval, 0.32-0.75). Korean patients with incident dialysis who underwent long-term dialysis had significantly more cardiovascular events and higher all-cause mortality rates than those who underwent KT. Thus, KT should be more actively recommended in Korean populations.
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Affiliation(s)
- Kyung Don Yoo
- Department of Internal Medicine, Division of Nephrology, Dongguk University Medical Center
| | | | - Myoung-Hee Kim
- Department of Dental Hygiene, College of Health Science, Eulji University, Daejeon
| | - Junhyug Noh
- College of Engineering, Seoul National University
| | - Gunhee Kim
- College of Engineering, Seoul National University
| | - Ho Kim
- School of Public Health, Seoul National University, Seoul
| | - Jung Nam An
- Department of Internal Medicine, Seoul National University Boramae Medical Center
| | - Jae Yoon Park
- Department of Internal Medicine, Division of Nephrology, Dongguk University Medical Center
| | - Hyunjeong Cho
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Kyoung Hoon Kim
- Department of Public Health, Graduate School, Korea University, Seoul
| | - Hyunwook Kim
- Department of Internal Medicine, Wonkwang University College of Medicine, Sanbon Hospital, Gyeonggi-do
| | - Dong-Ryeol Ryu
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center
- Correspondence: Jung Pyo Lee, Department of Internal Medicine, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 156-707, Republic of Korea (e-mail: )
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27
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Dipalma T, Fernández-Ruiz M, Praga M, Polanco N, González E, Gutiérrez-Solis E, Gutiérrez E, Andrés A. Pre-transplant dialysis modality does not influence short- or long-term outcome in kidney transplant recipients: analysis of paired kidneys from the same deceased donor. Clin Transplant 2016; 30:1097-107. [PMID: 27334715 DOI: 10.1111/ctr.12793] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2016] [Indexed: 01/26/2023]
Abstract
Previous studies have reported contradictory results regarding the effect of pre-transplant dialysis modality on the outcomes after kidney transplantation (KT). To minimize the confounding effect of donor-related variables, we performed a donor-matched retrospective comparison of 160 patients that received only one modality of pre-transplant dialysis (peritoneal dialysis [PD] and hemodialysis [HD] in 80 patients each) and that subsequently underwent KT at our center between January 1990 and December 2007. Cox regression models were used to evaluate the association between pre-transplant dialysis modality and primary study outcomes (death-censored graft survival and patient survival). To control for imbalances in recipient-related baseline characteristics, we performed additional adjustments for the propensity score (PS) for receiving pre-transplant PD (versus HD). There were no significant differences according to pre-transplant dialysis modality in death-censored graft survival (PS-adjusted hazard ratio [aHR]: 0.65; 95% confidence interval [95% CI]: 0.25-1.68) or patient survival (aHR: 0.58; 95% CI: 0.13-2.68). There were no differences in 10-year graft function or in the incidence of post-transplant complications either, except for a higher risk of lymphocele in patients undergoing PD (odds ratio: 4.31; 95% CI: 1.15-16.21). In conclusion, pre-transplant dialysis modality in KT recipients does not impact short- or long-term graft outcomes or patient survival.
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Affiliation(s)
- Teresa Dipalma
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Manuel Praga
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Natalia Polanco
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Esther González
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Elena Gutiérrez-Solis
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Eduardo Gutiérrez
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Amado Andrés
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain.
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28
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Vanholder R, Lameire N, Annemans L, Van Biesen W. Cost of renal replacement: how to help as many as possible while keeping expenses reasonable? Nephrol Dial Transplant 2015; 31:1251-61. [PMID: 26109485 DOI: 10.1093/ndt/gfv233] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 05/12/2015] [Indexed: 02/06/2023] Open
Abstract
The treatment of kidney diseases consumes a substantial amount of the health budget for a relatively small fraction of the overall population. If the nephrological community and society do not develop mechanisms to contain those costs, it will become impossible to continue assuring optimal outcomes and quality of life while treating all patients who need it. In this article, we describe several mechanisms to maintain sustainability of renal replacement therapy. These include (i) encouragement of transplantation after both living and deceased donation; (ii) stimulation of alternative dialysis strategies besides classical hospital haemodialysis, such as home haemodialysis, peritoneal dialysis or self-care and necessitating less reimbursement; (iii) promotion of educational activities guiding the patients towards therapies that are most suited for them; (iv) consideration of one or more of cost containment incentives such as bundling of reimbursement (if not affecting quality of the treatment), timely patient referral, green dialysis, start of dialysis based on clinical necessity rather than renal function parameters and/or prevention of CKD or its progression; (v) strategically planned adaptations to the expected growth of the ageing population in need of renal replacement; (vi) the necessity for support of research in the direction of helping as large as possible patient populations for acceptable costs; and (vii) the need for more patient-centred approaches. We also extend the discussion to the specific situation of kidney diseases in low- and middle-income countries. Finally, we point to the dramatic differences in accessibility and reimbursement of different modalities throughout Europe. We hope that this text will offer a framework for the nephrological community, including patients and nurses, and the concerned policy makers and caregivers on how to continue reaching all patients in need of renal replacement for affordable expenses.
