Reasons for Refusing Kidney Transplantation Among Chronic Dialysis Patients

Abstract Background and Aims Hyperoxaluria is a rare metabolic disorder chacterized by widespread calcium oxalate deposition, if plasmatic oxalate level (pOx) overcomes saturation threshold. It could be primary (PH), a recessive disease associated with mutation of the liver enzyme LDH, or secondary (SH), in 75% due to intestinal malabsorption. Urolithiasis could be the first complication, and renal involvement could progress until end-stage renal disease (ESRD). Mean pOx is higher in chronic dialysis patients than healthy individuals because of impaired renal clearance. Oxalate molecular weight (MW) is 88 Da and its clearance is that of low MW uremic toxins. Our aim is to assess an association between arteriovenous fistula (AVF) failures and Hyperoxaluria. Method In the period between 1/1/2004 and 12/31/2020, diagnosis of Hyperoxaluria was carried out in 6 patients out of 1530 chronic dialysis patients (0.39%). The median age of patients was 65.5 [26-72] years, the male/female ratio was 3:3 and the median dialysis vintage was 36 [1-181] months. Three patients come to nephrological referral at stage 5 of CKD while 1 patient came to Italy when chronic HD was already started. At that time pOx was not considered. In these 4 patients the presumptive diagnosis of ESRD was urolithiasis and diagnosis of Hyperoxaluria was carried out after the beginning of chronic dialysis, when pOx and genetic analysis were performed. In 1 case biopsy on the kidney graft and in 1 case kidney biopsy after nephrectomy were performed: oxalate deposition was detected. For 2/6 patients diagnosis was carried out after biopsy of native kidneys before starting dialysis. All patients started medical therapy for hyperoxaluria. Five out of 6 patients were eligible to HD, 1/6 to PD. AVF was judged the first choice vascular access. Results PH was diagnosed in 3/6 patients: mutations were detected on chromosome 2. Malabsorption secondary to short bowel syndrome and chronic pancreatitis could be assumed as causes of SH in 3 patients. Patient 1 underwent 2 combined liver-kidney transplantation: the first failed by arterial grafts thrombosis and the second by renal primary non-function but the liver was still functioning, he died on HD after 12 years. Patient 2 underwent liver and kidney transplantation and she is nowadays dialysis-free. The median pOx pre-dialysis and before diagnosis was 165 [98-259] umol/L (Table 1). Patients on chronic HD underwent median of 3 [2-5] AVF interventions. Nine AVFs were distal and 4 were proximal. The most frequent complication was AVF thrombosis despite ASA treatment: half of the cases showed secondary AVF non-function, the other half of AVFs failed to mature. Six tunneled cuffed permanent catheters (TCCs) as definitive vascular access were successfully placed in the 5 patients on chronic HD. Warfarin therapy was started to avoid TCCs thrombosis. The median survival of TCCs was 9.5 [3-48] months. All the patients had a history of deep venous thrombosis (DVT). Conclusion To our knowledge this is the first case series of multiple AVF failures in patients with hyperoxaluria. In our experience TCCs show longer survival then AVF in this group of patients, even if it could not be excluded the role of warfarin in favoring this result. Even though a link between hyperoxaluria and thrombosis is well established, the exact underlying mechanism is still uncleared. The role of PD as dialysis technique of “first choice” should be enhanced also when residual renal function is abolished. In ESRD patients with urolithiasis, diagnosis of Hyperoxaluria should be ruled out before AVF placement.

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COVID-19 in Children with Chronic Dialysis and Kidney Transplantation

10.21203/rs.3.rs-493945/v1 ◽

2021 ◽

Author(s):

Nur Canpolat ◽

Zeynep Yürük Yıldırım ◽

Nurdan Yıldız ◽

Mehmet Taşdemir ◽

Nilüfer Göknar ◽

...

