Predialysis Vascular Access Surgery in Patients With Failing Kidney Transplants

Dawoud, Dalia; Harms, James C.; Williams, Timothy; Kumar, Vineeta; Allon, Michael

doi:10.1053/j.ajkd.2013.03.033

Cited by 9 publications

(6 citation statements)

References 10 publications

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“…1 However, serum creatinine alone cannot be used to determine the level of eGFR, which is essential for detection and staging of chronic kidney disease and for management of its various complications, including anemia, mineral and bone disease 1 and some recent studies suggest worse stage-based management in kidney transplant recipients compared with patients with native kidney diseases. 53,54 Furthermore, transplant recipients require a large number of medications and eGFR is required for accurate dosing. Moreover, the level of eGFR has been shown to be a predictor of patient and allograft survival as well as health care expenditure in several large well-conducted studies.…”

Section: Discussionmentioning

confidence: 99%

Performance of Creatinine-Based GFR Estimating Equations in Solid-Organ Transplant Recipients

Shaffi

Uhlig

Perrone

et al. 2014

American Journal of Kidney Diseases

116

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Background Accurate assessment of kidney function is important for management of solid organ transplant recipients. In other clinical populations, glomerular filtration rate (GFR) is most commonly estimated using the CKD-EPI (Chronic Kidney Disease–Epidemiology Collaboration) creatinine or the 4-variable MDRD (Modification of Diet in Renal Disease) Study equation. The accuracy of these equations compared to other GFR estimating equations in transplant recipients has not been carefully studied. Study Design Diagnostic test study. Setting & Participants Solid organ transplant recipients >6 months post-transplantation from 5 clinical populations [N=3,622, including recipients of kidney (53%), liver (35%) and other or multiple organs (12%)] Index Test Estimated GFR (eGFR) using creatinine-based GFR estimating equations identified from a systematic review of the literature. Performance of the CKD-EPI creatinine and MDRD Study equations was compared to alternative equations. Reference Test Measured GFR (mGFR) from urinary clearance of iothalamate or plasma clearance of iohexol. Measurements Error (difference between the mGFR and eGFR) expressed as P30 (proportion of absolute percent error <30%) and mean absolute error. Results We identified 26 GFR estimating equations. Mean mGFR was 55.1 ± 22.7 (SD) ml/min/1.73 m2. P30 and mean absolute error for the CKD-EPI and MDRD Study equations were 78.9% (99.6% CI, 76.9%–80.8%) for both and 10.6 (99.6% CI, 10.1–11.1) vs. 11.0 (99.6% CI, 10.5–11.5) ml/min/1.73 m2, respectively; these equations were more accurate than any of the alternative equations (p<0.001 for all pair-wise comparisons for both measures). They performed better than or as well as the alternative equations in most subgroups defined by demographic and clinical characteristics, including the type of transplanted organ. Limitations Study population included few non-whites and people with solid organ transplants other than liver and kidneys. Conclusions The CKD-EPI creatinine and MDRD Study equations perform better than the alternative creatinine-based estimating equations in solid organ transplant recipients. They can be used for clinical management.

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Section: Discussionmentioning

confidence: 99%

Performance of Creatinine-Based GFR Estimating Equations in Solid-Organ Transplant Recipients

Shaffi

Uhlig

Perrone

et al. 2014

American Journal of Kidney Diseases

116

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“…Dawoud et al (27) recently showed in a single center study of 96 failing kidney transplants compared with 218 failing native kidneys that predialysis vascular access surgery was less common in the transplant group (25% versus 60%; hazard ratio, 0.42; 95% CI, 0.29 to 0.60; P,0.001). We also showed in an earlier single center study that, at 3 months after initiating dialysis, 41.4% had a CVC compared with 15.7% had an AVF (K. Gupta, M.R.…”

