scholarly journals The Kidney Failure Risk Equation for Prediction of Allograft Loss in Kidney Transplant Recipients

2020 ◽  
Vol 2 (6) ◽  
pp. 753-761.e1
Author(s):  
Chi D. Chu ◽  
Elaine Ku ◽  
Mohammad Kazem Fallahzadeh ◽  
Charles E. McCulloch ◽  
Delphine S. Tuot
Keyword(s):  
Kidney Transplant ◽  
Kidney Failure ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Risk Equation ◽  
Failure Risk ◽  
Allograft Loss

scholarly journals Validation of the Kidney Failure Risk Equation in Kidney Transplant Recipients

2020 ◽  
Vol 7 ◽  
pp. 205435812092262 ◽  
Author(s):  
Navdeep Tangri ◽  
Thomas W. Ferguson ◽  
Chris Wiebe ◽  
Frederick Eng ◽  
Michelle Nash ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Kidney Failure ◽  
Characteristic Curve ◽  
Transplant Recipients ◽  
Clinical Implementation ◽  
Kidney Transplant Recipients ◽  
Risk Equation ◽  
Failure Risk ◽  
Allograft Failure ◽  
C Statistic

Background: Predicting allograft failure in kidney transplant recipients can help plan renal replacement therapy and guide patient-provider communication. The kidney failure risk equation (KFRE) accurately predicts the need for dialysis in patients with chronic kidney disease (CKD), but has not been validated in kidney transplant recipients. Objective: We sought to validate the 4-variable KFRE (age, sex, estimated glomerular filtration rate [eGFR], and urine albumin-to-creatinine ratio [ACR]) for prediction of 2- and 5-year death-censored allograft failure. Design: Retrospective cohort study. Setting: Four independent North American Cohorts from Ontario, Canada; Alberta, Canada; Manitoba, Canada; and Wisconsin, United States, between January 1999 and December 2017. Patients: Adult kidney transplant patients at 1-year posttransplantation. Measurements: Kidney failure risk as measured by the KFRE (eGFR, urine ACR, age, and sex). Methods: We included all adult patients who had at least 1 serum creatinine and at least 1 urine ACR measurement approximately 1 year following kidney transplantation. The performance of the KFRE was evaluated using the area under the receiver operating characteristic curve (C-statistic). C-statistics from the 4 cohorts were meta-analyzed using random-effects models. Results: A total of 3659 patients were included. Pooled C-statistics were good in the entire population, at 0.81 (95% confidence interval: 0.72-0.91) for the 2-year KFRE and 0.73 (0.67-0.80) for the 5-year KFRE. Discrimination improved among patients with poorer kidney function (eGFR < 45 mL/min/1.73 m2), with a C-statistic of 0.88 (0.78-0.98) for the 2-year KFRE and 0.83 (0.74-0.91) for the 5-year KFRE. Limitations: The KFRE does not predict episodes of acute rejection and there was heterogeneity between cohorts. Conclusions: The KFRE accurately predicts kidney failure in kidney transplant recipients at 1-year posttransplantation. Further validation in larger cohorts with longer follow-up times can strengthen the case for clinical implementation.

Factors that Influence the Durability of Transplanted Kidneys in South Africa

2019 ◽  
Vol 21 (2) ◽  
Author(s):  
Hillary Ndemera ◽  
Busisiwe R. Bhengu
Keyword(s):  
South Africa ◽  
Kidney Transplant ◽  
Lifestyle Modification ◽  
P Value ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Kidney Allograft ◽  
Factors Influencing ◽  
Allograft Loss ◽  
Transplanted Kidneys

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.

scholarly journals A validation study of the 4-variable and 8-variable kidney failure risk equation in transplant recipients in the United Kingdom

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ibrahim Ali ◽  
Philip A. Kalra
Keyword(s):  
United Kingdom ◽  
Kidney Failure ◽  
Graft Failure ◽  
Risk Scores ◽  
Transplant Recipients ◽  
Good Discrimination ◽  
Risk Equation ◽  
The United Kingdom ◽  
Failure Risk ◽  
Risk Patients

Abstract Background There is emerging evidence that the 4-variable Kidney Failure Risk Equation (KFRE) can be used for risk prediction of graft failure in transplant recipients. However, geographical validation of the 4-variable KFRE in transplant patients is lacking, as is whether the more extensive 8-variable KFRE improves predictive accuracy. This study aimed to validate the 4- and 8-variable KFRE predictions of the 5-year death-censored risk of graft failure in patients in the United Kingdom. Methods A retrospective cohort study involved 415 transplant recipients who had their first renal transplant between 2003 and 2015 and were under follow-up at Salford Royal NHS Foundation Trust. The KFRE risk scores were calculated on variables taken 1-year post-transplant. The area under the receiver operating characteristic curves (AUC) and calibration plots were evaluated to determine discrimination and calibration of the 4- and 8-variable KFREs in the whole cohort as well as in a subgroup analysis of living and deceased donor recipients and in patients with an eGFR< 45 ml/min/1.73m2. Results There were 16 graft failure events (4%) in the whole cohort. The 4- and 8-variable KFREs showed good discrimination with AUC of 0.743 (95% confidence interval [CI] 0.610–0.876) and 0.751 (95% CI 0.629–0.872) respectively. In patients with an eGFR< 45 ml/min/1.73m2, the 8-variable KFRE had good discrimination with an AUC of 0.785 (95% CI 0.558–0.982) but the 4-variable provided excellent discrimination in this group with an AUC of 0.817 (0.646–0.988). Calibration plots however showed poor calibration with risk scores tending to underestimate risk of graft failure in low-risk patients and overestimate risk in high-risk patients, which was seen in the primary and subgroup analyses. Conclusions Despite adequate discrimination, the 4- and 8-variable KFREs are imprecise in predicting graft failure in transplant recipients using data 1-year post-transplant. Larger, international studies involving diverse patient populations should be considered to corroborate these findings.