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Affiliation(s)
- Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, University Hospital Ghent, Ghent, Belgium
| | - Norbert Lameire
- Nephrology Section, Department of Internal Medicine, University Hospital Ghent, Ghent, Belgium
| | - Lieven Annemans
- Department of Public Health, University Ghent, Ghent, Belgium
| | - Wim Van Biesen
- Nephrology Section, Department of Internal Medicine, University Hospital Ghent, Ghent, Belgium
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29
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Abraham G, Varughese S, Mathew M, Vijayan M. A review of acute and chronic peritoneal dialysis in developing countries. Clin Kidney J 2015; 8:310-7. [PMID: 26034593 PMCID: PMC4440475 DOI: 10.1093/ckj/sfv029] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 04/13/2015] [Indexed: 12/19/2022] Open
Abstract
Various modalities of renal replacement therapy (RRT) are available for the management of acute kidney injury (AKI) and end-stage renal disease (ESRD). While developed countries mainly use hemodialysis as a form of RRT, peritoneal dialysis (PD) has been increasingly utilized in developing countries. Chronic PD offers various benefits including lower cost, home-based therapy, single access, less requirement of highly trained personnel and major infrastructure, higher number of patients under a single nephrologist with probably improved quality of life and freedom of activities. PD has been found to be lifesaving in the management of AKI in patients in developing countries where facilities for other forms of RRT are not readily available. The International Society of Peritoneal Dialysis has published guidelines regarding the use of PD in AKI, which has helped in ensuring uniformity. PD has also been successfully used in certain special situations of AKI due to snake bite, malaria, febrile illness, following cardiac surgery and in poisoning. Hemodialysis is the most common form of RRT used in ESRD worldwide, but some countries have begun to adopt a 'PD first' policy to reduce healthcare costs of RRT and ensure that it reaches the underserved population.
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Affiliation(s)
- Georgi Abraham
- Madras Medical Mission Hospital , Chennai, Tamil Nadu , India ; Pondicherry Institute of Medical Sciences , Pondicherry, Tamil Nadu , India
| | | | - Milly Mathew
- Madras Medical Mission Hospital , Chennai, Tamil Nadu , India
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30
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Guedes-Marques M, Romãozinho C, Santos L, Macário F, Alves R, Mota A. Kidney Transplantation: Which Variables Should Be Improved? Transplant Proc 2015; 47:914-9. [DOI: 10.1016/j.transproceed.2015.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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31
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Donovan K, Carrington C. Peritoneal dialysis outcomes after temporary haemodialysis for peritonitis--influence on current practice. Nephrol Dial Transplant 2014; 29:1803-5. [DOI: 10.1093/ndt/gfu210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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32
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Janus kinase signaling activation mediates peritoneal inflammation and injury in vitro and in vivo in response to dialysate. Kidney Int 2014; 86:1187-96. [PMID: 25007168 DOI: 10.1038/ki.2014.209] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 04/17/2014] [Accepted: 04/24/2014] [Indexed: 11/08/2022]
Abstract
Peritoneal membrane pathology limits long-term peritoneal dialysis (PD). Here, we tested whether JAK/STAT signaling is implicated and if its attenuation might be salutary. In cultured mesothelial cells, PD fluid activated, and the pan-JAK inhibitor P6 reduced, phospho-STAT1 and phospho-STAT3, periostin secretion, and cleaved caspase-3. Ex vivo, JAK was phosphorylated in PD effluent cells from long-term but not new PD patients. MCP-1 and periostin were increased in PD effluent in long term compared with new patients. In rats, twice daily, PD fluid infusion induced phospho-JAK, mesothelial cell hyperplasia, inflammation, fibrosis, and hypervascularity after 10 days of exposure to PD fluid. Concomitant instillation of a JAK1/2 inhibitor virtually completely attenuated these changes. Thus, our studies directly implicate JAK/STAT signaling in the mediation of peritoneal membrane pathology as a consequence of PD.
