scholarly journals Association between the “Timed Up and Go Test” at transplant evaluation and outcomes after kidney transplantation

2018 ◽  
Vol 32 (11) ◽  
pp. e13410 ◽  
Author(s):  
Ariane T. Michelson ◽  
Demetra S. Tsapepas ◽  
S. Ali Husain ◽  
Corey Brennan ◽  
Mariana C. Chiles ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Timed Up And Go ◽  
Transplant Evaluation

scholarly journals Implementation of a Quality Improvement Strategy to Increase Outpatient Kidney Transplant Referrals

2020 ◽  
Author(s):  
Samira Farouk ◽  
Sarah Atallah ◽  
Kirk N Campbell ◽  
Joseph A Vassalotti ◽  
Jaime Uribarri
Keyword(s):  
Quality Improvement ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Outpatient Setting ◽  
Improvement Strategy ◽  
Quality Improvement Strategy ◽  
Important Barrier ◽  
Transplant Evaluation ◽  
End Stage ◽  
The Impact

Abstract Background: Kidney transplantation remains the optimal therapy for patients with end stage kidney disease (ESKD), though a small fraction of patients on dialysis are on organ waitlists. An important barrier to preemptive kidney transplantation and successful waitlisting is timely referral to a kidney transplant center. We implemented a quality improvement strategy to improve outpatient kidney transplant referrals in a single center academic outpatient nephrology clinic. Methods: Over a 3 month period (July 1 - September 30, 2016), we assessed the baseline kidney transplantation referral rate at our outpatient nephrology clinic for patients 18 - 75 years old with an estimated glomerular filtration rate (eGFR) of less than 20 mL/min/1.73m 2 (2 values over 90 days apart). Charts were manually reviewed by two reviewers to look for kidney transplant referrals and documentation of discussions about kidney transplantation. We then performed a root cause analysis to explore potential barriers to kidney transplantation. Our intervention began on July 1, 2017 and included the implementation of a column in the electronic medical record (EMR) which displayed the patient's last eGFR as part of the clinic schedule. Physicians were given a document listing their patients to be seen that day with an eGFR of < 20 mL/min/1.73m 2 . Results: 54 unique patients with eGFR ≤ 20 ml/min/1.73 m 2 were identified who were seen in the Clinic between July 1, 2016 and September 30, 2016. 29.6% (16) eligible patients were referred for kidney transplantation evaluation. 69.5% (37) of these patients were not referred for kidney transplant evaluation. 46.3% (25) did not have documentation regarding kidney transplant in the EMR. Following the intervention, 66 unique patients met criteria for eligibility for kidney transplant evaluation. Kidney transplant referrals increased to 60.6% (p < 0.001). Conclusions: Our pilot implementation study of a strategy to improve outpatient kidney transplant referrals showed that a free, simple, scalable intervention can significantly improve kidney transplant referrals in the outpatient setting Next steps include further study of the impact of early referral to kidney transplant centers on preemptive and living donor kidney transplantation as well as successful waitlisting.

scholarly journals Kidney Transplantation in COVID Pandemic—A Review of Guidelines

2021 ◽  
Vol 10 (13) ◽  
pp. 2877
Author(s):  
Gabriela Gut ◽  
Agata Góral ◽  
Zofia Dal Canton ◽  
Paweł Poznański ◽  
Magdalena Krajewska ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Diagnostic Procedures ◽  
Service Organization ◽  
Ct Scans ◽  
Nasopharyngeal Swab ◽  
Transplant Recipients ◽  
Face To Face ◽  
Green Areas ◽  
Transplant Evaluation ◽  
Transplantation Procedures

The paper describes problems with the transplantation process during the COVID-19 pandemic. Transplantation procedures and programs have been impacted by COVID-19. The number of transplants has fallen noticeably. The first part of the paper points out changes in service organization, in particular donor and recipient pre-transplant and peri-transplant management. If the patients during pre-transplant evaluation need to attend face-to-face appointments, such as blood testing or other investigations, the risk of contracting or spreading COVID-19 should be minimized. “Clear green areas”, which are COVID-19-free pathways, are highly recommended in hospitals during transplant procedures. Diagnostic procedures concerning donors, including CT scans and coronavirus testing (nasopharyngeal swab), are necessary before transplant surgery. COVID-19 symptoms and risks of the transplant population are described. Detailed guidelines from transplant societies concerning changes in immunosuppression in infected recipients are discussed. Management of infected or suspected medical staff is mentioned. The paper ends with guidelines concerning vaccination against COVID-19 in transplant recipients.

