scholarly journals Kidney Disease Symptoms Before and After Kidney Transplantation

2021 ◽  
pp. CJN.19031220
Author(s):  
Kathryn Taylor ◽  
Nadia Chu ◽  
Xiaomeng Chen ◽  
Zhan Shi ◽  
Eileen Rosello ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Symptom Score ◽  
Mortality Risk ◽  
Symptom Burden ◽  
Post Transplantation ◽  
Before And After ◽  
Transplant Candidates ◽  
Mental Stressors ◽  
Waitlist Mortality ◽  
Very High

Background and Objectives: Kidney failure patients report a high symptom burden, which likely increase while on dialysis due to physical and mental stressors and decrease after kidney transplantation due to restoration of kidney function. Design, Setting, Participants, and Measurements: We leveraged a 2-center prospective study of 1,298 kidney transplant candidates and 521 recipients (5/2014-3/2020). Symptom scores (0-100) at evaluation and admission for transplantation were calculated using KDQOL-SF, where lower scores represent greater burden, and burden was categorized as: very high: 0.0-71.0; high: 71.1-81.0; medium: 81.1-91.0; low: 91.1-100.0. We estimated adjusted waitlist mortality risk (competing risks regression), change in symptoms between evaluation and transplantation (n=190), and post-transplantation symptom score trajectories (mixed-effects models). Results: At evaluation, candidates reported being moderately to extremely bothered by fatigue (32%), xeroderma (27%), muscle soreness (26%), and pruritus (25%); 16% reported high and 21% reported very high symptom burden. Candidates with very high symptom burden were at greater waitlist mortality risk (aSHR=1.67, 95%CI:1.06,2.62). By transplantation, 34% experienced an increased symptom burden while 42% remained unchanged. The estimated overall symptom score was 82.3 points at transplantation, 90.6 points at 3 months (10% improvement); the score increased 2.75 points/month (95%CI:2.38,3.13) during 0-3 months, and plateaued (-0.06 points/month, 95%CI:-0.30,0.18) from 3 months through 12 months post-transplantation. There were early (first 3 months) improvements in 9 of 11 symptoms; pruritus (23% improvement) and fatigue (21% improvement) had the greatest improvements. Conclusions: Among candidates, very high symptom burden was associated with waitlist mortality, but for those surviving and undergoing kidney transplantation, symptoms improved.

scholarly journals Cognitive Function, Access to Kidney Transplantation, and Waitlist Mortality Among Kidney Transplant Candidates With or Without Diabetes

2020 ◽  
Vol 76 (1) ◽  
pp. 72-81 ◽  
Author(s):  
Nadia M. Chu ◽  
Zhan Shi ◽  
Christine E. Haugen ◽  
Silas P. Norman ◽  
Alden L. Gross ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Cognitive Function ◽  
Kidney Transplant ◽  
Transplant Candidates ◽  
Waitlist Mortality

scholarly journals FUNCTIONAL INDEPENDENCE, ACCESS TO KIDNEY TRANSPLANTATION, AND WAITLIST MORTALITY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S494-S495
Author(s):  
Nadia M Chu ◽  
Stephanie Sison ◽  
Abimereki Muzaale ◽  
Christine Haugen ◽  
Jacqueline Garonzik Wang ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Kidney Disease ◽  
Activities Of Daily Living ◽  
Competing Risks ◽  
Mortality Risk ◽  
Daily Living ◽  
Functional Independence ◽  
End Stage Kidney Disease ◽  
End Stage ◽  
Waitlist Mortality

Abstract Although functional independence is a health priority for patients with advanced CKD, 50% of those who progress to end-stage kidney disease (ESKD) develop difficulties carrying-out essential day-to-day activities. Functional independence is not routinely assessed at kidney transplant (KT) evaluation; therefore, it is unclear what percentage of candidates are functionally independent and whether independence is associated with access to KT and waitlist mortality. We studied a prospective cohort of 3,168 ESKD participants (1/2009-6/2018) who self-reported functional independence in basic Activities of Daily Living (ADL) and more complex Instrumental Activities of Daily Living (IADL). We estimated adjusted associations between functional independence (separately) and listing (Cox), waitlist mortality (competing risks), and transplant rates (Poisson). At evaluation, 92.4% were independent in ADLs, but only 68.5% were independent in IADLs. Functionally independent participants had a higher chance of listing for KT (ADL:aHR=1.55,95%CI:1.30-1.87; IADL:aHR=1.39,95%CI 1.26-1.52). Among KT candidates, ADL independence was associated with lower waitlist mortality risk (SHR=0.66,95%CI:0.44-0.98) and higher rate of KT (IRR=1.58,95%CI:1.12-2.22); the same was not observed for IADL independence (SHR=0.86,95%CI:0.65-1.12; IRR=1.01,95%CI:0.97-1.19). ADL independence was associated with better KT access and lower waitlist mortality; clinicians should screen KT candidates for ADL independence, and identify interventions to maintain independence to improve waitlist outcomes.

