Preoperative Noncoronary Cardiovascular Assessment and Management of Kidney Transplant Candidates

The pretransplant risk assessment for patients with ESKD who are undergoing evaluation for kidney transplant is complex and multifaceted. When considering cardiovascular disease in particular, many factors should be considered. Given the increasing incidence of kidney transplantation and the growing body of evidence addressing ESKD-specific cardiovascular risk profiles, there is an important need for a consolidated, evidence-based model that considers the unique cardiovascular challenges that these patients face. Cardiovascular physiology is altered in these patients by abrupt shifts in volume status, altered calcium-phosphate metabolism, high-output states (in the setting of arteriovenous fistulization), and adverse geometric and electrical remodeling, to name a few. Here, we present a contemporary review by addressing cardiomyopathy/heart failure, pulmonary hypertension, valvular dysfunction, and arrhythmia/sudden cardiac death within the ESKD population.

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To screen or not to screen? The development of a prediction model for aorto‐iliac stenosis in kidney transplant candidates

Transplant International ◽

10.1111/tri.14013 ◽

2021 ◽

Author(s):

Elsaline Rijkse ◽

Hongchao Qi ◽

Shabnam Babakry ◽

Diederik C. Bijdevaate ◽

Hendrikus J.A.N. Kimenai ◽

...

Keyword(s):

Prediction Model ◽

Kidney Transplant ◽

Transplant Candidates

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Fidelity to an evidence-based model for crisis resolution teams: a cross-sectional multicentre study in Norway

BMC Psychiatry ◽

10.1186/s12888-021-03237-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

N. Hasselberg ◽

K. H. Holgersen ◽

G. M. Uverud ◽

J. Siqveland ◽

B. Lloyd-Evans ◽

...

Keyword(s):

Mental Health ◽

Multidisciplinary Teams ◽

Evidence Based ◽

Crisis Resolution ◽

Health Crisis ◽

The Core ◽

Crisis Resolution Teams ◽

Fidelity Scale ◽

The Uk ◽

Evidence Based Model

Abstract Background Crisis resolution teams (CRTs) are specialized multidisciplinary teams intended to provide assessment and short-term outpatient or home treatment as an alternative to hospital admission for people experiencing a mental health crisis. In Norway, CRTs have been established within mental health services throughout the country, but their fidelity to an evidence-based model for CRTs has been unknown. Methods We assessed fidelity to the evidence-based CRT model for 28 CRTs, using the CORE Crisis Resolution Team Fidelity Scale Version 2, a tool developed and first applied in the UK to measure adherence to a model of optimal CRT practice. The assessments were completed by evaluation teams based on written information, interviews, and review of patient records during a one-day visit with each CRT. Results The fidelity scale was applicable for assessing fidelity of Norwegian CRTs to the CRT model. On a scale 1 to 5, the mean fidelity score was low (2.75) and with a moderate variation of fidelity across the teams. The CRTs had highest scores on the content and delivery of care subscale, and lowest on the location and timing of care subscale. Scores were high on items measuring comprehensive assessment, psychological interventions, visit length, service users’ choice of location, and of type of support. However, scores were low on opening hours, gatekeeping acute psychiatric beds, facilitating early hospital discharge, intensity of contact, providing medication, and providing practical support. Conclusions The CORE CRT Fidelity Scale was applicable and relevant to assessment of Norwegian CRTs and may be used to guide further development in clinical practice and research. Lower fidelity and differences in fidelity patterns compared to the UK teams may indicate that Norwegian teams are more focused on early interventions to a broader patient group and less on avoiding acute inpatient admissions for patients with severe mental illness.

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Abdominal Panniculectomy Can Simplify Kidney Transplantation in Obese Patients

Urologia Internationalis ◽

10.1159/000516678 ◽

2021 ◽

pp. 1-8

Author(s):

Dominik Promny ◽

Theresa Hauck ◽

Aijia Cai ◽

Andreas Arkudas ◽

Katharina Heller ◽

...