Keyword(s):

Kidney Transplantation ◽

Severe Disease ◽

Pediatric Nephrology ◽

Kidney Injury ◽

Chronic Dialysis ◽

Dialysis Patients ◽

Multicenter Observational Study ◽

Entire Cohort ◽

Mild Disease ◽

Increased Risk

Abstract The aim of the study is to present incidence of COVID-19 in children with renal replacement therapy (RRT) and compare the severity and outcomes of the disease between the groups undergoing dialysis and kidney transplantation (KTx). This multicenter observational study was based on data collected from children receiving RRT, either chronic dialysis or KTx, diagnosed with COVID-19. All members of the Istanbul branch of the Turkish Pediatric Nephrology Association were requested to submit all their confirmed COVID-19 cases between April 1 and December 31, 2020. They were also asked to report the number of their prevalent patients on RRT under the age of 20. A total of 46 RRT patients diagnosed with COVID-19 were reported from 12 centers. Of these, 29 were KTx recipients, and 17 were on dialysis. COVID-19 cases represented 9.3% of all prevalent dialysis patients and 9.2% of all prevalent KTx recipients. Twelve KTx recipients (41.4%) and three dialysis patients (17.6%) were asymptomatic (p = 0.12). The hospitalization rate was higher in dialysis patients than KTx recipients (82.4% vs. 27.6%, p = 0.001). Two patients, one in each group, experienced a severe disease course, and only one hemodialysis patient had a critical illness that required mechanical ventilation. Acute kidney injury developed in 36% of KTx recipients, but none required dialysis or lost their graft. In the entire cohort, one patient on hemodialysis with multiple comorbidities died.Conclusion: Although most of cases were asymptomatic or had a mild disease, children on RRT seem to have an increased risk for COVID-19.

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Reduced risk of new onset stroke after kidney transplantation in Asian dialysis patients: a propensity score-matched, competing risk study in Taiwan

QJM ◽

10.1093/qjmed/hcz051 ◽

2019 ◽

Vol 112 (7) ◽

pp. 489-495 ◽

Cited By ~ 1

Author(s):

S -F Weng ◽

Y -C Shen ◽

J -J Wang ◽

K -J Tien

Keyword(s):

Kidney Transplantation ◽

Incidence Rates ◽

Chronic Dialysis ◽

Rank Test ◽

Birth Date ◽

Dialysis Patients ◽

Cerebrovascular Events ◽

Increased Risk ◽

Reduced Risk ◽

New Onset

Abstract Background Kidney transplantation (KT) has been found to reduce cardiovascular events and mortality in chronic dialysis patients. There is little data, however, regarding the risk reduction of cerebrovascular events after KT in Asian populations. This study evaluates the risk of cerebrovascular events after KT in Taiwan. Methods Tapping Taiwan’s National Health Insurance claims data of patients with a diagnosis of end-stage renal disease (ESRD), we enrolled all KT recipients from 1999 to 2011 (n = 2908). For each KT patient, four controls (patients also diagnosed with ESRD) without KT were propensity matched by birth date, sex, selected comorbidities and duration of dialysis. All subjects were followed to the end of 2011. Results The incidence rate for stroke in the KT recipients and comparison group were 52.63 and 137.26 per 10 000 person-years, respectively. After adjustment for age, gender and comorbidities with competing mortality, KT recipients had 60% reduction in all kinds of stroke, compared to those who did not receive procedure. They were found to have a 48 and 74% reduction in ischemic and hemorrhagic stroke risk, respectively. Subgroup analyses also showed similar trends in the improvement of stroke after KT. While elderly patients, men, and those with diabetes, hypertension and coronary artery disease are at increased risk for stroke, our log-rank test revealed those that received KT had significantly lower cumulative incidence rates of stroke than those that did not (P < 0.001). Conclusions KT was associated with reduced risk of new onset stroke in chronic dialysis patients in Taiwan.

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Correlation Between Recombinant Human Erythropoietin Dose and Inflammatory Status in Dialysed Patients

Revista de Chimie ◽

10.37358/rc.17.2.5452 ◽

2017 ◽

Vol 68 (2) ◽

pp. 354-357 ◽

Cited By ~ 1

Author(s):

Andrei Niculae ◽

Cristiana David ◽

Razvan Florin Ion Dragomirescu ◽

Ileana Peride ◽

Flavia Liliana Turcu ◽

...