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33
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The Maintenance Immunosuppression Scheme Influences Early C4d Urinary Excretion in Kidney Graft Recipients but Does Not Affect the Long-term Graft Survival. Am J Ther 2014; 23:e778-84. [PMID: 24777031 DOI: 10.1097/mjt.0000000000000071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
C4d urinary excretion varies according to the risk of graft rejection or progression of chronic allograft nephropathy. The most common maintenance immunosuppression (IS) schemes include cyclosporine (CSA) or tacrolimus (TAC) with azathiopryne (AZA) or mycophenolate mophetil (MMF). The chosen IS may influence kidney transplant outcomes and possibly modify urinary C4d. The aim of the study was to determine whether early C4d urinary excretion varies in patients after kidney allograft transplantation (KTx) regarding administered IS and if these factors may help to predict long-term KTx outcomes. The study involved 185 patients who underwent KTx. The urinary specimens were assessed by enzyme-linked immunosorbent assay test for C4d excretion. To increase the objectivity, C4d excretion was divided by urinary creatinine excretion (ng/mgCr). The study population was grouped according to the IS scheme, that is, CSA + AZA, CSA + MMF, and TAC + MMF. At baseline, the greatest C4d urinary excretion was noticed in patients treated with CSA + AZA, 199.5 ± 175.9 ng/mL (5.3 ± 7.1 ng/mgCr) and the lowest in those in whom tacrolimus and mycophenolate mophetil was administered, 166.6 ± 186.3 ng/mL (3.9 ± 6.2 ng/mgCr). In the CSA + MMF group, C4d excretion was 195.6 ± 200.3 ng/mL (5.0 ± 6.6 ng/mgCr). Statistically significant differences were seen only between the CSA + AZA and TAC + MMF groups, analysis of variance P < 0.05 (P < 0.01 for C4d/urinary creatinine ratio). No statistically significant differences were found in graft survival rates between different immunosuppressive regimens. Although early C4d measurements vary in patients after kidney allograft transplantation regarding administered IS, this IS dependant variation does not seem to affect the long-term graft survival.
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Zwiech R. Absence of C4d urinary excretion in the early post-transplant period is associated with improved long-term kidney graft survival. Transpl Immunol 2013; 30:7-11. [PMID: 24291495 DOI: 10.1016/j.trim.2013.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 11/18/2013] [Accepted: 11/19/2013] [Indexed: 11/25/2022]
Abstract
INTRODUCTION C4d urinary excretion varies according to the risk of graft rejection or progression of chronic allograft nephropathy, but its influence on long-term kidney transplant (KTx) outcomes remains unclear. The aim of the study was to determine whether the initial (1-3 months post KTx) level of C4d urinary excretion may help to predict long-term kidney allograft transplantation outcomes. MATERIALS AND METHODS The study involved 185 patients who had undergone KTx. The urinary specimens taken from the morning urine portion were assessed by ELISA test for C4d excretion. To increase the objectivity of the assessment, all measurements were divided by urinary creatinine excretion (ng/mgCr). The study population was grouped according to the C4d excretion cut-off value into low (LC4d, 109 participants) and high (HC4d, 76 participants) C4d excretion groups. Additionally a subgroup with absence of C4d in the urine (ZC4d, 26 patients) was formed. RESULTS The calculated Roc curve indicated the cut off value of the urinary C4d excretion as 12.4ng/mgCr (AUC 0.77; 95%CI 0.73-0.95). The mean C4d urinary excretions in LC4d and HC4d were 1.9±3.27 and 20.6±4.6ng/mgCr, respectively, whereas after exclusion of ZC4d subgroup, the mean C4d was 14.9±6.3ng/mgCr in the remainder. Kaplan-Meier curve analysis demonstrated a slightly higher graft survival rate (GSR) in LC4d than in HC4d group (p=0.04 by log-rank). The subsequent analysis showed the highest GSR in ZC4d subgroup (p=0.0006 by log-rank). CONCLUSION Although lower C4d urinary excretion in the early post-transplant period seems to be associated with better long-term kidney allograft transplantation outcomes, only its absence in the urine appears to be a solid predictor of improved graft survival.
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Affiliation(s)
- Rafał Zwiech
- Department of Kidney Transplantation, Medical University of Lodz, Poland; Dialysis Department, Norbert Barlicki Memorial Teaching Hospital No. 1, 90-153 Lodz, Kopcinskiego 22, Poland.