Keyword(s):

Wound Healing ◽

Kidney Transplantation ◽

Postoperative Complications ◽

Kidney Transplant ◽

Interdisciplinary Approach ◽

Wound Complications ◽

Obese Patients ◽

Patient Cohort ◽

Transplant Candidates ◽

Stage Renal Disease

Background: Obesity is frequently present in patients suffering from end-stage renal disease (ESRD). However, overweight kidney transplant candidates are a challenge for the transplant surgeon. Obese patients tend to develop a large abdominal panniculus after weight loss creating an area predisposed to wound-healing disorders. Due to concerns about graft survival and postoperative complications after kidney transplantation, obese patients are often refused in this selective patient cohort. The study aimed to analyze the effect of panniculectomies on postoperative complications and transplant candidacy in an interdisciplinary setting. Methods: A retrospective database review of 10 cases of abdominal panniculectomies performed in patients with ESRD prior to kidney transplantation was conducted. Results: The median body mass index was 35.2 kg/m2 (range 28.5–53.0 kg/m2) at first transplant-assessment versus 31.0 kg/m2 (range 28.0–34.4 kg/m2) at panniculectomy, and 31.6 kg/m2 (range 30.3–32.4 kg/m2) at kidney transplantation. We observed no major postoperative complications following panniculectomy and minor wound-healing complications in 2 patients. All aside from 1 patient became active transplant candidates 6 weeks after panniculectomy. No posttransplant wound complications occurred in the transplanted patients. Conclusion: Abdominal panniculectomy is feasible in patients suffering ESRD with no major postoperative complications, thus converting previously ineligible patients into kidney transplant candidates. An interdisciplinary approach is advisable in this selective patient cohort.

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Coronary microvascular dysfunction is associated with degree of anaemia in end‐stage renal disease

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02025-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ashwin Radhakrishnan ◽

Luke C. Pickup ◽

Anna M. Price ◽

Jonathan P. Law ◽

Kirsty C. McGee ◽

...

Keyword(s):

Confidence Interval ◽

Renal Disease ◽

Kidney Transplant ◽

End Stage Renal Disease ◽

Microvascular Dysfunction ◽

Left Ventricular ◽

Coronary Microvascular Dysfunction ◽

Transplant Candidates ◽

Stage Renal Disease ◽

End Stage

Abstract Background Coronary microvascular dysfunction (CMD) is common in end-stage renal disease (ESRD) and is an adverse prognostic marker. Coronary flow velocity reserve (CFVR) is a measure of coronary microvascular function and can be assessed using Doppler echocardiography. Reduced CFVR in ESRD has been attributed to factors such as diabetes, hypertension and left ventricular hypertrophy. The contributory role of other mediators important in the development of cardiovascular disease in ESRD has not been studied. The aim of this study was to examine the prevalence of CMD in a cohort of kidney transplant candidates and to look for associations of CMD with markers of anaemia, bone mineral metabolism and chronic inflammation. Methods Twenty-two kidney transplant candidates with ESRD were studied with myocardial contrast echocardiography, Doppler CFVR assessment and serum multiplex immunoassay analysis. Individuals with diabetes, uncontrolled hypertension or ischaemic heart disease were excluded. Results 7/22 subjects had CMD (defined as CFVR < 2). Demographic, laboratory and echocardiographic parameters and serum biomarkers were similar between subjects with and without CMD. Subjects with CMD had significantly lower haemoglobin than subjects without CMD (102 g/L ± 12 vs. 117 g/L ± 11, p = 0.008). There was a positive correlation between haemoglobin and CFVR (r = 0.7, p = 0.001). Similar results were seen for haematocrit. In regression analyses, haemoglobin was an independent predictor of CFVR (β = 0.041 95% confidence interval 0.012–0.071, p = 0.009) and of CFVR < 2 (odds ratio 0.85 95% confidence interval 0.74–0.98, p = 0.022). Conclusions Among kidney transplant candidates with ESRD, there is a high prevalence of CMD, despite the absence of traditional risk factors. Anaemia may be a potential driver of microvascular dysfunction in this population and requires further investigation.

