Latest News on Dialysis and Transplantation : Nov 2020

Latest News on Dialysis and Transplantation : Nov 2020

Pulmonary function in chronic renal failure: effects of dialysis and transplantation

Many possible pulmonary complications of renal disease have been described, but little is known of their physiological importance or the effects on them of different forms of renal replacement therapy. Four groups were recruited, each containing 20 patients. The groups consisted of patients with chronic renal failure before dialysis (group 1); patients receiving continuous ambulatory peritoneal dialysis, never having received a transplant (group 2); patients receiving haemodialysis, never having received a transplant (group 3); and patients after their first successful cadaveric renal transplant (group 4). All were attending the same regional dialysis and transplant unit. None was known to have clinically important lung or chest wall disease. Flow-volume loops were recorded before and after 400 micrograms of salbutamol, and plethysmographic lung volumes and airway conductance and single breath carbon monoxide transfer factor were measured. Only nine of 80 patients had normal lung function. The reductions in spirometric values were minor. Whole lung carbon monoxide transfer factor was reduced in all groups (mean % predicted with 95% confidence intervals: group 1 81.7% (74-89%); group 2 69.7% (62-77%); group 3 87.5% (80-96%); group 4 82.5% (78-87%]. The values were significantly lower in those having continuous ambulatory peritoneal dialysis (group 2). Residual volume was reduced significantly in the group who had undergone renal transplantation (85.7%, 77-94%). There was no correlation between these changes and smoking habit, age, duration or severity of renal failure, duration of treatment, or biochemical derangement. It is concluded that abnormal lung function is common in renal disease. The main change is a reduction in carbon monoxide transfer that persists after transplantation. The likeliest explanation is that subclinical pulmonary oedema progresses to fibrosis before transplantation. The fibrosis may worsen further to cause the reduced residual volume in the recipients of grafts. [1]

Dialysis, Kidney Transplantation, or Pancreas Transplantation for Patients with Diabetes Mellitus and Renal Failure: A Decision Analysis of Treatment Options

ABSTRACT. Patients with type 1 diabetes mellitus and end-stage renal disease may remain on dialysis or undergo cadaveric kidney transplantation, living kidney transplantation, sequential pancreas after living kidney transplantation, or simultaneous pancreas-kidney transplantation. It is unclear which of these options is most effective. The objective of this study was to determine the optimal treatment strategy for type 1 diabetic patients with renal failure using a decision analytic Markov model. Input data were obtained from the published medical literature, the United Network for Organ Sharing registry, and patient interviews. The outcome measures were life expectancy (in life-years [LY]) and quality-adjusted life expectancy (in quality-adjusted life-years [QALY]). Living kidney transplantation was associated with 18.30 LY and 10.29 QALY; pancreas after kidney transplantation, 17.21 LY and 10.00 QALY; simultaneous pancreas-kidney transplantation, 15.74 LY and 9.09 QALY; cadaveric kidney transplantation, 11.44 LY and 6.53 QALY; dialysis, 7.82 LY and 4.52 QALY. The results were sensitive to the value of several key variables. Simultaneous pancreas-kidney transplantation had the greatest life expectancy and quality-adjusted life expectancy when living kidney transplantation was excluded from the analysis. These data indicate that living kidney transplantation is associated with the greatest life expectancy and quality-adjusted life expectancy for type 1 diabetic patients with renal failure. Treatment strategies involving pancreas transplantation should be considered for patients with frequent metabolic complications of diabetes and for those patients who favor kidney-pancreas transplantation over kidney transplantation alone. For patients without a living donor, simultaneous pancreas-kidney transplantation is associated with the greatest life expectancy. [2]

The cost of dialysis and kidney transplantation in France in 2007, impact of an increase of peritoneal dialysis and transplantation

INTRODUCTION: This study estimates the costs for the national health insurance in 2007 of the patients with end-stage renal disease (ESRD) according to therapies modalities. METHOD: Data for all patients covered by the general health insurance scheme (77% of the French population) from hospital discharge and outpatients reimbursement databases were linked. ESRD therapies were identified using an algorithm mainly based on discharge diagnosis and immunosuppressive drugs refunds. RESULTS: Extrapolated to all French population at the end of 2007, 60,900 patients had an ESRD therapy: 30,900 were treated on haemodialysis (HD) (51%), 2600 on peritonea dialysis (DP) (4%) and 27,300 had a kidney transplant (45%). Patients with dialysis therapies had more often complementary universal coverage for low earners. According to the French regions, patient treated with DP were between 0 to 26% and 19 to 57% for those with a transplant. The total refund cost for National Health Insurance was four billion euro of which 77% for HD. Annual mean costs per patient were 64 keuro for DP, 89 keuro for HD, 86 keuro for the year of transplantation and 20 keuro for the following years. A 25% increase of DP would allow a decrease of the annual cost of 155 millions euro and 900 transplantations more each year during 10 years a decrease of 2.5 billions euro. CONCLUSION: The increase of ESRD prevalence and its total cost require patients and professionals information and formation about the less expensive and more autonomous therapies and others alternatives facing the lack of kidney transplants from deceased donors. [3]

Correction of Serum Leptin after Successful Kidney Transplantation

Introduction: Serum leptin levels are increased in chronic kidney disease (CKD) patients primarily due to decreased clearance by kidneys. As leptin is a 16 Kda protein, it is also not cleared even by dialysis using conventional dialyzers or by continuous ambulatory peritoneal dialysis (CAPD). Studies have shown that elevated leptin levels are corrected after successful renal transplantation. With this intention, we determined if restoration of renal function with kidney transplantation can reduce serum leptin concentration in CKD patients.