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López-Oliva MO, Rivas B, Pérez-Fernández E, Ossorio M, Ros S, Chica C, Aguilar A, Bajo MA, Escuin F, Hidalgo L, Selgas R, Jiménez C. Pretransplant peritoneal dialysis relative to hemodialysis improves long-term survival of kidney transplant patients: a single-center observational study. Int Urol Nephrol 2013; 46:825-32. [PMID: 24014131 DOI: 10.1007/s11255-013-0521-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 07/15/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Kidney transplantation is the best option for the treatment of end-stage renal disease in terms of survival and quality of life. These results can be influenced by the pretransplant dialysis modality. The aim of this study was to evaluate whether the pretransplantation dialysis modality influences patient and allograft survival beyond 10 years and examine the potential risk factors associated with the outcomes. METHODS We conducted an observational, retrospective, single-center clinical study that included 236 patients [118 undergoing peritoneal dialysis (PD) and 118 undergoing hemodialysis (HD)] who proceeded to transplantation during the period December 1990-2002. Donor and recipient data were collected from our hospital's clinical registries. The follow-up period extended to the patient's death, the loss of the allograft, or loss to follow-up. The end date of the study was set at March 2012. RESULTS In the multivariate analysis, the long-term patient survival rate was higher for the PD group than for the HD group [HR = 2.62 (1.01-6.8); p = 0.04]; however, the allograft survival rate was not significantly different between the two groups [HR = 0.68 (0.41-1.10); p = 0.12]. CONCLUSION Pretransplantation dialysis modality is associated with long-term patient survival, with outcomes favoring peritoneal dialysis over hemodialysis. However, the pretransplant dialysis modality does not influence long-term graft loss risk.
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Affiliation(s)
- María O López-Oliva
- Department of Nephrology, University Hospital La Paz, IdiPAZ, Madrid, Spain,
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Inda-Filho A, Neugarten J, Putterman C, Broder A. Improving outcomes in patients with lupus and end-stage renal disease. Semin Dial 2013; 26:590-6. [PMID: 24004337 DOI: 10.1111/sdi.12122] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The development of lupus-related end-stage renal disease (ESRD) confers the highest mortality rates among individuals with lupus. Lupus-related ESRD is also associated with higher morbidity and mortality rates compared with non-lupus ESRD. We review the evidence that persistent lupus activity, hypercoagulability, and continuing immunosuppression may contribute to unfavorable outcomes in dialysis and renal transplantation among lupus patients. Robust epidemiologic studies are needed to develop individualized evidence-based approaches to treating lupus-related ESRD. In the meantime, managing lupus-related ESRD presents a significant challenge for clinicians and requires a team approach involving nephrologists and rheumatologists. Goals of therapy after developing ESRD should include continuing monitoring of lupus activity, minimizing corticosteroid exposure, and choosing the most appropriate renal replacement therapy based on patient's risk profile and quality-of-life considerations.
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Affiliation(s)
- Antonio Inda-Filho
- Division of Nephrology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
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Mendelson AA, Guan Q, Chafeeva I, da Roza GA, Kizhakkedathu JN, Du C. Hyperbranched polyglycerol is an efficacious and biocompatible novel osmotic agent in a rodent model of peritoneal dialysis. Perit Dial Int 2013; 33:15-27. [PMID: 23349194 DOI: 10.3747/pdi.2012.00148] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To enhance the effectiveness of peritoneal dialysis (PD), new biocompatible PD solutions may be needed. The present study was designed to test the efficacy and biocompatibility of hyperbranched polyglycerol (HPG)-a nontoxic, nonimmunogenic water-soluble polyether polymer-in PD. METHODS Adult Sprague-Dawley rats were instilled with 30 mL HPG solution (molecular weight 3 kDa; 2.5% - 15%) or control glucose PD solution (2.5% Dianeal: Baxter Healthcare Corporation, Deerfield, IL, USA), and intraperitoneal fluid was recovered after 4 hours. Peritoneal injury and cellular infiltration were determined by histologic and flow cytometric analysis. Human peritoneal mesothelial cells were assessed for viability in vitro after 3 hours of PD fluid exposure. RESULTS The 15% HPG solution achieved a 4-hour dose-related ultrafiltration up to 43.33 ± 5.24 mL and a dose-related urea clearance up to 39.17 ± 5.21 mL, results that were superior to those with control PD solution (p < 0.05). The dialysate-to-plasma (D/P) ratios of urea with 7.5% and 15% HPG solution were not statistically different from those with control PD solution. Compared with fluid recovered from the control group, fluid recovered from the HPG group contained proportionally fewer neutrophils (3.63% ± 0.87% vs 9.31% ± 2.89%, p < 0.0001). Detachment of mesothelial cells positive for human bone marrow endothelial protein 1 did not increase in the HPG group compared with the stain control (p = 0.1832), but it was elevated in the control PD solution group (1.62% ± 0.68% vs 0.41% ± 0.31%, p = 0.0031). Peritoneal biopsies from animals in the HPG PD group, compared with those from control PD animals, demonstrated less neutrophilic infiltration and reduced thickness. Human peritoneal mesothelial cell survival after HPG exposure was superior in vitro (p < 0.0001, 7.5% HPG vs control; p < 0.01, 15% HPG vs control). Exposure to glucose PD solution induced cytoplasmic vacuolation and caspase 3-independent necrotic cell death that was not seen with HPG solution. CONCLUSIONS Our novel HPG PD solution demonstrated effective ultrafiltration and waste removal with reduced peritoneal injury in a rodent model of PD.
