Impaired renal function is associated with worse self-reported outcomes after kidney transplantation

Neri, Luca; Dukes, Jonathan; Brennan, Daniel C.; Salvalaggio, Paolo R.; Seelam, Susmitha; Desiraju, Srividya; Schnitzler, Mark A.

doi:10.1007/s11136-011-9905-8

Cited by 22 publications

(22 citation statements)

References 53 publications

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“…Overall, the KDQOL-36™ scores were similar to those reported in other US studies of non-dialysis CKD and kidney transplant recipients, 27,28 and higher than in dialysis patients. 29 Similar to findings from the Dialysis Outcomes and Practice Patterns Study, 29 we observed that Hispanics with CKD had lower HRQOL than non-Hispanics.…”

Section: Discussionsupporting

confidence: 84%

264 Validation of the Kidney Disease Quality of Life 36 (KDQOL-36) U.S. Spanish and English Versions in Hispanics with Chronic Kidney Disease

Ricardo

Hacker

Lora

et al. 2011

American Journal of Kidney Diseases

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Section: Discussionsupporting

confidence: 84%

264 Validation of the Kidney Disease Quality of Life 36 (KDQOL-36) U.S. Spanish and English Versions in Hispanics with Chronic Kidney Disease

Ricardo

Hacker

Lora

et al. 2011

American Journal of Kidney Diseases

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“…sick leave in the 12-month period prior to the interview and the number of comorbidities) components of work ability drove the association observed. CKD causes several changes in key physiological function that may directly or indirectly impair quality of life and well-being [9]. Hence, it is not surprising that the association between eGFR and WAI was attenuated after the inclusion of a marker of CKD-related anemia.…”

Section: Discussionmentioning

confidence: 99%

“…Side effects of immunosuppression and posttransplant complications contribute to loss of allograft function [5,6,7,8], which leads to reduced quality of life [9,10,11] and possibly impaired ability to work. Work ability is a dynamic process resulting from the interaction of individual resources (including health, functional capacity, generic and specific education, motivation), working conditions (environment, tools, psychosocial factors), and the society (e.g.…”

Section: Introductionmentioning

confidence: 99%

Work Ability and Labor Supply after Kidney Transplantation

et al. 2014

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Background: The vocational rehabilitation after kidney transplantation (KTX) is suboptimal. We sought to evaluate correlates of occupational outcomes after KTX. Methods: We included 336 working-age patients with at least one creatinine assessment in the 3-month screening period. We collected clinical information from medical records. All subjects answered a self-administered questionnaire, and a follow-up questionnaire was mailed to each participant after 6 months. Study outcomes were the Work Ability Index (WAI) and labor supply (the number of days each patient worked in the follow-up period). We estimated the glomerular filtration rate (eGFR) with the Modification of Diet in Renal Disease Study equation. Results: The mean eGFR was 52.76 ± 23.68 ml/min/1.73 m². The age-standardized employment-to-population ratio was 62%. Comorbidities, self-reported work ability, gender, age, health insurance type, and time since transplant were associated with employment status at baseline. The WAI (38.79 ± 5.88) was associated with the severity of renal impairment, work attachment and comorbidities. After 6 months, labor supply (mean 19.4 ± 9.7 weeks) was associated with WAI item 1 (ρ = 0.22; p = 0.03); eGFR was significantly associated with labor supply, and this association was slightly stronger in patients with physically demanding jobs. Conclusions: We identified modifiable factors associated with poor occupational outcomes in kidney transplant recipients. Consistent with labor supply theory, our results suggest that health care coverage plays a key role in employment decisions after KTX independent of possible confounders. Additionally, our study provides the rationale to further evaluate the implications of renal function-preserving strategies for indirect cost savings and self-reported ability to work after transplant.

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“…Estimates of utilities were derived from the study by Neri et al, 363 who reported EQ-5D health states measured in a cross-sectional study of people with kidney-only transplants in the UK, valued using UK tariffs, as a function of CKD states. As renal function deteriorated so did the HRQoL (utility) values experienced by the simulated patient in the model.…”

Section: Utilitiesmentioning

confidence: 99%

Immunosuppressive therapy for kidney transplantation in adults: a systematic review and economic model

