GFR after kidney donation: early recovery and subsequent decline

Goyal, Nitender; Levey, Andrew S.

doi:10.1016/j.kint.2020.04.025

Kidney International

2020

DOI: 10.1016/j.kint.2020.04.025

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GFR after kidney donation: early recovery and subsequent decline

Nitender Goyal

Andrew S. Levey

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2021

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“…Carefully conducted studies with 10 years of follow-up show a consistent increase in GFR during the first few years after kidney donation, followed by a GFR decline that seems slower than the GFR decline in controls. 5 Regardless of whether kidney dysfunction is the cause or mediator, our research highlights a population likely to benefit from dementia screening.…”

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confidence: 90%

Author Response: Kidney Function, Kidney Function Decline, and the Risk of Dementia in Older Adults

Xu¹,

García-Ptacek²,

Lindholm³

et al. 2021

Neurology

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I read the article by Xu et al. 1 with interest. However, I would like to raise a few questions about the study. The published literature shows a strong difference between patients who received a prescription for a cholinesterase inhibitor (ChEI) and those who did not. 2 The authors also mention that they had trouble matching the 2 groups because their groups differed significantly. Although the authors tried to correct for this, it does not seem that the stage or severity of comorbidities was considered in this study, despite its critical clinical relevance to survival Editors' Note: Long-term Effects of Cholinesterase Inhibitors on Cognitive Decline and Mortality Dr. Xu et al. compared cognitive trajectories and the occurrence of severe dementia or death in 11,652 patients started on cholinesterase inhibitors (ChEIs) vs 5,826 untreated patients with Alzheimer dementia (AD) in the Swedish Dementia Registry. During an average of 5 years of follow-up, they found that ChEIs were associated with modest but persistent cognitive benefits with lower mortality. Galantamine was the only ChEI that was associated with a significantly lower risk of developing severe dementia. In response, Dr. Kuschpel noted that there were important baseline differences between patients who were and were not treated with ChEIs, with associated difficulties matching the 2 groups for analyses. Dr. Kuschpel also highlighted the importance of considering the stage and severity of comorbidities about survival estimates and is skeptical of the sizeable mortality reduction with ChEIs seen in the study, given the lack of precedence, the absence of a plausible molecular mechanism, and potential confounding by prescription bias. Concerns are raised about potential discrepancies in numbers between the abstract and the results section about observed differences in Mini-Mental State Examination (MMSE) scores. Responding to these comments, the authors argue that although there were significant baseline differences between the 2 groups, they were able to achieve a well-matched cohort, although they acknowledge the possibility of residual and unknown confounders, especially in the absence of data on comorbidity severity. They cite the previous work by their group observing reductions in myocardial infarction, stroke, and mortality with ChEI use, as well as a lower 2-year mortality with galantamine seen in a prior randomized-controlled trial. They note that previous trials of ChEIs have had considerably shorter follow-up durations. In summary, this exchange highlights the uncertain causal association between ChEI use and lower mortality in patients with AD, and the challenges of convincingly demonstrating such an association with observational data. Robust validation of this association would have important implications for the care of patients with AD.

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confidence: 90%

Author Response: Kidney Function, Kidney Function Decline, and the Risk of Dementia in Older Adults

Xu¹,

García-Ptacek²,

Lindholm³

et al. 2021

Neurology

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GFR after kidney donation: early recovery and subsequent decline

Cited by 1 publication

References 9 publications

Author Response: Kidney Function, Kidney Function Decline, and the Risk of Dementia in Older Adults

Author Response: Kidney Function, Kidney Function Decline, and the Risk of Dementia in Older Adults

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