Long-Term Posttransplantation Care: The Expanding Role of Community Nephrologists

Howard, Andrew D.

doi:10.1053/j.ajkd.2005.12.040

Cited by 13 publications

(6 citation statements)

References 15 publications

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“…16 After the first 6 -12 months of transplantation, referring nephrologists are usually encouraged to take responsibility and participate in the care of their transplant recipients. 46 The timing of this transition is generally based on local expectations, patients' needs and the transplant program's relationship with the referring provider. When the allograft begins to fail, there are many more opportunities and need for improved communication and coordination of care.…”

Section: The Role S Of the Tr An S Pl Ant Prog R Am And G Ener Al Nephrolog Is Tsmentioning

confidence: 99%

The failing kidney allograft: A review and recommendations for the care and management of a complex group of patients

Lubetzky

Tantisattamo

Molnar

et al. 2021

American Journal of Transplantation

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The return to dialysis after allograft failure is associated with increased morbidity and mortality. This transition is made more complex by the rising numbers of patients who seek repeat transplantation and therefore may have indications for remaining on low levels of immunosuppression, despite the potential increased morbidity. Management strategies vary across providers, driven by limited data on how to transition off How to cite this article: Lubetzky M, Tantisattamo E, Molnar MZ, et al. The failing kidney allograft: A review and recommendations for the care and management of a complex group of patients.

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Section: The Role S Of the Tr An S Pl Ant Prog R Am And G Ener Al Nephrolog Is Tsmentioning

confidence: 99%

The failing kidney allograft: A review and recommendations for the care and management of a complex group of patients

Lubetzky

Tantisattamo

Molnar

et al. 2021

American Journal of Transplantation

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“…Among the possible cause of chronic kidney dysfunction are behavioural aspects of the medication regimen, such as non adherence to the immunosuppressive prescription [5,7,8]. Next to the observation that non adherence has been linked to increased serum creatinine levels, a marker of decreased kidney function [9], the microscopic morphology of transplanted kidney tissue in non adherent patients shows a greater number of histological lesions than in those who adhere closely [10].…”

mentioning

confidence: 99%

Clinical consequences of non adherence to immunosuppressive medication in kidney transplant patients

Denhaerynck

Burkhalter

Schäfer-Keller

et al. 2009

Transplant International

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In recent decades, improvements in immunosuppressive medication have considerably increased the shortterm life expectancy of transplanted kidneys by reducing the incidence of acute rejections, primarily in the first year post-transplant. However, over the same period, long-term patient survival curves have been relatively flat [1,2]. Extending the perspectives of kidney transplant recipients is therefore a profound challenge and an important research priority [3][4][5].A major limiter of long-term survival is the gradual deterioration of kidney graft function [3][4][5][6], resulting from a range of function-impairing problems known collectively as chronic kidney dysfunction. Among the possible cause of chronic kidney dysfunction are behavioural aspects of the medication regimen, such as non adherence to the immunosuppressive prescription [5,7,8]. Next to the observation that non adherence has been linked to increased serum creatinine levels, a marker of decreased kidney function [9], the microscopic morphology of transplanted kidney tissue in non adherent patients shows a greater number of histological lesions than in those who adhere closely [10]. As surveys have shown that at least 28% of kidney transplant patients are non adherent to their regimens, non adherence may be a significant contributor to long-term kidney dysfunction [11].One common disadvantage of existing studies exploring the associations between non adherence and clinical outcomes is that they were based predominantly on the older azathioprine-and cyclosporine-based regimens, which are no longer considered state-of-the-art. How far their conclusions can be applied to regimens using subsequent generations of medications, such as tacrolimus, mycophenolate mofetil or sirolimus is an issue that has previously only been investigated in a retrospective study of SummaryLittle is known of the long-term clinical effects of non adherence on transplanted kidneys, especially regarding newer immunosuppressive regimens. In a study of 356 adult Swiss kidney transplant patients, non adherence was measured at inclusion by means of self-reporting, electronic monitoring, collateral reporting and blood assay. Long-term clinical outcomes regarding graft loss and creatinine levels were collected prospectively over a period of 5 years. A Cox proportional hazards model and mixed regression analysis were used, respectively, to examine the effects of non adherence on kidney survival and kidney function. The majority of patients (62%) were on immunosuppressive regimens that included mycophenolate mofetil, tacrolimus or sirolimus. No associations were found between non adherence and kidney graft survival or graft function. Notwithstanding weaknesses of this study, this negative result suggests that high adherence may protect patients against detrimental clinical outcomes, and/or that immunosuppressive regimens containing newer drugs allow wider non adherence margins than those based on previous generation medications such as cyclosporine, azathioprine and corticosteroids.

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“…Blood was now collected before the start of the midweek dialysis session (2 days after the previous dialysis) instead of the first dialysis session in the week (3 days after). All the above-described changes were done to adapt our routines to international guidelines [11] and the National Hemodialysis Cross-Sectional Study performed twice a year throughout the country by the Swedish Dialysis Data Base.…”

Section: Methodsmentioning

confidence: 99%

Dosing of Erythropoiesis-Stimulating Agents Can Be Reduced by a New Administration Regimen

Stefánsson¹,

Haraldsson²,

Nilsson³

2011

Nephron Extra

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Background/Aims:At our hemodialysis (HD) unit, we noted a drop in the treatment dose of erythropoietin-stimulating agents (ESAs) when the frequency of dose adjustment was reduced from weekly, where doses were withheld if hemoglobin was >130 g/l, to monthly, where doses were not withheld. The aim of this study was to find an explanation for this reduction in ESA requirement. Methods: This is a retrospective study on 18 stable HD patients. Comparable follow-up periods of 6 months with the two different ESA adjustment regimens were established and data on ESA dose, hemoglobin and known predictors of ESA response were collected. Results: With the new ESA administration regimen, a 22.5% drop in the total ESA dose was noted. The corresponding fall in the erythropoietin resistance index was 20.0%. Simultaneously, the dialysis dose and transferrin saturation increased significantly. However, in a multivariate linear regression model, changes in these factors did not significantly predict changes in ESA requirement. No relevant changes were noted in other erythropoiesis-modulating factors. Conclusion: Frequent dose adjustments and the current ESA administration practice of withholding ESA doses does not seem to reduce ESA demand. On the contrary, such practice is likely to increase ESA requirement over time.

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Long-Term Posttransplantation Care: The Expanding Role of Community Nephrologists

Cited by 13 publications

References 15 publications

The failing kidney allograft: A review and recommendations for the care and management of a complex group of patients

The failing kidney allograft: A review and recommendations for the care and management of a complex group of patients

Clinical consequences of non adherence to immunosuppressive medication in kidney transplant patients

Dosing of Erythropoiesis-Stimulating Agents Can Be Reduced by a New Administration Regimen

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