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Affiliation(s)
- Asher A Mendelson
- Division of Nephrology, Department of Medicine, University of British Columbia, Canada
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Kramer A, Jager KJ, Fogarty DG, Ravani P, Finne P, Pérez-Panadés J, Prütz KG, Arias M, Heaf JG, Wanner C, Stel VS. Association between pre-transplant dialysis modality and patient and graft survival after kidney transplantation. Nephrol Dial Transplant 2013; 27:4473-80. [PMID: 23235955 DOI: 10.1093/ndt/gfs450] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Previous studies have found inconsistent associations between pre-transplant dialysis modality and subsequent post-transplant survival. We aimed to examine this relationship using the instrumental variable method and to compare the results with standard Cox regression. METHODS We included 29 088 patients (age >20 years) from 16 European national or regional renal registries who received a first kidney transplant between 1 January 1999 and 31 December 2008 and were on dialysis before transplantation for a period between 90 days and 10 years. Standard multivariable Cox regression examined the association of individually assigned pre-transplant dialysis modality with post-transplant patient and graft survival. To decrease confounding-by-indication through unmeasured factors, we applied the instrumental variable method that used the case-mix adjusted centre percentage of peritoneal dialysis (PD) as predictor variable. RESULTS Standard analyses adjusted for age, sex, primary renal disease, donor type, duration of dialysis, year of transplantation and country suggested that PD before transplantation was associated with better patient [hazard ratio, HR (95% CI) = 0.83 (0.76-0.91)] and graft survival (HR (95% CI) 0.90 (0.84-0.96)) when compared with haemodialysis (HD). In contrast, the instrumental variable analysis showed that a 10% increase in the case-mix adjusted centre percentage of patients on PD was neither associated with post-transplant patient survival [HR (95% CI = 1.00 (0.97-1.04)] nor with graft survival [HR (95% CI) = 1.01 (0.98-1.04)]. CONCLUSIONS The instrumental variable method failed to confirm the associations found in standard Cox regression between pre-transplant dialysis modality and patient and graft survival after transplantation. The lack of association in instrumental variable analysis may be due to better control of residual confounding.
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Affiliation(s)
- Anneke Kramer
- ERA–EDTA Registry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Optimal Choice of Dialysis Access for Chronic Kidney Disease Patients: Developing a Life Plan for Dialysis Access. Semin Nephrol 2012; 32:530-7. [DOI: 10.1016/j.semnephrol.2012.10.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Klarić D, Knotek M. Long-term effects of peritonitis on peritoneal dialysis outcomes. Int Urol Nephrol 2012; 45:519-25. [PMID: 22893493 DOI: 10.1007/s11255-012-0257-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 07/13/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE Prevalence of peritoneal dialysis is low in part because of the perceived high risk for complications such as peritonitis. However, in the most recent era, peritonitis incidence and its effects on patient outcomes may have diminished. The aim of this study was to analyze peritonitis incidence and its impact on patient and technique survival, as well as on the kidney transplantation rate and outcome. METHODS All peritoneal dialysis patients from a county hospital between year 2001 and 2011 were retrospectively included. Patients were divided into two groups with respect to peritonitis. The primary composite end-point consisted of a 3-year patient mortality or technique loss. Secondary end-points were patient survival and probability of kidney transplantation with respect to peritonitis history. RESULTS Among 85 study patients, there were 61 peritonitis episodes. The incidence of peritonitis was 0.339 ± 0.71 episode per patient per 12 months or one episode per 29.3 ± 22.2 patient-months. The time to peritonitis was shorter, and peritonitis was more likely in patients on continuous ambulatory peritoneal dialysis than in automated peritoneal dialysis patients. Patient and technique survival and transplantation rate were similar in the group with and without peritonitis history. The primary end-point was recorded in 35 % of patients with peritonitis history and in 54 % of those without peritonitis (p = 0.04). In a multivariate analysis, the only variable significantly associated with the primary end-point and with patient survival was patient age at start of peritoneal dialysis. CONCLUSIONS In contemporary peritoneal dialysis patients, timely treated peritonitis may not be associated with adverse patient and technique outcomes. The transplantation rate is unaffected by the peritonitis history. Peritoneal dialysis may be promoted as the first dialysis method in appropriate patients.