Materials and Methods: A total of 21 Patients undergoing living donor kidney transplantation were studied. There were 13 men and 8 women, from 16 to 45 years of age. All patients were receiving Hemodialysis prior to transplant. All patients received triple immunosuppressant therapy after the surgery. There were no graft rejections. Blood samples were collected under fasting conditions before and 6 days after transplantation.

Results: The mean age of the patients was 28.38±9.38 years. Pre transplantation leptin concentration was 9.96 + 3.48 ng/ml and this decreased to 4.07±1.7 ng/ml within six days of transplantation (p<0.0001). However there was no concomitant change in Body Mass Index (BMI) as the follow-up was too short. Plasma Creatinine level declined from 7.5±1.6 mg/dl to 1.1±0.7 mg/dl within six days after transplantation.

Conclusion: Successful renal transplantation immediately reduces serum leptin levels along with serum creatinine. The reduction in serum leptin levels after renal transplantation is likely due to reversal of renal function. Neither pre nor post transplant plasma Leptin levels correlated significantly with BMI in our study. [4]

Detecting Latent Tuberculosis Infection Prior to Kidney Transplantation in a Tertiary Hospital in Saudi Arabia: Comparison of the T-SPOT.TB Test and Tuberculin Test

Background: Tuberculosis (TB) remains a major worldwide public health problem with over 8.8 million newly diagnosed cases in 2010. Patients with end-stage renal disease (ESRD) who are on hemodialysis (HD) have a significantly higher incidence of Mycobacterium tuberculosis infection or disease than healthy individuals. Most cases of active tuberculosis (TB) in patients with ESRD are due to the reactivation of a latent infection, and this patient group is at roughly 10- to 25-fold higher risk for reactivating TB infection than the general population. Candidates for solid organ transplantation are routinely screened for latent tuberculosis infection (LTBI). In this study we aimed to compare Tuberculin Skin Test (TST) with T-SPOT.TB, for the detection of LTBI in candidates for kidney transplantation.

Methods: Prospective study of 133 HD Patients who did not have a diagnosis of active TB diseases or LTBI previously referred, through a 5-month period, to our institutions. Forty four kidney donors without evidence of renal insufficiency or immunocompromising conditions by medical history served as control group. All patients were tested with tuberculin (TST), and T-Spot.TB and the results were compared.

Results: In donors, the concordance between the T-SPOT and the TST was moderate (90.9 %, к=0.46). Forty of 44 donors (90.9%) had concordance results between the T-Spot TB and TST.In hemodialysis patients, the concordance between the T-SPOT.TB and the TST was poor (60.15 %, к=0.07). Fifty three of 133 patients (40%) had discordant results between the T-SPOT.TB and TST. Of these, 13 patients had a positive TST but negative T-SPOT.TB and 40 had a positive T-SPOT.TB but a negative TST.

Conclusion: Our data strongly argue against the use of TST in screening of LTBI in HD patients. T-SPOT.TB test in dialysis patients correlated better than TST with the risk of TB infection (e.g. increased age and low body mass index). It is a more reliable and powerful diagnostic tool than TST. However, further studies should be carried out to determine the tests with higher sensitivity and most permitted specificity. [5]

Reference

[1] Bush, A. and Gabriel, R., 1991. Pulmonary function in chronic renal failure: effects of dialysis and transplantation. Thorax, 46(6), pp.424-428.

[2] Knoll, G.A. and Nichol, G., 2003. Dialysis, kidney transplantation, or pancreas transplantation for patients with diabetes mellitus and renal failure: a decision analysis of treatment options. Journal of the American Society of Nephrology, 14(2), pp.500-515.

[3] Blotiere, P.O., Tuppin, P., Weill, A., Ricordeau, P. and Allemand, H., 2010. The cost of dialysis and kidney transplantation in France in 2007, impact of an increase of peritoneal dialysis and transplantation. Néphrologie & thérapeutique, 6(4), pp.240-247.

[4] Kolla, P., Desai, M., Pathapati, R., Rajashekar, S. and Ramalingam, K. (2014) “Correction of Serum Leptin after Successful Kidney Transplantation”, Journal of Advances in Medicine and Medical Research, 4(9), pp. 1938-1942. doi: 10.9734/BJMMR/2014/5598.

[5] Hassan, H., Shorman, M., E. l. Housawi, A. and Elsammak, M. Y. (2013) “Detecting Latent Tuberculosis Infection Prior to Kidney Transplantation in a Tertiary Hospital in Saudi Arabia: Comparison of the T-SPOT.TB Test and Tuberculin Test”, Microbiology Research Journal International, 3(2), pp. 116-127. doi: 10.9734/BMRJ/2013/2926.

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