Jones-Hughes

Snowsill

Haasova

et al. 2016

Health Technol Assess

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BackgroundEnd-stage renal disease is a long-term irreversible decline in kidney function requiring renal replacement therapy: kidney transplantation, haemodialysis or peritoneal dialysis. The preferred option is kidney transplantation, followed by immunosuppressive therapy (induction and maintenance therapy) to reduce the risk of kidney rejection and prolong graft survival.ObjectivesTo review and update the evidence for the clinical effectiveness and cost-effectiveness of basiliximab (BAS) (Simulect®, Novartis Pharmaceuticals UK Ltd) and rabbit anti-human thymocyte immunoglobulin (rATG) (Thymoglobulin®, Sanofi) as induction therapy, and immediate-release tacrolimus (TAC) (Adoport®, Sandoz; Capexion®, Mylan; Modigraf®, Astellas Pharma; Perixis®, Accord Healthcare; Prograf®, Astellas Pharma; Tacni®, Teva; Vivadex®, Dexcel Pharma), prolonged-release tacrolimus (Advagraf®Astellas Pharma), belatacept (BEL) (Nulojix®, Bristol-Myers Squibb), mycophenolate mofetil (MMF) (Arzip®, Zentiva; CellCept®, Roche Products; Myfenax®, Teva), mycophenolate sodium (MPS) (Myfortic®, Novartis Pharmaceuticals UK Ltd), sirolimus (SRL) (Rapamune®, Pfizer) and everolimus (EVL) (Certican®, Novartis) as maintenance therapy in adult renal transplantation.MethodsClinical effectiveness searches were conducted until 18 November 2014 in MEDLINE (via Ovid), EMBASE (via Ovid), Cochrane Central Register of Controlled Trials (via Wiley Online Library) and Web of Science (via ISI), Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Health Technology Assessment (The Cochrane Library via Wiley Online Library) and Health Management Information Consortium (via Ovid). Cost-effectiveness searches were conducted until 18 November 2014 using a costs or economic literature search filter in MEDLINE (via Ovid), EMBASE (via Ovid), NHS Economic Evaluation Database (via Wiley Online Library), Web of Science (via ISI), Health Economic Evaluations Database (via Wiley Online Library) and the American Economic Association’s electronic bibliography (via EconLit, EBSCOhost). Included studies were selected according to predefined methods and criteria. A random-effects model was used to analyse clinical effectiveness data (odds ratios for binary data and mean differences for continuous data). Network meta-analyses were undertaken within a Bayesian framework. A new discrete time–state transition economic model (semi-Markov) was developed, with acute rejection, graft function (GRF) and new-onset diabetes mellitus used to extrapolate graft survival. Recipients were assumed to be in one of three health states: functioning graft, graft loss or death.ResultsEighty-nine randomised controlled trials (RCTs), of variable quality, were included. For induction therapy, no treatment appeared more effective than another in reducing graft loss or mortality. Compared with placebo/no induction, rATG and BAS appeared more effective in reducing biopsy-proven acute rejection (BPAR) and BAS appeared more effective at improving GRF. For maintenance therapy, no treatment was better for all outcomes and no treatment appeared most effective at reducing graft loss. BEL + MMF appeared more effective than TAC + MMF and SRL + MMF at reducing mortality. MMF + CSA (ciclosporin), TAC + MMF, SRL + TAC, TAC + AZA (azathioprine) and EVL + CSA appeared more effective than CSA + AZA and EVL + MPS at reducing BPAR. SRL + AZA, TAC + AZA, TAC + MMF and BEL + MMF appeared to improve GRF compared with CSA + AZA and MMF + CSA. In the base-case deterministic and probabilistic analyses, BAS, MMF and TAC were predicted to be cost-effective at £20,000 and £30,000 per quality-adjusted life-year (QALY). When comparing all regimens, only BAS + TAC + MMF was cost-effective at £20,000 and £30,000 per QALY.LimitationsFor included trials, there was substantial methodological heterogeneity, few trials reported follow-up beyond 1 year, and there were insufficient data to perform subgroup analysis. Treatment discontinuation and switching were not modelled.Future workHigh-quality, better-reported, longer-term RCTs are needed. Ideally, these would be sufficiently powered for subgroup analysis and include health-related quality of life as an outcome.ConclusionOnly a regimen of BAS induction followed by maintenance with TAC and MMF is likely to be cost-effective at £20,000–30,000 per QALY.Study registrationThis study is registered as PROSPERO CRD42014013189.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Impaired renal function is associated with worse self-reported outcomes after kidney transplantation

Abstract: Several health-related quality of life dimensions may be affected by poor renal function after transplantation.

Cited by 22 publications

References 53 publications

264 Validation of the Kidney Disease Quality of Life 36 (KDQOL-36) U.S. Spanish and English Versions in Hispanics with Chronic Kidney Disease

264 Validation of the Kidney Disease Quality of Life 36 (KDQOL-36) U.S. Spanish and English Versions in Hispanics with Chronic Kidney Disease

Work Ability and Labor Supply after Kidney Transplantation

Immunosuppressive therapy for kidney transplantation in adults: a systematic review and economic model

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