scholarly journals Racial/Ethnic Differences in Barriers to Kidney Transplant Evaluation among Hemodialysis Patients

2017 ◽  
Vol 47 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Derek Jones ◽  
Zhiying You ◽  
Jessica B. Kendrick
Keyword(s):  
Kidney Transplantation ◽  
Multivariate Analyses ◽  
Hemodialysis Patients ◽  
Demographic Information ◽  
Chi Square ◽  
Know How ◽  
Survey Response Rate ◽  
Transplant Evaluation ◽  
Racial Ethnic ◽  
Timely Referral

Background: Only a small percentage of dialysis patients receive a transplant and this is particularly the case for racial/ethnic minorities. Our objective was to identify barriers to initial transplant evaluation in our dialysis centers. Methods: We conducted a survey of adult hemodialysis patients from 4 dialysis units in the Denver Metro area in 2016. Participants completed an 11-item survey with demographic information and questions regarding time on dialysis, if a provider ever spoke to them about transplant, and whether they had been evaluated for a transplant. Reasons for not having an evaluation were explored. Descriptive statistics, chi-square analyses, and multivariate analyses were used to examine the responses. Results: A total of 167 patients completed the survey (response rate 63.9%). The majority of participants were male and were Hispanic (49%) or Non-Hispanic black (31.7%). Of these, 140 patients (84.0%) reported discussing kidney transplantation with their doctor but only 53% reported having a transplant evaluation. After adjustment for age, gender, and time on dialysis, significantly fewer blacks reported having an evaluation than Non-Hispanic whites or Hispanics (43.4 vs. 57.7% [whites] and 59.7% [Hispanics], p = 0.03). The most frequent responses of the patients who had not been evaluated were the following: not referred by their provider (46%), did not know how to proceed (43.4%), or did not understand the benefits (39.5%) or transplant process (38.2%). Compared to Non-Hispanic whites, blacks and Hispanics reported less understanding of the benefits and process of transplant. Conclusion: Timely referral by providers and improved kidney transplantation education may reduce disparities in access to kidney transplantation.

scholarly journals Implementation of a Quality Improvement Strategy to Increase Outpatient Kidney Transplant Referrals

2020 ◽  
Author(s):  
Samira Farouk ◽  
Sarah Atallah ◽  
Kirk N Campbell ◽  
Joseph A Vassalotti ◽  
Jaime Uribarri
Keyword(s):  
Quality Improvement ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Outpatient Setting ◽  
Improvement Strategy ◽  
Quality Improvement Strategy ◽  
Important Barrier ◽  
Transplant Evaluation ◽  
End Stage ◽  
The Impact

Abstract Background: Kidney transplantation remains the optimal therapy for patients with end stage kidney disease (ESKD), though a small fraction of patients on dialysis are on organ waitlists. An important barrier to preemptive kidney transplantation and successful waitlisting is timely referral to a kidney transplant center. We implemented a quality improvement strategy to improve outpatient kidney transplant referrals in a single center academic outpatient nephrology clinic. Methods: Over a 3 month period (July 1 - September 30, 2016), we assessed the baseline kidney transplantation referral rate at our outpatient nephrology clinic for patients 18 - 75 years old with an estimated glomerular filtration rate (eGFR) of less than 20 mL/min/1.73m 2 (2 values over 90 days apart). Charts were manually reviewed by two reviewers to look for kidney transplant referrals and documentation of discussions about kidney transplantation. We then performed a root cause analysis to explore potential barriers to kidney transplantation. Our intervention began on July 1, 2017 and included the implementation of a column in the electronic medical record (EMR) which displayed the patient's last eGFR as part of the clinic schedule. Physicians were given a document listing their patients to be seen that day with an eGFR of < 20 mL/min/1.73m 2 . Results: 54 unique patients with eGFR ≤ 20 ml/min/1.73 m 2 were identified who were seen in the Clinic between July 1, 2016 and September 30, 2016. 29.6% (16) eligible patients were referred for kidney transplantation evaluation. 69.5% (37) of these patients were not referred for kidney transplant evaluation. 46.3% (25) did not have documentation regarding kidney transplant in the EMR. Following the intervention, 66 unique patients met criteria for eligibility for kidney transplant evaluation. Kidney transplant referrals increased to 60.6% (p < 0.001). Conclusions: Our pilot implementation study of a strategy to improve outpatient kidney transplant referrals showed that a free, simple, scalable intervention can significantly improve kidney transplant referrals in the outpatient setting Next steps include further study of the impact of early referral to kidney transplant centers on preemptive and living donor kidney transplantation as well as successful waitlisting.

