Changes in renal function and predictors affecting renal outcome of living kidney donors: a nationwide prospective cohort study

BackgroundApproximately 40% of the kidneys for transplant worldwide come from living donors. Despite advantages of living donor transplants, rates have stagnated in recent years. One possible barrier may be costs related to the transplant process that potential willing donors may incur for travel, parking, accommodation, and lost productivity.MethodsTo better understand and quantify the financial costs incurred by living kidney donors, we conducted a prospective cohort study, recruiting 912 living kidney donors from 12 transplant centers across Canada between 2009 and 2014; 821 of them completed all or a portion of the costing survey. We report microcosted total, out-of-pocket, and lost productivity costs (in 2016 Canadian dollars) for living kidney donors from donor evaluation start to 3 months after donation. We examined costs according to (1) the donor’s relationship with their recipient, including spousal (donation to a partner), emotionally related nonspousal (friend, step-parent, in law), or genetically related; and (2) donation type (directed, paired kidney, or nondirected).ResultsLiving kidney donors incurred a median (75th percentile) of $1254 ($2589) in out-of-pocket costs and $0 ($1908) in lost productivity costs. On average, total costs were $2226 higher in spousal compared with emotionally related nonspousal donors (P=0.02) and $1664 higher in directed donors compared with nondirected donors (P<0.001). Total costs (out-of-pocket and lost productivity) exceeded $5500 for 205 (25%) donors.ConclusionsOur results can be used to inform strategies to minimize the financial burden of living donation, which may help improve the donation experience and increase the number of living donor kidney transplants.

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Low erythropoietin levels predict faster renal function decline in diabetic patients with anemia: a prospective cohort study

Scientific Reports ◽

10.1038/s41598-019-51207-8 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 4

Author(s):

Yohei Fujita ◽

Yohei Doi ◽

Takayuki Hamano ◽

Masahiro Hatazaki ◽

Yutaka Umayahara ◽

...

Keyword(s):

Renal Function ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Iron Status ◽

Renal Outcome ◽

Diabetic Patients ◽

Epo Deficiency ◽

Egfr Decline ◽

Egfr Slope

Abstract Elevated erythropoietin (EPO) levels have been reported to predict poor survival in various populations including diabetic patients. However, data regarding its impact on renal outcomes are scarce. We conducted a single-center, prospective cohort study of 339 type 2 diabetic patients with anemia. The primary outcome was the estimated glomerular filtration rate (eGFR) slope for two years. We performed multiple linear regression and restricted cubic spline analyses to assess the association of serum EPO levels with the renal outcome. Chronic kidney disease (CKD) was defined as eGFR <60 mL/min/1.73 m2 or urine albumin-to-creatinine ratio >30 mg/g creatinine. Median baseline EPO and eGFR level were 14.4 IU/L and 53 mL/min/1.73 m2, respectively. Inappropriately low EPO levels were observed in 73% of anemic patients and 59% of anemic patients even without CKD, suggesting that EPO deficiency precedes the onset of CKD in diabetes mellitus. Multivariable analysis revealed that iron status and hemoglobin levels were major determinants of EPO levels. Median eGFR slope was −1.3 mL/min/1.73 m2/year. We found that low EPO levels, but not low hemoglobin levels, were associated with a faster decline in eGFR, independent of clinically relevant factors. The eGFR decline was steeper, particularly when the EPO level was below the upper limit of normal. Lower EPO concentrations were associated with rapid eGFR decline, especially in patients with iron deficiency (P for interaction = 0.01). Relative EPO deficiency should be considered as a culprit in anemia of unknown etiology in diabetic patients, even those without CKD. Low EPO levels, especially when accompanied by poor iron status, are predictive of rapid loss of renal function.

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FP326PHYSICAL ACTIVITY IS ASSOCIATED WITH CKD DEVELOPMENT RISK IN SUBJECTS WITH NORMAL RENAL FUNCTION: COMMUNITY BASED PROSPECTIVE COHORT STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfy104.fp326 ◽

2018 ◽

Vol 33 (suppl_1) ◽

pp. i140-i140

Author(s):

Young Su Joo ◽

Jee young Lee ◽

Jung Tak Park

Keyword(s):

Renal Function ◽

Cohort Study ◽

Prospective Cohort Study ◽

Normal Renal Function ◽

Prospective Cohort ◽

Community Based ◽

Development Risk

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Long-Term Effects on Renal Function in Children and Adolescents Due to Environmental Exposure to Lead-Results from an 11-Year Prospective Cohort Study

Journal of Toxicology and Risk Assessment ◽

10.23937/2572-4061.1510003 ◽

2015 ◽

Vol 1 (1) ◽

Author(s):

Recio-Vega R

Keyword(s):

Renal Function ◽

Cohort Study ◽

Children And Adolescents ◽

Environmental Exposure ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Long Term Effects

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Relevance of Screening for Urinary Tract Infection in Well Infants with Prolonged Jaundice: A Prospective Cohort Study

Malaysian Journal of Paediatrics and Child Health ◽

10.51407/mjpch.v25i1.50 ◽

2019 ◽

Vol 25 (1) ◽

pp. 13-18

Author(s):

Caroline Siew Yin Eng ◽

Thalitha Vijayakulasingam ◽

Boon Hong Ng ◽

Maryam Jamilah Surdi Roslan ◽

Muhammad Zamakhshari Zainal Abidin ◽

...

Keyword(s):

Urinary Tract Infection ◽

Cohort Study ◽

Urinary Tract ◽

Tract Infection ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Unit Cost ◽

Renal Outcome ◽

Term Infants ◽

Prolonged Jaundice

Background: Recent retrospective studies suggest irrelevance of urine screening for neonate with prolonged jaundice. We re-evaluated the incidence of urinary tract infection (UTI) among these infants, their renal outcome and evaluated the cost incurred. Methods: This is a prospective cohort study. Asymptomatic, prolonged jaundiced infants with unconjugated hyperbilirubinemia were screened for evidence of UTI as per local guidelines. Infants with pyuria would have urine sent for culture and sensitivity. Unit cost was referenced from hospital purchase. Statistical analysis was performed using SPSS 24.0. Results: A total of 291 cases were analyzed. Majority were term infants (93.8%). The commonest cause of prolonged jaundice was breast milk jaundice, hence an incidence rate of 0.34%. Only one infant persistently showed single uropathogen on urinary culture with concurrent pyuria. Urinary structures were normal on ultrasonography and there was no evidence of renal cortical scarring. No recurrence of UTI documented in the first year of life. Each “clean-catch” urinalysis costed RM7. This unit cost escalated to RM37 for catheterized sample. A negative urine culture costed RM28 while a positive culture twice this price. The average cost effectiveness ratio (ACER) in this study was RM5856.56 per detection of case. Conclusion: Incidence of UTI is low. In our study, an undesirable outcome is negligible. Unnecessary parental anxiety from the potentially laborious procedure could be avoided. This study refutes previous literature to include such screening in prolonged jaundice as this may well be irrelevant.

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