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Affiliation(s)
- Dragan Klarić
- Department of Medicine, Renal Division, Zadar County Hospital, Zadar, Croatia
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Lim WH, Clayton P, Wong G, Dogra G, Budgeon CA, Murray K, Campbell SB, Cohney S, Russ GR, Polkinghorne KR, Chadban SJ, McDonald SP. Association between initial and pretransplant dialysis modality and graft and patient outcomes in live- and deceased-donor renal transplant recipients. Transpl Int 2012; 25:1032-40. [DOI: 10.1111/j.1432-2277.2012.01528.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Teplan V, Malý J, Gürlich R, Teplan V, Kudla M, Pit'ha J, Racek J, Haluzík M, Senolt L, Stollová M. Muscle and fat metabolism in obesity after kidney transplantation: no effect of peritoneal dialysis or hemodialysis. J Ren Nutr 2012; 22:166-70. [PMID: 22200436 DOI: 10.1053/j.jrn.2011.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 10/13/2011] [Indexed: 11/11/2022] Open
Abstract
Our prospective study analyzed selected adipocytokines: adiponectin (ADPN), leptin, visfatin, and asymmetric dimethylarginine (ADMA) in the plasma of renal transplant recipients previously treated by peritoneal dialysis and hemodialysis. A total of 70 patients were on follow-up for 12 months after transplantation. Of these, 30 patients (group I) developed obesity, and 40 patients were nonobese (group II). All were receiving standard immunosuppressive therapy (cyclosporine A or tacrolimus and mycophenolate mofetil, with prednisone added in the early posttransplant period) and did not differ statistically in HLA typing, age, sex, duration of previous dialysis, history of cardiovascular disease, and rate of rejection episodes. At the end of the study period, there were significant differences between groups I and II (t test, analysis of variance) in plasma: ADPN, 22.30 ± 10.2 versus 14.3 ± 7.2 μg/mL; visfatin, 1.7 ± 0.1 versus 1.2 ± 0.1 ng/mL; ADMA, 3.60 ± 0.47 versus 2.10 ± 0.36 μmol/L; P < .01; leptin, 55.6 ± 10.2 versus 25.6 ± 8.3 ng/L; P < .01 (P < .02). In conclusion, an increase of body fat after renal transplantation was associated with an increase of ADMA and leptin, TNF-α, MCP-1, and visfatin and decrease of adiponectin. Our study documented there was now long-term beneficial metabolic effect of peritoneal dialysis in developing posttransplant obesity.
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Affiliation(s)
- Vladimír Teplan
- Department of Nephrology, Transplant Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
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Molnar MZ, Mehrotra R, Duong U, Bunnapradist S, Lukowsky LR, Krishnan M, Kovesdy CP, Kalantar-Zadeh K. Dialysis modality and outcomes in kidney transplant recipients. Clin J Am Soc Nephrol 2011; 7:332-41. [PMID: 22156753 DOI: 10.2215/cjn.07110711] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES The influence of pretransplant dialysis modality on post-transplant outcomes is not clear. This study examined associations of pretransplant dialysis modality with post-transplant outcomes in a large national cohort of kidney transplant recipients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Linking the 5-year patient data of a large dialysis organization to the Scientific Registry of Transplant Recipients, 12,416 hemodialysis and 2092 peritoneal dialysis patients who underwent first kidney transplantation were identified. Mortality or graft failure and delayed graft function risks were estimated by Cox regression (hazard ratio) and logistic regression (odds ratio), respectively. RESULTS Recipients treated with peritoneal dialysis pretransplantation had lower (21.9/1000 patient-years [95% confidence interval: 18.1-26.5]) crude all-cause mortality rate than those recipients treated with hemodialysis (32.8/1000 patient-years [30.8-35.0]). Pretransplant peritoneal dialysis use was associated with 43% lower adjusted all-cause and 66% lower cardiovascular death. Furthermore, pretransplant peritoneal dialysis use was associated with 17% and 36% lower unadjusted death-censored graft failure and delayed graft function risk, respectively. However, after additional adjustment for relevant covariates, pretransplant peritoneal dialysis modality was not a significant predictor of death-censored graft failure delayed graft function, respectively. Similar trends were noted on analyses using a propensity score matched cohort of 2092 pairs of patients. CONCLUSIONS Compared with hemodialysis, patients treated with peritoneal dialysis before transplantation had lower mortality but similar graft loss or delayed graft function. Confounding by residual selection bias cannot be ruled out.