Keyword(s):

Adverse Effects ◽

Recombinant Human Erythropoietin ◽

Best Practice ◽

Daily Practice ◽

Therapeutic Benefit ◽

Chronic Dialysis ◽

Dialysis Patients ◽

Protein Levels ◽

Human Erythropoietin ◽

Inflammatory Status

Once recombinant human erythropoietin (r-HuEPO) was introduced in daily practice, huge steps were made in combating the adverse effects induced by anemia in chronic kidney disease population. Still, r-HuEPO resistance and the doses ensuring the maximum therapeutic benefit remain matters of debate. The aim of our study was to assess the correlation between the presence and the degree of inflammation and the r-HuEPO requirements in chronic dialysis patients. We conducted a 2 years prospective study on 146 patients undergoing chronic dialysis treated with r-HuEPO. Based on their average CRP (C-reactive protein) levels, obtained from repeated samplings at 3 months interval, 3 groups were formed; we noted in each group the average values of r-HuEPO prescribed to achieve the optimum hemoglobin levels according to the dialysis best practice guidelines and all the adverse effects of the therapy. A direct correlation was observed between CRP levels and r-HuEPO requirements in the first 2 groups of patients (CRP under 6 mg/L and CRP values 6-20 mg/L), with significant increase in r-HuEPO doses between groups (p [ 0.001); the third group, CRP values over 20 mg/dL, showed a minor, insignificant increase in average r-HuEPO doses compared to mild inflammation group (p = 0.199) and more adverse effects of the therapy (p [ 0.05). Inflammation is an important determinant of anemia in chronic dialysis patients and can induce an increase in the doses of r-HuEPO. However, prescribing excessive r-HuEPO doses is not the answer in severe inflammatory status, due to lack of response and possible adverse effects.

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SP400EFFECT OF CHOLECALCIFEROL SUPPLEMENTATION ON TLR7, TLR9, IL-6 AND IFN-Y EXPRESSION IN B AND T LYMPHOCYTES ON CHRONIC DIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfv193.08 ◽

2015 ◽

Vol 30 (suppl_3) ◽

pp. iii511-iii511

Author(s):

Jose Tarcisio Giffoni de Carvalho ◽

Marion Schneider ◽

Lilian Cuppari ◽

Caren Cristina Grabulosa ◽

Silvia Regina Manfredi ◽

...

Keyword(s):

T Lymphocytes ◽

Chronic Dialysis ◽

Dialysis Patients ◽

Cholecalciferol Supplementation ◽

B And T Lymphocytes

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COVID-19 in pediatric patients undergoing chronic dialysis and kidney transplantation

European Journal of Pediatrics ◽

10.1007/s00431-021-04191-z ◽

2021 ◽

Author(s):

Nur Canpolat ◽

Zeynep Yürük Yıldırım ◽

Nurdan Yıldız ◽

Mehmet Taşdemir ◽

Nilüfer Göknar ◽

...

Keyword(s):

Kidney Transplantation ◽

Pediatric Patients ◽

Chronic Dialysis

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Returning to dialysis after kidney allograft failure: the experience of the Italian Registry of Paediatric Chronic Dialysis

Pediatric Nephrology ◽

10.1007/s00467-021-05140-6 ◽

2021 ◽

Author(s):

Edoardo La Porta ◽

Ester Conversano ◽

Daniela Zugna ◽

Roberta Camilla ◽

Raffaella Labbadia ◽

...

