Cardiovascular risk assessment in kidney transplantation

Hart, Allyson; Weir, Matthew R.; Kasiske, Bertram L.

doi:10.1038/ki.2014.335

Cited by 76 publications

(62 citation statements)

References 86 publications

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“…Unfortunately, the optimal method of screening for cardiovascular disease, in particular coronary artery disease, is not known[8,9]. Transplant centers may have variable approaches, usually ranging from cardiac stress testing to more invasive testing such as coronary angiography.…”

Section: Who Is An Appropriate Candidate?mentioning

confidence: 99%

Older candidates for kidney transplantation: Who to refer and what to expect?

Concepcion¹,

Forbes²,

Schaefer³

2016

WJT

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The number of older end-stage renal disease patients being referred for kidney transplantation continues to increase. This rise is occurring alongside the continually increasing prevalence of older end-stage renal disease patients. Although older kidney transplant recipients have decreased patient and graft survival compared to younger patients, transplantation in this patient population is pursued due to the survival advantage that it confers over remaining on the deceased donor waiting list. The upper limit of age and the extent of comorbidity and frailty at which transplantation ceases to be advantageous is not known. Transplant physicians are therefore faced with the challenge of determining who among older patients are appropriate candidates for kidney transplantation. This is usually achieved by means of an organ systems-based medical evaluation with particular focus given to cardiovascular health. More recently, global measures of health such as functional status and frailty are increasingly being recognized as potential tools in risk stratifying kidney transplant candidates. For those candidates who are deemed eligible, living donor transplantation should be pursued. This may mean accepting a kidney from an older living donor. In the absence of any living donor, the choice to accept lesser quality kidneys should be made while taking into account the organ shortage and expected waiting times on the deceased donor list. Appropriate counseling of patients should be a cornerstone in the evaluation process and includes a discussion regarding expected outcomes, expected waiting times in the setting of the new Kidney Allocation System, benefits of living donor transplantation and the acceptance of lesser quality kidneys.

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Section: Who Is An Appropriate Candidate?mentioning

confidence: 99%

Older candidates for kidney transplantation: Who to refer and what to expect?

Concepcion¹,

Forbes²,

Schaefer³

2016

WJT

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“…Bazı ülkelerde istisnai durumlar söz konusu olsa da günümüzde dünya çapında en sık uygulanan RRT şekli hemodiyalizdir. Hemodiyaliz maliyeti yüksek bir tedavidir ve bu özellikle az gelişmiş ülkelerde büyük ekonomik sorunlara yol açmakta ve bazı hastalar bu ekonomik nedenlerden dolayı tedaviye devam edememekte ve hayatını kaybetmektedir (2). Transplant sonrası ilk yıl böbrek naklinin maliyeti HD e göre daha yüksek olsa da bu dönemden sonra maliyet açısından daha avantajlı görünmektedir.…”

Section: Discussionunclassified

Hemodialysis Patients’ Perspective on Renal Transplantation

Gorgel¹,

Yılmaz²,

Kesler³

et al. 2016

Turk Neph Dial Transpl

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ÖzAMAÇ: Son dönem böbrek yetmezliğinin en seçkin tedavi yöntemi böbrek naklidir. Ancak günümüzde, ülkemizde böbrek nakli sayısı istenilen düzeye ulaşamamıştır. Biz bu çalışmada, kronik hemodiyaliz hastalarının böbrek nakli konusundaki istekliliklerini, bilgi düzeyini ve beklentilerini ölçmeyi amaçladık. GEREÇ ve YÖNTEMLER:18 yaş üzeri ve en az 3 ay hemodiyaliz tedavisi gören hastalar çalışmaya alındı. Hastalara 23 soru soruldu ve cevapları analiz edildi. BULGULAR:Hastaların böbrek nakli konusunda yeterince bilgi sahibi olmadığını, buna rağmen nakil konusunda istekli olduklarını ve böbrek nakli olma konusunda hekimlerden ve toplumdan beklentileri olduğunu tespit ettik. SONUÇ:Hemodiyaliz hastaları böbrek nakli konusunda bilgilendirilmeli ve teşvik edilmelidir. ANAhTAR SÖzcükLER: Hemodiyaliz, Böbrek nakli, Bakış açısı ABSTRAcTOBJEcTIVE: Renal transplantation is the best treatment method of end-stage renal disease. Unfortunately, renal transplantation rates have not reached the desired level yet in our country. In this study, we aimed to evaluate the willingness, knowledge levels and expectation of hemodialysis patients about renal transplantation. MATERIAL and METhODS:Patients older than 18 years of age and treated with hemodialysis for at least 3 months were enrolled in the study. Twenty-three questions were asked and the answers evaluated. RESULTS:We determined that most patients have insufficient information about transplantation but are willing to undergo kidney transplantation and have expectations from physicians and the society about transplantation.

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“…17 Although a reasonably low-risk group of patients with diabetes and renal disease can be identified and treated with successful renal transplant, recipients with diabetes demonstrated an excess risk for both cardiovascular and infectious events when compared to non-diabetic populations. [18][19][20][21] Successful prediction of subsequent cardiovascular events (SCVE) from a history of PCVE has been demonstrated for diabetic patients with impaired renal function. 22 In a small study of diabetic patients on long-term dialysis, we were unable to demonstrate this predictability; however, the populations were quite different.…”

mentioning

confidence: 99%

Does diabetes impact therapeutic immunomodulation therapy decisions for kidney transplant recipients? Data from the Folic Acid for Vascular Outcome Reduction in Transplant (FAVORIT) trial

Weinrauch

D’Elia

Weir

et al. 2017

IJNRD

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Abstract:Although survival has improved for kidney transplant recipients over the past several decades, long-term survival in diabetic cohorts still is significantly less than that of non-diabetic cohorts. We hypothesized that among stable kidney transplant recipients, there might be differences between subgroups with and without diabetes with respect to prevalence of prior cardiovascular events and post-transplant antihypertensive and immunosuppressive therapy. We performed a post hoc analysis of participants in the Folic Acid for Vascular Outcome Reduction in Transplant (FAVORIT) trial, a multicenter international trial of 4110 prevalent kidney transplant recipients enrolled from 2002 to 2007 evaluating the effect of homocysteine-lowering vitamin therapy on cardiovascular outcomes. There were 2447 participants without diabetes, 166 with type 1 diabetes, and 1447 with type 2 diabetes at study entry, which occurred on average 4 years post-transplant. Recipients with diabetes had a greater prevalence of prior cardiovascular events, were more likely to have required multiple medications to control hypertension, and were more likely to have received tacrolimus as opposed to cyclosporine than the non-diabetic transplant recipients (all p<0.001). The effect of differences in treatment of non-diabetic vs diabetic cohorts after stable renal transplantation upon outcomes has not yet been studied and could provide additional information that might lead to improved care.

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Cardiovascular risk assessment in kidney transplantation

Cited by 76 publications

References 86 publications

Older candidates for kidney transplantation: Who to refer and what to expect?

Older candidates for kidney transplantation: Who to refer and what to expect?

Hemodialysis Patients’ Perspective on Renal Transplantation

Does diabetes impact therapeutic immunomodulation therapy decisions for kidney transplant recipients? Data from the Folic Acid for Vascular Outcome Reduction in Transplant (FAVORIT) trial

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