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Development and testing of an evidence-based model of mentoring nursing students in clinical practice

Nurse Education Today ◽

10.1016/j.nedt.2019.104272 ◽

2020 ◽

Vol 85 ◽

pp. 104272 ◽

Cited By ~ 1

Author(s):

Kristina Mikkonen ◽

Marco Tomietto ◽

Giancarlo Cicolini ◽

Boris Miha Kaucic ◽

Bojana Filej ◽

...

Keyword(s):

Clinical Practice ◽

Nursing Students ◽

Evidence Based ◽

Evidence Based Model

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Prevalence of frailty among kidney transplant candidates and recipients in the United States: Estimates from a National Registry and Multicenter Cohort Study

American Journal of Transplantation ◽

10.1111/ajt.15709 ◽

2019 ◽

Vol 20 (4) ◽

pp. 1170-1180 ◽

Cited By ~ 6

Author(s):

Christine E. Haugen ◽

Alvin G. Thomas ◽

Nadia M. Chu ◽

Ashton A. Shaffer ◽

Silas P. Norman ◽

...

Keyword(s):

United States ◽

Cohort Study ◽

Kidney Transplant ◽

The United States ◽

National Registry ◽

Multicenter Cohort Study ◽

Multicenter Cohort ◽

Transplant Candidates

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Assessment of Biochemical and Densitometric Markers of Calcium-Phosphate Metabolism in the Groups of Patients with Multiple Sclerosis Selected due to the Serum Level of Vitamin D3

BioMed Research International ◽

10.1155/2018/9329123 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Natalia Niedziela ◽

Krystyna Pierzchała ◽

Jolanta Zalejska-Fiolka ◽

Jacek T. Niedziela ◽

Ewa Romuk ◽

...

Keyword(s):

Multiple Sclerosis ◽

Vitamin D ◽

Calcium Phosphate ◽

Serum Level ◽

Clinical Stage ◽

Phosphate Metabolism ◽

Disability Status ◽

Relapsing Remitting ◽

Relapsing Remitting Multiple Sclerosis ◽

Calcium Phosphate Metabolism

Background. In addition to the widely known effect of vitamin D3 (vitD3) on the skeleton, its role in the regulation of the immune response was also confirmed. Aim. The assessment of biochemical and densitometric markers of calcium-phosphate metabolism in the groups of patients with relapsing-remitting multiple sclerosis (RRMS) selected due to the serum level of vitamin D3. Methods. The concentrations of biochemical markers and indices of lumbar spine bone densitometry (DXA) were determined in 82 patients divided into vitamin D3 deficiency (VitDd), insufficiency (VitDi), and normal vitamin D3 level (VitDn) subgroups. Results. The highest level of the parathyroid hormone (PTH) and the highest prevalence of hypophosphatemia and osteopenia were demonstrated in VitDd group compared to VitDi and VitDn. However, in VitDd, VitDi, and VitDn subgroups no significant differences were observed in the levels of alkaline phosphatase (ALP) and ionized calcium (Ca2+) and in DXA indices. A negative correlation was observed between the level of vitamin D3 and the Expanded Disability Status Scale (EDSS) in the whole MS group. The subgroups were significantly different with respect to the EDSS scores and the frequency of complaints related to walking according to the EQ-5D. Conclusions. It is necessary to assess calcium-phosphate metabolism and supplementation of vitamin D3 in RRMS patients. The higher the clinical stage of the disease assessed with the EDSS, the lower the level of vitamin D3 in blood serum. Subjectively reported complaints related to difficulties with walking were reflected in the EDSS in VitDd patients.

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