Section: Discussionmentioning

confidence: 99%

Initial Vascular Access Type in Patients with a Failed Renal Transplant

Chan¹,

Oza-Gajera²,

Chapla³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Permanent hemodialysis vascular access is crucial for RRT in ESRD patients and patients with failed renal transplants, because central venous catheters are associated with greater risk of infection and mortality than arteriovenous fistulae or arteriovenous grafts. The objective of this study was to determine the types of vascular access used by patients initiating hemodialysis after a failed renal transplant.Design, setting, participants, & measurements Data from the US Renal Data System database on 16,728 patients with a failed renal transplant and 509,643 patients with native kidney failure who initiated dialysis between January 1, 2006, and September 30, 2011 were examined.Results At initiation of dialysis, of patients with a failed transplant, 27.7% (n=4636) used an arteriovenous fistula, 6.9% (n=1146) used an arteriovenous graft, and 65.4% (n=10,946) used a central venous catheter. Conversely, 80.8% (n=411,997) of patients with native kidney failure initiated dialysis with a central venous catheter (P,0.001). Among patients with a failed transplant, predictors of central venous catheter use included women (adjusted odds ratio, 1.75; 95% confidence interval, 1.63 to 1.87), lack of referral to a nephrologist (odds ratio, 2.00; 95% confidence interval, 1.72 to 2.33), diabetes (odds ratio, 1.14; 95% confidence interval, 1.06 to 1.22), peripheral vascular disease (odds ratio, 1.31; 95% confidence interval, 1.16 to 1.48), and being institutionalized (odds ratio, 1.53; 95% confidence interval, 1.23 to 1.89). Factors associated with lower odds of central venous catheter use included older age (odds ratio, 0.85 per 10 years; 95% confidence interval, 0.83 to 0.87), public insurance (odds ratio, 0.74; 95% confidence interval, 0.68 to 0.80), and current employment (odds ratio, 0.87; 95% confidence interval, 0.80 to 0.95).Conclusions Central venous catheters are used in nearly two thirds of failed renal transplant patients. These patients are usually followed closely by transplant physicians before developing ESRD after a failed transplant, but the relatively low prevalence of arteriovenous fistulae/arteriovenous grafts in this group at initiation of dialysis needs to be investigated more thoroughly.

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“…A definitive dialysis access, especially for hemodialysis (HD), is another important issue in KT recipients returning to dialysis. Several authors have reported that KT recipients start HD by a CVC more frequently than arteriovenous fistula, and a large registry study concluded that 65% of patients restart dialysis using a CVC [ 31 , 32 ]. Considering that KT patients are immunosuppressed and have a higher incidence of infection, these findings are alarming and need to be addressed [ 33 ].…”

Section: Management Of the Failing Allograftmentioning

confidence: 99%

Challenges in the Management of the Patient with a Failing Kidney Graft: A Narrative Review

Leal

Pardinhas

Martinho

et al. 2022

JCM

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Patients with a failed kidney allograft have steadily increase in recent years and returning to dialysis after graft loss is one of the most difficult transitions for chronic kidney disease patients and their assistant physicians. The management of these patients is complex and encompasses the treatment of chronic kidney disease complications, dialysis restart and access planning, immunosuppression withdrawal, graft nephrectomy, and evaluation for a potential retransplant. In recent years, several groups have focused on the management of the patient with a failing renal graft and expert recommendations are arising. A review of Pubmed, ScienceDirect and the Cochrane Library was performed focusing on the specific care of these patients, from the management of low clearance complications to concerns with a subsequent kidney transplant. Conclusion: There is a growing interest in the failing renal graft and new approaches to improve these patients’ outcomes are being defined including specific multidisciplinary programs, individualized immunosuppression withdrawal schemes, and strategies to prevent HLA sensitization and increase retransplant rates.

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Predialysis Vascular Access Surgery in Patients With Failing Kidney Transplants

Cited by 9 publications

References 10 publications

Performance of Creatinine-Based GFR Estimating Equations in Solid-Organ Transplant Recipients

Performance of Creatinine-Based GFR Estimating Equations in Solid-Organ Transplant Recipients

Initial Vascular Access Type in Patients with a Failed Renal Transplant

Challenges in the Management of the Patient with a Failing Kidney Graft: A Narrative Review

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