Cardiovascular disease in kidney donors: matched cohort study

Garg, Amit X.; Meirambayeva, Aizhan; Huang, Anjie; Kim, J.; Prasad, G. V. Ramesh; Knoll, Greg; Boudville, Neil; Lok, Charmaine E.; McFarlane, Phil; Karpinski, Martin; Storsley, Leroy; Klarenbach, Scott; Lam, Ngan N.; Thomas, Sonia M.; Dipchand, Christine; Reese, Peter P.; Doshi, Mona D.; Gibney, Eric M.; Taub, Ken; Young, Ann

doi:10.1136/bmj.e1203

Cited by 179 publications

(142 citation statements)

References 30 publications

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“…The largest of these studies in the United States was limited by the inclusion of primarily white donors who donated in an era when conditions such as hypertension and obesity were less common and usually were exclusions for donation (2). Subsequent work confirmed a lower risk of death and cardiovascular disease in donors compared with healthy persons in the general population who may have been suitable to donate (6)(7)(8). Two recent studies, however, reported an increased risk of ESRD in donors compared with control groups derived from healthy participants in unrelated epidemiological studies (9,10).…”

Section: Uncertainty About the Long-term Risk Of Donationmentioning

confidence: 99%

Engaging Living Kidney Donors in a New Paradigm of Postdonation Care

Newell

Formica

Gill

2016

American Journal of Transplantation

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Section: Uncertainty About the Long-term Risk Of Donationmentioning

confidence: 99%

Engaging Living Kidney Donors in a New Paradigm of Postdonation Care

Newell

Formica

Gill

2016

American Journal of Transplantation

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“…Understanding of the medical risks to living kidney donors is evolving, with the progressive publication of more robust long-term data (7)(8)(9). Recent evidence of small absolute increases in the risk of ESKD, hypertension, hypertension in pregnancy, and allcause mortality in donors in the three decades after donation, compared with the general or healthy population (4,7,8,(10)(11)(12)(13), reinforces the need for ongoing research and follow-up of living kidney donors.…”

Section: Introductionmentioning

confidence: 99%

Identifying Outcomes that Are Important to Living Kidney Donors

Hanson

Chapman

Gill

et al. 2018

CJASN

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Background and objectives Living kidney donor candidates accept a range of risks and benefits when they decide to proceed with nephrectomy. Informed consent around this decision assumes they receive reliable data about outcomes they regard as critical to their decision making. We identified the outcomes most important to living kidney donors and described the reasons for their choices.Design, setting, participants, & measurements Previous donors were purposively sampled from three transplant units in Australia (Sydney and Melbourne) and Canada (Vancouver). In focus groups using the nominal group technique, participants identified outcomes of donation, ranked them in order of importance, and discussed the reasons for their preferences. An importance score was calculated for each outcome. Qualitative data were analyzed thematically.Results Across 14 groups, 123 donors aged 27-78 years identified 35 outcomes. Across all participants, the ten highest ranked outcomes were kidney function (importance=0.40, scale 0-1), time to recovery (0.27), surgical complications (0.24), effect on family (0.22), donor-recipient relationship (0.21), life satisfaction (0.18), lifestyle restrictions (0.18), kidney failure (0.14), mortality (0.13), and acute pain/discomfort (0.12). Kidney function and kidney failure were more important to Canadian participants, compared with Australian donors. The themes identified included worthwhile sacrifice, insignificance of risks and harms, confidence and empowerment, unfulfilled expectations, and heightened susceptibility.Conclusions Living kidney donors prioritized a range of outcomes, with the most important being kidney health and the surgical, lifestyle, functional, and psychosocial effects of donation. Donors also valued improvements to their family life and donor-recipient relationship. There were clear regional differences in the rankings.Clin J Am Soc Nephrol 13: 916-926, 2018.

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“…These databases have been used extensively to research health outcomes. [18][19][20][21][22] Whenever possible, we defined patient characteristics, surgery characteristics and outcomes using database codes that have been proven reliable when compared with manual chart review (Ap pendices 1 and 2, available at www .cmaj .ca /lookup /suppl /doi :10.1503/cmaj.110895/-/DC1).…”

Section: Data Sourcesmentioning

confidence: 99%

Secular trends in acute dialysis after elective major surgery — 1995 to 2009

Siddiqui

Coca

Devereaux

et al. 2012

CMAJ

119

116

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Research CMAJBackground: Acute kidney injury is a serious complication of elective major surgery. Acute dialysis is used to support life in the most severe cases. We examined whether rates and outcomes of acute dialysis after elective major surgery have changed over time. Methods:We used data from Ontario's universal health care databases to study all consecutive patients who had elective major surgery at 118 hospitals between 1995 and 2009. Our primary outcomes were acute dialysis within 14 days of surgery, death within 90 days of surgery and chronic dialysis for patients who did not recover kidney function.Results: A total of 552 672 patients underwent elective major surgery during the study period, 2231 of whom received acute dialysis. The incidence of acute dialysis increased steadily from 0.2% in 1995 (95% confidence interval [CI] 0.15-0.2) to 0.6% in 2009 (95% CI 0.6-0.7). This increase was primarily in cardiac and vascular surgeries. Among patients who received acute dialysis, 937 died within 90 days of surgery (42.0%, 95% CI 40.0-44.1), with no change in 90-day survival over time. Among the 1294 patients who received acute dialysis and survived beyond 90 days, 352 required chronic dialysis (27.2%, 95% CI 24.8-29.7), with no change over time.Interpretation: The use of acute dialysis after cardiac and vascular surgery has increased substantially since 1995. Studies focusing on interventions to better prevent and treat perioperative acute kidney injury are needed. Abstract

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Cardiovascular disease in kidney donors: matched cohort study

Cited by 179 publications

References 30 publications

Engaging Living Kidney Donors in a New Paradigm of Postdonation Care

Engaging Living Kidney Donors in a New Paradigm of Postdonation Care

Identifying Outcomes that Are Important to Living Kidney Donors

Secular trends in acute dialysis after elective major surgery — 1995 to 2009

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