Keyword(s):

Kidney Transplantation ◽

Chronic Dialysis ◽

Supplementary Information ◽

Dialysis Modality ◽

Specific Population ◽

Kidney Allograft ◽

Allograft Failure ◽

Younger Age ◽

Complicated Course ◽

Significant Mortality

Abstract Background The need for dialysis after kidney allograft failure (DAGF) is among the top five reasons for dialysis initiation, making this an important topic in clinical nephrology. However, data are scarce on dialysis choice after transplantation and clinical outcomes for DAGF in children. Methods Patients receiving chronic dialysis < 18 years were recorded from January 1991 to January 2019 by the Italian Registry of Pediatric Chronic Dialysis (IRPCD). We investigated factors influencing choice of dialysis modality, patient outcome in terms of mortality, switching dialysis modality, and kidney transplantation. Results Among 118 patients receiving DAGF, 41 (35%) were treated with peritoneal dialysis (PD), and 77 (65%) with haemodialysis (HD). Significant predictors for treatment with PD were younger age at dialysis start (OR 0.85 per year increase [95%CI 0.72–1.00]) and PD use before kidney transplantation (OR 8.20 [95%CI 1.82–37.01]). Patients entering DAGF in more recent eras (OR 0.87 per year increase [95%CI 0.80–0.94]) and with more than one dialysis modality before kidney transplantation (OR 0.56 for being treated with PD [0.12–2.59]) were more likely to be initiated on HD. As compared to patients on HD, those treated with PD exhibited increased but non-significant mortality risk (HR 2.15 [95%CI 0.54–8.6]; p = 0.28) and higher prevalence of dialysis-related complications during DAGF (p = 0.002) Conclusions Patients entering DAGF in more recent years are more likely to be initiated on HD. In this specific population of children, use of PD seems associated with a more complicated course. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information

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POS-543 EXPERIENCE OF COVID 19 DISEASE ON 159 ECUADORIAN CHRONIC DIALYSIS PATIENTS

Kidney International Reports ◽

10.1016/j.ekir.2021.03.571 ◽

2021 ◽

Vol 6 (4) ◽

pp. S237

Author(s):

J. SANTACRUZ ◽

C. Santacruz Tipanta ◽

A. Vasquez Pérez ◽

P. Reinoso ◽

S. Carlotta ◽

...

Keyword(s):

Chronic Dialysis ◽

Dialysis Patients

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COVID-19—Importance for Patients on the Waiting List and after Kidney Transplantation—A Single Center Evaluation in 2020–2021

Pathogens ◽

10.3390/pathogens10040429 ◽

2021 ◽

Vol 10 (4) ◽

pp. 429

Author(s):

Simone C. Boedecker ◽

Pascal Klimpke ◽

Daniel Kraus ◽

Stefan Runkel ◽

Peter R. Galle ◽

...

Keyword(s):

Kidney Transplantation ◽

Waiting List ◽

Smoking History ◽

Immunocompromised Patients ◽

Dialysis Patients ◽

Vaccination Programs ◽

Mild Disease ◽

Probability Of Survival ◽

Number Of Patients ◽

Immunosuppressed Patients

(1) Background: Dialysis patients and recipients of a kidney allograft are at high risk for infection with SARS-CoV-2. It has been shown that the development of potent neutralizing humoral immunity against SARS CoV-2 leads to an increased probability of survival. However, the question of whether immunocompromised patients develop antibodies has not yet been sufficiently investigated; (2) Methods: SARS-CoV-2 antibodies were examined in hemodialysis patients on the waiting list for kidney transplantation as well as patients after kidney transplantation. Patients were interviewed about symptoms and comorbidities, BMI, and smoking history; (3) Results: SARS-CoV-2 antibodies were found in 16 out of 259 patients (6%). The trend of infections here reflects the general course of infection in Germany with a peak in November/December of 2020. Remarkably, patients on the waiting list experienced only mild disease. In contrast, transplanted patients had to be hospitalized but recovered rapidly from COVID-19. Most interesting is that all immunosuppressed patients developed antibodies against SARS-CoV-2 after infection; (4) Conclusions: Even with extensive hygiene concepts, an above-average number of patients were infected with SARS-CoV-2 during the second wave of infections in Germany. Because SARS-CoV-2 infection triggered the formation of antibodies even in these immunocompromised patients, we expect vaccination to be effective in this group of patients. Thus, dialysis patients and patients after kidney transplantation should be given high priority in vaccination programs.

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