Returning to dialysis after kidney allograft loss: conflicting survival benefit beyond transplant-naïve maintenance dialysis patients

Kidney transplantation is the cornerstone for renal treatment in patients with end-stage renal failure. Despite improvements in short-term outcomes of renal transplantation, kidney allograft loss remains a huge challenge. The aim of the study was to assess factors influencing the durability of transplanted kidneys among transplant recipients in South Africa. A descriptive cross-sectional study design was used. A random sampling was used to select 171 participants. Data were collected through structured face-to-face interviews developed from in-depth consideration of relevant literature. Data were coded and entered into the SPSS software, version 24. The entered data were analysed using descriptive and inferential statistics. The results revealed that the average durability of transplanted kidneys was 9.07 years among selected kidney transplant recipients in South Africa. Factors associated with the durability of transplanted kidneys included age, the sewerage system and strict immunosuppressive adherence, all with a P-value = .000, followed by the mode of transport (P-value = .001) and support system (P-value = .004). Other variables including demographics, the healthcare system, medication and lifestyle modification engagement were not associated with the durability of transplanted kidneys. Understanding the factors influencing the durability of transplanted kidneys among kidney transplant recipients in South Africa is crucial. The study revealed associated factors and gaps which may be contributory factors to kidney allograft loss. This study provides an opportunity to introduce specific interventions to nephrology professionals to promote prolonged graft durability. It is recommended that a specific intervention model be developed, which targets South African kidney recipients taking into account the significant variables in this study and the socio-economic status of the country.

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Overview of blood purification in uremia

The International Journal of Artificial Organs ◽

10.1177/039139888000300402 ◽

1980 ◽

Vol 3 (4) ◽

pp. 203-208

Author(s):

B.T. Burton

Keyword(s):

Renal Failure ◽

Peritoneal Dialysis ◽

Renal Transplantation ◽

Rejection Rate ◽

Blood Purification ◽

Maintenance Hemodialysis ◽

Dialysis Patients ◽

Transplant Patients ◽

Maintenance Dialysis ◽

Transplanted Kidneys

Today, management of irreversible renal failure is based primarily on maintenance hemodialysis and renal transplantation with a growing minority of patients treated by peritoneal dialysis. With regard to renal transplantation — the early promise of renal transplantation in the mid 1960's has given way to the realities of the late 1970's. There have been no major changes in the rejection rate of transplanted kidneys in recent years though today's mortality of transplant patients is considerably reduced over what it used to be. Moreover, universally the lack of availability of a sufficient number of organs for transplantation poses a formidable problem. It is all too apparent that current methods of blood purification in uremia are far from optimal. Even though the mortality in maintenance dialysis is relatively low, hemodialysis is characterized by a variety of complications and most maintenance dialysis patients are not optimally rehabilitated.

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Differential Effect of Viral Hepatitis Infection on Mortality among Korean Maintenance Dialysis Patients: A Prospective Multicenter Cohort Study

PLoS ONE ◽

10.1371/journal.pone.0135476 ◽

2015 ◽

Vol 10 (8) ◽

pp. e0135476 ◽

Cited By ~ 13

Author(s):

Eugene Kwon ◽

Jang-Hee Cho ◽

Hye Min Jang ◽

Yon Su Kim ◽

Shin-Wook Kang ◽

...

Keyword(s):

Cohort Study ◽

Viral Hepatitis ◽

Differential Effect ◽

Dialysis Patients ◽

Multicenter Cohort Study ◽

Multicenter Cohort ◽

Hepatitis Infection ◽

Maintenance Dialysis ◽

Viral Hepatitis Infection

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SP637EFFECT OF DIALYSIS MODALITY ON FRAILTY PHENOTYPE, DISABILITY, AND HEALTH RELATED QUALITY OF LIFE IN MAINTENANCE DIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfx154.sp637 ◽

2017 ◽

Vol 32 (suppl_3) ◽

pp. iii351-iii351

Author(s):

Jun Chul Kim ◽

Seok Hui Kang ◽

Joon Hyuk Seo

Keyword(s):

Quality Of Life ◽

Dialysis Modality ◽

Health Related Quality ◽

Disability And Health ◽

Dialysis Patients ◽

Frailty Phenotype ◽

Related Quality ◽

Health Related ◽

Maintenance Dialysis

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Vitamin B6 deficiency in maintenance dialysis patients: metabolic effects of repletion

American Journal of Clinical Nutrition ◽

10.1093/ajcn/33.7.1612 ◽

1980 ◽

Vol 33 (7) ◽

pp. 1612-1619 ◽

Cited By ~ 39

Author(s):

M J Kleiner ◽

S S Tate ◽

J F Sullivan ◽

J Chami

Keyword(s):

Vitamin B6 ◽

Metabolic Effects ◽

Dialysis Patients ◽

Vitamin B6 Deficiency ◽

Maintenance Dialysis

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Seroresponse to SARS-CoV-2 vaccines among maintenance dialysis patients over six months

10.1101/2021.09.13.21263535 ◽

2021 ◽

Author(s):

Caroline M Hsu ◽

Daniel E Weiner ◽

Harold J Manley ◽

Gideon N Aweh ◽

Vladimir Ladik ◽

...

Keyword(s):

Proportional Hazards ◽

Cox Proportional Hazards ◽

Prior History ◽

Time To Event ◽

Dialysis Patients ◽

History Of ◽

Maximum Titer ◽

Lower Titer ◽

Maintenance Dialysis ◽

Over Time

Background and Objectives: While most maintenance dialysis patients exhibit initial seroresponse to vaccination, concerns remain regarding the durability of this antibody response. This study evaluated immunity over time. Design, setting, participants, and measurements: This retrospective cohort study included maintenance dialysis patients from a midsize national dialysis provider who received a complete SARS-CoV-2 vaccine series and had at least one antibody titer checked after full vaccination. Immunoglobulin G spike antibodies (SAb-IgG) titers were assessed monthly with routine labs beginning after full vaccination and followed over time; the semiquantitative SAb-IgG titer reported a range between 0 and ≥20 U/L. Descriptive analyses compared trends over time by prior history of COVID-19 and type of vaccine received. Time-to-event analyses were conducted for the outcome of loss of seroresponse (SAb-IgG < 1 U/L or development of COVID-19). Cox proportional hazards regression was used to adjust for additional clinical characteristics of interest. Results: Among 1898 maintenance dialysis patients, 1567 (84%) had no prior history of COVID-19. Patients without a history of COVID-19 had declining titers over time. Among 441 BNT162b2/Pfizer recipients, median [IQR] SAb-IgG titer declined from 20 [5.99-20] U/L in month 1 to 1.30 [0.15-3.59] U/L by month 6. Among 779 mRNA-1273/Moderna recipients, median [IQR] SAb-IgG titer declined from 20 [20-20] in month 1 to 6.20 [1.74-20] by month 6. The 347 Ad26.COV2.S/Janssen recipients had a lower titer response than mRNA vaccine recipients over all time periods. In time-to-event analyses, Ad26.COV2.S/Janssen and mRNA-1273/Moderna recipients had the shortest and longest time to loss of seroresponse, respectively. The maximum titer reached in the first two months after full vaccination was predictive of the durability of the SAb-IgG seroresponse; patients with SAb-IgG titer 1-19.99 U/L were more likely to have loss of seroresponse compared to patients with SAb-IgG titer ≥20 U/L (HR 23.9 [95% CI: 16.1-35.5]). Conclusions: Vaccine-induced seroresponse wanes over time among maintenance dialysis patients across vaccine types. Early titers after full vaccination predict the durability of seroresponse.

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