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Affiliation(s)
- Miklos Z Molnar
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Harbor-University of California at Los Angeles Medical Center, Torrance, CA 90509-2910, USA
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Nakamura M, Seki G, Iwadoh K, Nakajima I, Fuchinoue S, Fujita T, Teraoka S. Acute kidney injury as defined by the RIFLE criteria is a risk factor for kidney transplant graft failure. Clin Transplant 2011; 26:520-8. [DOI: 10.1111/j.1399-0012.2011.01546.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sinnakirouchenan R, Holley JL. Peritoneal dialysis versus hemodialysis: risks, benefits, and access issues. Adv Chronic Kidney Dis 2011; 18:428-32. [PMID: 22098661 DOI: 10.1053/j.ackd.2011.09.001] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 09/02/2011] [Accepted: 09/02/2011] [Indexed: 12/13/2022]
Abstract
Peritoneal dialysis (PD) and hemodialysis (HD) are dialysis options for end-stage renal disease patients in whom preemptive kidney transplantation is not possible. The selection of PD or HD will usually be based on patient motivation, desire, geographic distance from an HD unit, physician and/or nurse bias, and patient education. Unfortunately, many patients are not educated on PD before beginning dialysis. Most studies show that the relative risk of death in patients on in-center HD versus PD changes over time with a lower risk on PD, especially in the first 3 months of dialysis. The survival advantage of PD continues for 1.5-2 years but, over time, the risk of death with PD equals or becomes greater than with in-center HD, depending on patient factors. Thus, PD survival is best at the start of dialysis. Patient satisfaction may be higher with PD, and PD costs are significantly lower than HD costs. The new reimbursement system, including bundling of dialysis services, may lead to an increase in the number of incident patients on PD. The high technique failure of PD persists, despite significant reductions in peritonitis rates. Infection also continues to be an important cause of mortality and morbidity among HD patients, especially those using a central venous catheter as HD access. Nephrologists' efforts should be focused on educating themselves and their patients about the opportunities for home modality therapies and reducing the reliance on central venous catheter for long-term HD access.
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Predicting three-year kidney graft survival in recipients with systemic lupus erythematosus. ASAIO J 2011; 57:300-9. [PMID: 21701272 DOI: 10.1097/mat.0b013e318222db30] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Predicting the outcome of kidney transplantation is important in optimizing transplantation parameters and modifying factors related to the recipient, donor, and transplant procedure. As patients with end-stage renal disease (ESRD) secondary to lupus nephropathy are generally younger than the typical ESRD patients and also seem to have inferior transplant outcome, developing an outcome prediction model in this patient category has high clinical relevance. The goal of this study was to compare methods of building prediction models of kidney transplant outcome that potentially can be useful for clinical decision support. We applied three well-known data mining methods (classification trees, logistic regression, and artificial neural networks) to the data describing recipients with systemic lupus erythematosus (SLE) in the US Renal Data System (USRDS) database. The 95% confidence interval (CI) of the area under the receiver-operator characteristic curves (AUC) was used to measure the discrimination ability of the prediction models. Two groups of predictors were selected to build the prediction models. Using input variables based on Weka (a open source machine learning software) supplemented with additional variables of known clinical relevance (38 total predictors), the logistic regression performed the best overall (AUC: 0.74, 95% CI: 0.72-0.77)-significantly better (p < 0.05) than the classification trees (AUC: 0.70, 95% CI: 0.67-0.72) but not significantly better (p = 0.218) than the artificial neural networks (AUC: 0.71, 95% CI: 0.69-0.73). The performance of the artificial neural networks was not significantly better than that of the classification trees (p = 0.693). Using the more parsimonious subset of variables (six variables), the logistic regression (AUC: 0.73, 95% CI: 0.71-0.75) did not perform significantly better than either the classification tree (AUC: 0.70, 95% CI: 0.68-0.73) or the artificial neural network (AUC: 0.73, 95% CI: 0.70-0.75) models. We generated several models predicting 3-year allograft survival in kidney transplant recipients with SLE that potentially can be used in practice. The performance of logistic regression and classification tree was not inferior to more complex artificial neural network. Prediction models may be used in clinical practice to identify patients at risk.
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Ryckelynck JP, Abbadie O, Castrale C, Lavainne F, Fakhouri F, Lobbedez T. [Why and how to promote peritoneal dialysis?]. Presse Med 2011; 40:1053-8. [PMID: 21924862 DOI: 10.1016/j.lpm.2011.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 06/10/2011] [Indexed: 11/26/2022] Open
Abstract
The prevalence of peritoneal dialysis in France remains one of the lowest in Europe in spite of official recommendations in 2008. Progress in peritoneal catheter placement and a good knowledge of the management of catheter complications are essential. A more frequent use of biocompatible solutions should achieve a better preservation of the peritoneal membrane. Such physiological peritoneal fluids seem to decrease morbidity and mortality. Best peritoneal dialysis indications are mainly young patients waiting for a kidney transplantation, old patients without malnutrition and patients with cardiac insufficiency. Objective and complete information dedicated to both peritoneal dialysis and hemodialysis is necessary, even for patients seen in emergency or unplanned or late referral patients. A pre-end-stage renal disease education program has to be mandatory. Non-medical obstacles, mainly financial, are still common so that economic incitations are necessary for the development of peritoneal dialysis. A university formation of nephrologists is now available.
