Preemptive Transplantation for Patients With Diabetes-Related Kidney Disease

Becker, Bryan N.; Rush, Sarah H.; Dykstra, Dawn M.; Becker, Yolanda T.; Port, Friedrich K.

doi:10.1001/archinte.166.1.44

Cited by 72 publications

(60 citation statements)

References 22 publications

(22 reference statements)

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“…Early studies reported comparable graft and patient survival for preemptive transplant patients and patients transplanted after dialysis (3,4). More recent studies show that preemptive transplantation is associated with better patient and graft survival (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Additional advantages have been documented, such as avoidance of complications with dialysis access infections, reduced severity of sequelae of chronic kidney disease, increased ability to maintain employment, and decreased overall costs (16 -18).…”

supporting

confidence: 85%

A Survey of Nephrologists’ Views on Preemptive Transplantation

Pradel

Jain

Mullins

et al. 2008

Clinical Journal of the American Society of Nephrology

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Background and objectives: Despite emerging evidence that preemptive transplantation is the best treatment modality for patients reaching end-stage renal disease (ESRD), it is underutilized. Nephrologists' views on preemptive transplantation are explored herein.Design, setting, participants, & measurements: A web-based survey elicited barriers to preemptive transplantation as perceived by nephrologists as well as demographic and practice variables associated with a favorable attitude toward preemptive transplantation.Results: Four hundred seventy-six of 5,901 eligible nephrologists responded (8% participation rate). Seventy-one percent of respondents agreed that preemptive transplantation is the best treatment modality for eligible chronic kidney disease (CKD) patients reaching ESRD, 69% reported that late referrals did not allow enough time for patients to be evaluated for preemptive transplantation, and 50% stated that there was too much delay between a patient's referral and the time the patient was seen at the transplant center. Nephrologists agreed to a lesser extent that they should be held accountable for CKD patients' education (26%) and preemptive transplant referrals (23%). The most important patient factors considered when deciding not to discuss preemptive transplant were poor health status (70%), lack of compliance (69%), other medical problems (51%), being too old (40%), lack of prescription coverage (37%), and lack of health insurance to cover the costs of the procedure (36%).Conclusions: Surveyed nephrologists consider preemptive transplantation as the optimal treatment modality for eligible patients. Late referral, patient health and insurance status, and delayed transplant center evaluation are perceived as major barriers to preemptive transplantation.

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supporting

confidence: 85%

A Survey of Nephrologists’ Views on Preemptive Transplantation

Pradel

Jain

Mullins

et al. 2008

Clinical Journal of the American Society of Nephrology

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“…Our findings seem to be better than those of other reports. 10,11,29 Because our study group is small, our finding about the effectiveness of pre-emptive kidney transplantation in patients with T1D and ESRD needs to be seen as preliminary. The challenge is how to increase frequency of pre-emptive kidney transplantation in patients with T1D and ESRD.…”

Section: Discussionmentioning

confidence: 97%

Risk for ESRD in Type 1 Diabetes Remains High Despite Renoprotection

Rosolowsky

Skupień

Smiles

et al. 2011

Journal of the American Society of Nephrology

172

174

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Historically, patients with type 1 diabetes and macroalbuminuria had high competing risks: cardiovascular death or renal failure. Here, we assessed these risks in patients receiving therapies implemented during the last 30 years. Between 1991 and 2004, we enrolled 423 white patients with type 1 diabetes who developed macroalbuminuria (albumin excretion rate, Ն300 g/min). With follow-up for 98% through 2008, ESRD developed in 172 patients (incidence rate, 5.8/100 person-years), and 29 died without ESRD (mortality rate, 1/100 person-years). The majority of these outcomes occurred between ages 36 and 52 years with durations of diabetes of 21 to 37 years. The 15-year cumulative risks were 52% for ESRD and 11% for pre-ESRD death. During the 15 years of follow-up, the use of renoprotective treatment increased from 56 to 82%, and BP and lipid levels improved significantly; however, the risks for both ESRD and pre-ESRD death did not change over the years analyzed. There were 70 post-ESRD deaths, and the mortality rate was very similar during the 1990s and the 2000s (11/100 person-years versus 12/100 person-years, respectively). Mortality was low in patients who received a pre-emptive kidney transplant (1/100 person-years), although these patients did not differ from dialyzed patients with regard to predialysis eGFR, sex, age at onset of ESRD, or duration of diabetes. In conclusion, despite the widespread adoption of renoprotective treatment, patients with type 1 diabetes and macroalbuminuria remain at high risk for ESRD, suggesting that more effective therapies are desperately needed.

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“…Among patients with type 1 diabetes, benefits of preemptive transplantation are well defined, but availability of pancreas transplantation may influence the choice of approaches. Indeed, recent data indicate that outcomes with simultaneous kidney-pancreas transplantation from a deceased donor may rival those associated with preemptive transplantation of a kidney alone from a LD (24,25). Finally, although elderly patients make up the fastest growing component of incident patients with ESRD and clearly benefit from preemptive transplantation, an appropriate LD may be less readily identifiable, again necessitating individualization of approaches (26).…”

Section: Preemptive Transplantation and The Ckd Paradigmmentioning

confidence: 99%

Kidney Transplantation as Primary Therapy for End-Stage Renal Disease

Abecassis

Bartlett

Collins

et al. 2008

Clinical Journal of the American Society of Nephrology

517

338

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Results: Participants explored the benefits of early transplantation on costs and outcomes, identified current barriers (at multiple levels) that impede access to early transplantation, and recommended specific interventions to overcome those barriers.Conclusions: With implementation of early education, referral to a transplant center coincident with creation of vascular access, timely transplant evaluation, and identification of potential living donors, early transplantation can be an option for substantially more patients with chronic kidney disease.

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Preemptive Transplantation for Patients With Diabetes-Related Kidney Disease

Cited by 72 publications

References 22 publications

A Survey of Nephrologists’ Views on Preemptive Transplantation

A Survey of Nephrologists’ Views on Preemptive Transplantation

Risk for ESRD in Type 1 Diabetes Remains High Despite Renoprotection

Kidney Transplantation as Primary Therapy for End-Stage Renal Disease

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