scholarly journals Outcomes of pancreas transplantation in older diabetic patients

2020 ◽  
Vol 8 (1) ◽  
pp. e000916 ◽  
Author(s):  
Enrique Montagud-Marrahi ◽  
Alicia Molina-Andújar ◽  
Adriana Pané ◽  
Maria José Ramírez-Bajo ◽  
Antonio Amor ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Pancreas Transplantation ◽  
Major Adverse Cardiovascular Events ◽  
Diabetic Patients ◽  
Delayed Presentation ◽  
Post Transplantation ◽  
Term Survival ◽  
Post Transplant ◽  
Before And After

ObjectiveImprovement in insulin alternatives is leading to a delayed presentation of microvascular and macrovascular complications of diabetes. The objective of this study was to evaluate the long-term outcomes of older (≥50 years) diabetic patients who receive a pancreas transplantation (PT).Research design and methodsWe retrospectively evaluated all 338 PTs performed at our center between 2000 and 2016 (mean follow-up 9.4±4.9 years). Recipient and graft survivals were estimated for up to 10 years after PT. Major adverse cardiovascular events (MACEs) before and after PT were included in the analysis.ResultsThirty-nine patients (12%) were ≥50 years old (52.7±2.3 years) at the day of PT, of which 29 received a simultaneous pancreas–kidney transplantation (SPK) and 10 a pancreas after kidney transplantation (PAK). SPK recipients were first transplants, whereas in the PAK up to 50% were pancreas re-transplantations. Recipient and pancreas graft survivals at 10 years were similar between the group <50 years old and the older group for both SPK and PAK (log-rank p>0.05). The prevalence of MACE prior to PT was similar between both groups (31% vs 29%). Following PT, older recipients presented inferior post-transplant MACE-free survival. In a multivariate regression model, diabetes vintage (HR 1.054, p=0.03) and pre-transplantation MACE (HR 1.98, p=0.011), but not recipient age (HR 1.45, p=0.339), were associated with post-transplant MACE.ConclusionsLong-term survival of older pancreas transplant recipients are similar to younger counterparts. Diabetes vintage, but not age, increased the risk of post-transplantation MACE. These results suggest pancreas transplantation is a valuable treatment alternative to older diabetic patients.

Implementation of a mortality risk predictive analytics model.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 211-211
Author(s):  
Stephanie Broadnax Broussard ◽  
John Russell Hoverman ◽  
Lalan S. Wilfong ◽  
Sabrina Q. Mikan ◽  
Holly Books ◽  
...  
Keyword(s):  
High Risk ◽  
End Of Life ◽  
Mortality Risk ◽  
Predictive Analytics ◽  
Risk Identification ◽  
Close Monitoring ◽  
Network Analytics ◽  
Risk Of Mortality ◽  
Before And After ◽  
Very High

211 Background: Improving the quality of End of Life (EOL) care continues to be a challenge. Enhanced prognostic awareness is critical for all members of the clinical team. In December 2020, The McKesson Advance Care Planning Enrollment eXtended (APEX) mortality risk predictive analytics model was implemented to improve prognostic awareness in OCM population and improve the timing of initiation of end of life care. (See ASCO 2021 abstract #1560). Methods: The APEX tool was provided in collaboration with the McKesson/US Oncology network analytics team. A process was established for dissemination of the report information. In the pilot, 12 practice locations with varying community landscapes, socio-cultural dynamics, and site clinical personnel resources were selected. At each site clinical leads and physician champions were selected. Education was provided on the tool, prognostic variables, and appropriate interventions. Biweekly, each site was provided a list of stratified patients based on their risk of mortality within the next 90 days. Patients that were identified as “very high” or “high” risk were reviewed by the clinical teams and discussed in routine huddles. Physicians and teams reported their planned interventions before and after mortality risk identification. Results: In the pilot, 105 patients were identified as very high or high risk. Reported interventions included the option to continue treatment, ACP Discussion, hospice referral/enrollment, palliative care referral, or continue close monitoring. Prior to the report, 14 identified patients were admitted to hospice and 30 patients had 1 or more advance directives documented. For 26 patients, treatment changes occurred including hospice enrollment, reduction in chemotherapy dosage, change in regimen, or initiating intensive monitoring. 23 patients indicated on the report expired in the interim between generation of the report and receipt by the clinic. No changes in treatment were made in 22 patients. There was physician reported disagreement with the mortality risk assessment in 4 patients. Conclusions: We describe implementation of a mortality predictive model in our practice. The care teams found the tool useful to identify patients at high risk of mortality. Interventions were varied and we will track the outcomes based on intervention. We are using the information from the pilot to continue refining the tool and implementation.