P1550ACCESS TO KIDNEY TRANSPLANTATION IN A NON-PROFIT FACILITY IN GERMANY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Stephan Kemmner ◽  
Wolfgang Arns ◽  
Gero Von Gersdorff ◽  
Rolf Dieter Bach ◽  
Michael Fischereder
Keyword(s):  
Kidney Transplantation ◽  
Waiting List ◽  
Dialysis Treatment ◽  
Non Profit ◽  
For Profit ◽  
The Status ◽  
Dialysis Facility ◽  
Transplant Evaluation ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims Recent studies demonstrate that US patients undergoing chronic dialysis treatment for end stage renal disease (ESRD) at for-profit facilities had a lower access to kidney transplantation than patients at non-profit facilities. However, even at non-profit facilities only around 20% of patients were placed on the kidney transplantation waiting list. At first glance, this number appears rather low, as kidney transplantation is the only way to curatively treat ESRD. We want to compare these figures with a recently performed survey in Germany. Method We analyzed the status of transplant evaluation in the largest non-profit facility in Germany, the Kuratorium für Dialyse und Nierentransplantation e.V. (kfh, www.kfh.de). In total, the transplant status was assessed in 16,705 patients. Results Out of these only 19.4% of patients (n=3241) are on the kidney transplant waiting list, comparable to recently performed US studies. The reason why patients are not waitlisted are multifaceted as seen in attached figure. Due to severe comorbidities about 50% are considered too sick to benefit from transplantation, in turn representing the complex and high multi-morbidity of patients with ESRD. On the other hand, approximately 10% of dialysis patients actively decline listing for renal transplantation at least at some point. Conclusion We conclude that further research is needed to identify and break the mechanisms behind the low likelihood for access to kidney transplantation waiting list. Distribution of patients with surveyed transplant status in the largest non-profit dialysis facility (kfh, www.kfh.de) in Germany

scholarly journals The Kidney Transplant Evaluation Process in the Elderly: Reasons for Being Turned down and Opportunities to Improve Cost-Effectiveness in a Single Center

2016 ◽  
Vol 2016 ◽  
pp. 1-8
Author(s):  
Beatrice P. Concepcion ◽  
Rachel C. Forbes ◽  
Aihua Bian ◽  
Heidi M. Schaefer
Keyword(s):  
Kidney Transplantation ◽  
Statistical Analysis ◽  
Kidney Transplant ◽  
Evaluation Process ◽  
The Elderly ◽  
Chronic Obstructive ◽  
Comorbid Conditions ◽  
Clinical Predictors ◽  
Obstructive Pulmonary Disease ◽  
Transplant Evaluation

Background. The kidney transplant evaluation process for older candidates is complex due to the presence of multiple comorbid conditions.Methods. We retrospectively reviewed patients ≥60 years referred to our center for kidney transplantation over a 3-year period. Variables were collected to identify reasons for patients being turned down and to determine the number of unnecessary tests performed. Statistical analysis was performed to estimate the association between clinical predictors and listing status.Results. 345 patients were included in the statistical analysis. 31.6% of patients were turned down: 44% due to coronary artery disease (CAD), peripheral vascular disease (PVD), or both. After adjustment for patient demographics and comorbid conditions, history of CAD, PVD, or both (OR = 1.75, 95% CI (1.20, 2.56),p=0.004), chronic obstructive pulmonary disease (OR = 8.75, 95% CI (2.81, 27.20),p=0.0002), and cancer (OR 2.59, 95% CI (1.18, 5.67),p=0.02) were associated with a higher risk of being turned down. 14.8% of patients underwent unnecessary basic testing and 9.6% underwent unnecessary supplementary testing with the charges over a 3-year period estimated at $304,337.Conclusion. A significant number of older candidates are deemed unacceptable for kidney transplantation with primary reasons cited as CAD and PVD. The overall burden of unnecessary testing is substantial and potentially avoidable.

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