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Domenici A, Comunian MC, Fazzari L, Sivo F, Dinnella A, Della Grotta B, Punzo G, Menè P. Incremental peritoneal dialysis favourably compares with hemodialysis as a bridge to renal transplantation. Int J Nephrol 2011; 2011:204216. [PMID: 21941652 PMCID: PMC3173956 DOI: 10.4061/2011/204216] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Revised: 06/29/2011] [Accepted: 07/14/2011] [Indexed: 11/23/2022] Open
Abstract
Background. The value of incremental peritoneal dialysis (PD) as a bridge to renal transplantation (Tx) has not been specifically addressed. Methods. All consecutive Stage 5 CKD patients with at least 1 year predialysis followup, starting incremental PD or HD under our care and subsequently receiving their first renal Tx were included in this observational cohort study. Age, gender, BMI, underlying nephropathy, residual renal function (RRF) loss rate before dialysis and RRF at RRT start, comorbidity, RRT schedules and adequacy measures, dialysis-related morbidity, Tx waiting time, RRF at Tx, incidence of delayed graft function (DGF), in-hospital stay for Tx, serum creatinine at discharge and one year later were collected and compared between patients on incremental PD or HD before Tx. Results. Seventeen patients on incremental PD and 24 on HD received their first renal Tx during the study period. Age, underlying nephropathy, RRF loss rate in predialysis, RRF at the start of RRT and comorbidity did not differ significantly. While on dialysis, patients on PD had significantly lower epoetin requirements, serum phosphate, calciumxphosphate product and better RRF preservation. Delayed graft function (DGF) occurred in 12 patients (29%), 1 on incremental PD and 11 on HD. Serum creatinine at discharge and 1 year later was significantly higher in patients who had been on HD. Conclusions. In patients receiving their first renal Tx, previous incremental PD was associated with low morbidity, excellent preservation of RRF, easier attainment of adequacy targets and significantly better immediate and 1-year graft function than those observed in otherwise well-matched patients previously treated with HD.
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Affiliation(s)
- Alessandro Domenici
- Nephrology and Dialysis Unit, Department of Cardiovascular, Renal and Pulmonary Diseases, Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Maria Cristina Comunian
- Nephrology and Dialysis Unit, Department of Cardiovascular, Renal and Pulmonary Diseases, Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Loredana Fazzari
- Nephrology and Dialysis Unit, Department of Cardiovascular, Renal and Pulmonary Diseases, Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Francesca Sivo
- Nephrology and Dialysis Unit, Department of Cardiovascular, Renal and Pulmonary Diseases, Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Angela Dinnella
- Peritoneal Dialysis Regional Referral Centre, Nephrology and Dialysis Unit, Civic Hospital, 00042 Anzio, Italy
| | - Barbara Della Grotta
- Peritoneal Dialysis Regional Referral Centre, Nephrology and Dialysis Unit, Civic Hospital, 00042 Anzio, Italy
| | - Giorgio Punzo
- Nephrology and Dialysis Unit, Department of Cardiovascular, Renal and Pulmonary Diseases, Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Paolo Menè
- Nephrology and Dialysis Unit, Department of Cardiovascular, Renal and Pulmonary Diseases, Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
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Dalal P, Sangha H, Chaudhary K. In Peritoneal Dialysis, Is There Sufficient Evidence to Make "PD First" Therapy? Int J Nephrol 2011; 2011:239515. [PMID: 21776392 PMCID: PMC3139118 DOI: 10.4061/2011/239515] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 04/06/2011] [Accepted: 04/20/2011] [Indexed: 11/20/2022] Open
Abstract
Since its introduction more than 3 decades ago, the use of peritoneal dialysis (PD) has increased greatly due to its simplicity, convenience, and low cost. Advances in technique, antibiotic prophylaxis, and the introduction of newer solutions have improved survival, quality of life, and reduced rate of complications with PD. In Hong Kong, approximately 80% end-stage renal disease (ESRD) patients perform PD; in others, that is, Canada, Australia, and New Zealand, 20%-30% patients use PD. However, in the United States, the annual rate of prevalent patients receiving PD has reduced to 8% from its peak of 15% in mid-1980s. PD as the initial modality is being offered to far less patients than hemodialysis (HD), resulting in the current annual incidence rate of less than 10% in USA. There are many reasons preventing the PD first initiative including the increased numbers of in-center hemodialysis units, physician comfort with the modality, perceived superiority of HD, risk of peritonitis, achieving adequate clearances, and reimbursement incentives to providers. Patient fatigue, membrane failure, and catheter problems are other reasons which discourage PD utilization. In this paper, we discuss the available evidence and provide rationale to support PD as the initial renal replacement modality for ESRD patients.
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Affiliation(s)
- Pranav Dalal
- Division of Nephrology, Department of Internal Medicine, University of Missouri, Columbia, Mo 65212, USA
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