Deformation Replication

1970 ◽  
Vol 28 ◽  
pp. 280-281
Author(s):  
J. Temple Black
Keyword(s):  
Cutting Speed ◽  
Machining Process ◽  
Depth Of Cut ◽  
Rake Face ◽  
Orthogonal Machining ◽  
Aluminum Chips ◽  
Before And After ◽  
Materials Used ◽  
Glass Knife ◽  
Very High

Tool materials used in ultramicrotomy are glass, developed by Latta and Hartmann (1) and diamond, introduced by Fernandez-Moran (2). While diamonds produce more good sections per knife edge than glass, they are expensive; require careful mounting and handling; and are time consuming to clean before and after usage, purchase from vendors (3-6 months waiting time), and regrind. Glass offers an easily accessible, inexpensive material ($0.04 per knife) with very high compressive strength (3) that can be employed in microtomy of metals (4) as well as biological materials. When the orthogonal machining process is being studied, glass offers additional advantages. Sections of metal or plastic can be dried down on the rake face, coated with Au-Pd, and examined directly in the SEM with no additional handling (5). Figure 1 shows aluminum chips microtomed with a 75° glass knife at a cutting speed of 1 mm/sec with a depth of cut of 1000 Å lying on the rake face of the knife.

scholarly journals Effects of renal transplantation on erectile dysfunction: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Irham Arif Rahman ◽  
Nur Rasyid ◽  
Ponco Birowo ◽  
Widi Atmoko
Keyword(s):  
Systematic Review ◽  
Erectile Dysfunction ◽  
Kidney Transplantation ◽  
Renal Transplantation ◽  
End Stage Renal Disease ◽  
Erectile Function ◽  
Meta Analysis ◽  
Post Transplantation ◽  
Stage Renal Disease ◽  
End Stage

AbstractErectile dysfunction (ED) is a major global health burden commonly observed in patients with end-stage renal disease (ESRD). Although renal transplantation improves the problem in some patients, it persists in ≈20–50% of recipients. Studies regarding the effects of kidney transplantation on ED present contradictory findings. We performed a systematic review to summarise the effects of kidney transplantation on ED. A systematic literature search was performed across PubMed, Cochrane, and Scopus databases in April 2020. We included all prospective studies that investigated the pre and posttransplant international index of erectile function (IIEF-5) scores in recipients with ED. Data search in PubMed and Google Scholar produced 1326 articles; eight were systematically reviewed with a total of 448 subjects. Meta-analysis of IIEF-5 scores showed significant improvements between pre and post transplantation. Our findings confirm that renal transplantation improves erectile function. Furthermore, transplantation also increases testosterone level. However, the evidence is limited because of the small number of studies. Further studies are required to investigate the effects of renal transplantation on erectile function.

scholarly journals B-cell activating factor BAFF as a novel alert marker for the immunological risk stratification after kidney transplantation

2021 ◽  
Author(s):  
Antonia Margarete Schuster ◽  
N. Miesgang ◽  
L. Steines ◽  
C. Bach ◽  
B. Banas ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
B Cell ◽  
Graft Function ◽  
Risk Profile ◽  
Kidney Transplant Recipients ◽  
Post Transplantation ◽  
Antibody Mediated Rejection ◽  
B Cell Activating Factor ◽  
Medium Risk ◽  
Patients At Risk

AbstractThe B cell activating factor BAFF has gained importance in the context of kidney transplantation due to its role in B cell survival. Studies have shown that BAFF correlates with an increased incidence of antibody-mediated rejection and the development of donor-specific antibodies. In this study, we analyzed a defined cohort of kidney transplant recipients who were treated with standardized immunosuppressive regimens according to their immunological risk profile. The aim was to add BAFF as an awareness marker in the course after transplantation to consider patient’s individual immunological risk profile. Included patients were transplanted between 2016 and 2018. Baseline data, graft function, the occurrence of rejection episodes, signs of microvascular infiltration, and DSA kinetics were recorded over 3 years. BAFF levels were determined 14 d, 3 and 12 months post transplantation. Although no difference in graft function could be observed, medium-risk patients showed a clear dynamic in their BAFF levels with low levels shortly after transplantation and an increase in values of 123% over the course of 1 year. Patients with high BAFF values were more susceptible to rejection, especially antibody-mediated rejection and displayed intensified microvascular inflammation; the combination of high BAFF + DSA puts patients at risk. The changing BAFF kinetics of the medium risk group as well as the increased occurrence of rejections at high BAFF values enables BAFF to be seen as an awareness factor. To compensate the changing immunological risk, a switch from a weaker induction therapy to an intensified maintenance therapy is required.

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