Chronic Kidney Disease Management: Comparison between Renal Transplant Recipients and Nontransplant Patients with Chronic Kidney Disease

Abstract

Background/Aim: Renal transplant recipients (RTR) and patients with native chronic kidney disease (CKD) have similar complications. It is not known how the management of CKD in RTR differs from that of patients with native CKD. This study compares the management of complications related to CKD between RTR and patients with native CKD. Methods: Cross-sectional study of all RTR with stage 4 or 5 CKD (n = 72). The control group consisted of 72 native CKD patients matched by glomerular filtration rate (within 2 ml/min/1.73 m²). Multivariate logistic regression analysis was performed to account for potential confounding variables. Results: Multivariate analysis revealed RTR to more likely have uncontrolled hypertension (adjusted odds ratio AOR 3.8; 95% confidence interval CI 1.3–10.7), less likely to be on angiotensin-converting enzyme inhibitors (AOR 0.11; 95% CI 0.04–0.32), more likely to be anemic and not be on erythropoietin (AOR 6.4; 95% CI 0.99–41.9), and more likely to have dyslipidemia and not be on statin (AOR 4.3; 95% CI 1.4–13.4). Conclusions: This study suggests that the management of non-RTR in a multidisciplinary CKD clinic differs significantly from the CKD management in a traditional transplant clinic. A disease management approach like a multidisciplinary clinic may be an appropriate model for the future.

Posttransplantation Proteinuria

“…Studies that used a high threshold to define proteinuria (Ͼ2 to 3 g/d) had a much lower prevalence of proteinuria with an average of 13% (6,20,21). These data suggest that proteinuria is a common problem after kidney transplantation, approximating values reported in a cohort of predialysis patients with CKD (22). Although the prevalence and definitions are varied, even low levels of proteinuria are associated with decreased graft survival and as such warrant attention even if it does not reach the higher threshold defined by some authors.…”

Estimating glomerular filtration rate in kidney transplantation: Still searching for the best marker

“…PRECISION expresses the therefore assessment of the equation performance in these subgroups is limited [57] . However we can't ignore that SCr levels are affected by factors besides GFR, and several studies suggest worse stage-based care in kidney transplant patients compared with native kidney diseases [59,60] , so any eGFR equations based on SCr still have limitations.…”

Untitled

“…[4][5][6] Because a major concern in follow-up of KTRs includes the alloimmune phenomena, transplant outpatient care may often provide reduced attention to classical clinical factors that favor the progression to CKD, as well as an incomplete clinical approach of CKD-related complications. [7][8][9] The recently published "Kidney Disease Improving Global Outcomes"(KDIGO) guideline highlights that KTRs are a subset of patients at high risk for progression to category 5 CKD, suggesting a multidisciplinary approach directed toward slowing CKD progression in this population. 10,11 The benefit of multidisciplinary care in the follow-up of PDP has been wellestablished in the literature, as it can lead to better achievement of specific therapeutic targets, as well as longer patient and kidney survival rates.…”

“…12,13 To date, a small number of studies have compared the prevalence and quality of treatment of CKD-related complications in KTR and PDP, pointing to a potential role of multidisciplinary clinics in improving CKD management among KTR. 3,9,14 The present study first performed a crosssectional, comparative analyses of the prevalence of CKD-related complications and their clinical management in 2 groups of patients, one consisting of KTRs and the other of PDPs, when both were under multidisciplinary care. The purpose of this study was to evaluate whether a specific treatment for every CKD-related complication was available equally for each group of patients, thus providing supporting evidence in favor of the adoption of multidisciplinary posttransplant clinics.…”