scholarly journals Osmoregulation Performance and Kidney Transplant Outcome

2019 ◽  
Vol 30 (7) ◽  
pp. 1282-1293 ◽  
Author(s):  
Manal Mazloum ◽  
Jordan Jouffroy ◽  
François Brazier ◽  
Christophe Legendre ◽  
Antoine Neuraz ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Renal Outcome ◽  
Plasma Sodium ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Loading Test ◽  
Water Loading ◽  
All Cause Mortality ◽  
Allograft Loss ◽  
Transplantation Outcomes

BackgroundKidney transplant recipients have an impaired ability to dilute urine but seldom develop baseline hyponatremia before ESRD. Although hyponatremia is a risk factor for adverse events in CKD and in kidney transplant recipients, it remains unclear whether subtler alterations in osmoregulation performance are associated with outcome.MethodsWe studied a single-center prospective cohort of 1258 kidney transplant recipients who underwent a water-loading test 3 months after transplant to determine osmoregulation performance. Measured GFR (mGFR) was performed at the same visit. A group of 164 healthy candidates for kidney donation served as controls. We further evaluated the association of osmoregulation performance with transplantation outcomes and subsequent kidney function.ResultsUnlike controls, most kidney transplant recipients failed to maintain plasma sodium during water loading (plasma sodium slope of −0.6±0.4 mmol/L per hour in transplant recipients versus −0.12±0.3 mmol/L per hour in controls; P<0.001). Steeper plasma sodium reduction during the test independently associated with the composite outcome of all-cause mortality and allograft loss (hazard ratio [HR], 1.73 per 1 mmol/L per hour decrease in plasma sodium; 95% confidence interval [95% CI], 1.23 to 2.45; P=0.002) and allograft loss alone (HR, 2.04 per 1 mmol/L per hour decrease in plasma sodium; 95% CI, 1.19 to 3.51; P=0.01). The association remained significant in a prespecified sensitivity analysis excluding patients with hyperglycemia. In addition, a steeper plasma sodium slope 3 months after transplantation independently correlated with lower mGFR at 12 months (β=1.93; 95% CI, 0.46 to 3.41; P=0.01).ConclusionsReduced osmoregulation performance occurs frequently in kidney transplant recipients and is an independent predictor of renal outcome.

scholarly journals Impaired immune response to SARS-CoV-2 vaccination in dialysis patients and in kidney transplant recipients

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0003512021
Author(s):  
Thilo Kolb ◽  
Svenja Fischer ◽  
Lisa Müller ◽  
Nadine Lübke ◽  
Jonas Hillebrandt ◽  
...  
Keyword(s):  
Immune Responses ◽  
Kidney Transplant ◽  
Kidney Failure ◽  
Neutralizing Antibodies ◽  
Neutralizing Antibody ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Dialysis Patients ◽  
Specific Antibodies ◽  
Neutralization Capacity

Background: Kidney failure patients on dialysis or after renal transplantation have a high risk for severe COVID-19 infection and vaccination against SARS-CoV-2 is the only expedient prophylaxis. Generally, immune responses are attenuated in kidney failure patients, however, systematic analyses of immune responses to SARS-CoV-2 vaccination in dialysis patients and in kidney transplant recipients (KTR) are still missing. Methods: In this prospective multicentric cohort study, antibody responses COVID-19 mRNA vaccines (BNT162b2; Biontech/Pfizer or mRNA-1273; Moderna) were measured in 32 dialysis patients and in 28 KTRs. SARS-CoV-2-specific antibodies and neutralization capacity were evaluated and compared to controls (n=78) in a similar age-range. Results: After the first vaccination, SARS-CoV-2-specific antibodies were nearly undetectable in kidney failure patients. After the second vaccination, 93% of the controls and 88% of dialysis patients but only 37% of KTRs developed SARS-CoV-2-specific IgG above cut-off. Moreover, mean IgG levels were significantly lower in KTRs (54±93 BAU/ml) compared to dialysis patients (503±481 BAU/ml, p<0.01). Both KTRs as well as dialysis patients had significantly lower IgG levels compared to controls (1992±2485 BAU/ml; p<0.001 and p<0.01). Importantly, compared to controls, neutralizing antibody titers were significantly lower in KTRs and dialysis patients. After the second vaccination, 76% of KTRs did not show any neutralization capacity against SARS-CoV-2 suggesting impaired seroprotection. Conclusions: Kidney failure patients show a significantly weaker antibody response compared to controls. Most strikingly, only one out four KTRs developed neutralizing antibodies against SARS-CoV-2 after two doses of vaccine. These data suggest that vaccination strategies need modification in immune transplant and dialysis patients.

Hyperparathyroidism and increased fractional excretion of phosphate predict allograft loss in long-term kidney transplant recipients

2016 ◽  
Vol 21 (5) ◽  
pp. 926-931 ◽  
Author(s):  
Sumanee Prakobsuk ◽  
Supinda Sirilak ◽  
Kotcharat Vipattawat ◽  
Pahnwat T. Taweesedt ◽  
Vasant Sumethkul ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Fractional Excretion ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Allograft Loss ◽  
Fractional Excretion Of Phosphate
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