The Role of the General Nephrologist in Evaluating Patients for Kidney Transplantation: Core Curriculum 2020

Virmani, Sarthak; Asch, William S.

doi:10.1053/j.ajkd.2020.01.001

Cited by 4 publications

(5 citation statements)

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“…This was an expected result that is still reassuring in terms of our center’s transplant evaluation procedure. Patients with a high cumulative risk of death because of high age, cardiovascular risk, malignancies, or other medical conditions [23] are effectively separated from the collective with lower mortality likely experience advantage from retransplantation.…”

Section: Discussionmentioning

confidence: 99%

What happens after graft loss? A large, long‐term, single‐center observation

et al. 2021

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Summary The number of patients returning to dialysis after graft failure increases. Surprisingly, little is known about the clinical and immunological outcomes of this cohort. We retrospectively analyzed 254 patients after kidney allograft loss between 1997 and 2017 and report clinical outcomes such as mortality, relisting, retransplantations, transplant nephrectomies, and immunization status. Of the 254 patients, 49% had died 5 years after graft loss, while 27% were relisted, 14% were on dialysis and not relisted, and only 11% were retransplanted 5 years after graft loss. In the complete observational period, 111/254 (43.7%) patients were relisted. Of these, 72.1% of patients were under 55 years of age at time of graft loss and only 13.5% of patients were ≥65 years. Age at graft loss was associated with relisting in a logistic regression analysis. In the complete observational period, 42 patients (16.5%) were retransplanted. Only 4 of those (9.5%) were ≥65 years at time of graft loss. Nephrectomy had no impact on survival, relisting, or development of dnDSA. Patients after allograft loss have a high overall mortality. Immunization contributes to long waiting times. Only a very limited number of patients are retransplanted especially when ≥65 years at time of graft loss.

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Section: Discussionmentioning

confidence: 99%

What happens after graft loss? A large, long‐term, single‐center observation

et al. 2021

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“…The correlation between years of experience and the observations among the different Sudanese ethnic groups being with Nuba and Fulani and that may be due to high number of cases from those categories of ethnic groups and also could be related to the percentage of those groups in the whole population as recorded in literature by study investigated by H.Y. Hassan et al (3,6). And for no observation as most of this study population had experience less than five years therefore, low level of interaction with transplant patients suggested to their poor knowledge about the different ethnic groups and trough concentrations diversity among them.…”

Section: Table (1): Areas Of Currently Practicing Doctor Specialty Ye...mentioning

confidence: 76%

“…The good tacrolimus level ranged based on the time post-transplant as (10 -15 ng\ml) with 5 (38.5%) considered as the clinical target in the first month after transplant. Represented in Table (3). Significant correlation between years of experience and the observation obtained for Nuba and Fulani ,and also for the group who weren't record any observations P value 0.040, 0.000, 0.003 respectively.…”

Section: Table (1): Areas Of Currently Practicing Doctor Specialty Ye...mentioning

confidence: 84%

“…Transplantation is the preferred modality of replacement therapy for most patients with kidney failure. In the United States, more than 3,000 new patients are registered each month on the kidney transplant waiting list for this life-saving therapy (2,3). Transplant recipients require life-long immunosuppression to prevent allograft rejection (4,5).…”

Section: Introductionmentioning

confidence: 99%

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Exploring the Knowledge, Attitude, and Practice of Sudanese Medical Doctors Towards Tacrolimus, at Ahmed Gasim Hospital, Kidney Transplant Center Unit, Khartoum, Sudan (2022 – 2023)

et al. 2024

IJFMR

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Tacrolimus is one of the most commonly prescribed immunosuppressive drugs that varies between individuals depending on different ethnic groups, the presence of different CYP3A5 genetic variants, and the duration of time since the transplantation, which makes targeting optimal tacrolimus concentration levels more challenging. This study aimed to explore the knowledge, attitude, and practice of Sudanese medical doctors towards Tacrolimus. An observational, cross-sectional study was conducted on the Sudanese medical doctors in the nephrology clinic at Ahmed Gasim Hospital, Kidney Transplant Center Unit, Khartoum, Sudan, who were in direct contact with kidney transplant patients under tacrolimus treatment. Data were collected using a questionnaire modified to record the pharmacogenomic impact. The data were analyzed using a statistical package for social sciences (SPSS). Total of 15 medical doctors, Female 8 (53.3%) and male 7 (46.7%) with mean ± SD age of 31.60 ± (3.906). All of them were currently practicing in governmental hospitals (n=15; 83.3%), private hospitals (n=2; 11.1%), and private clinics (n=1; 6.7%). There were 67% of the medical doctors had high knowledge about the genetic profile of the patient's impact on the tacrolimus trough concentrations, while 66.7% of the medical doctors had low attitude levels toward tacrolimus. The observations among the different Sudanese ethnic groups tacrolimus trough concentrations were found to be variable, as Arabs and Fulani were observed to have low trough concentrations (n=6; 40%), while Nuba and Beja were observed to have high trough concentrations (n=5; 33.3%), instead of fur observed to had fluctuations (n=2; 13.3%). A significant correlation between practice toward tacrolimus with the location of practice, doctor specialty, and years of experience was found (P value ≤ 0.05). The medical doctors exerted a high level of knowledge about the impact of the genetic profile (metabolic alleles) in the dosing and dose adjustment of tacrolimus.

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“…Among the contraindications to transplant are active coronary disease; cardiopulmonary disease; active use of illicit substances; active local or systemic infections; obesity; post-transplant life expectancy <5 years; decompensated cirrhosis; poorly controlled psychiatric illness; malignancy; and non-adherence to prescribed therapies (Virmani & Asch, 2020).…”

Section: Resultsmentioning

confidence: 99%

Chronic Kidney Disease: Clinical and Epidemiological Scenario of Patients in Hemodialysis

Campos¹,

Toffoli-Kadri²,

Matos³

2021

GJHS

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OBJECTIVE: To describe the clinical and epidemiological scenario of patients with chronic kidney disease undergoing hemodialysis. METHOD: Retrospective study with secondary data collected from the medical records of patients over 18 years of age on hemodialysis from January 2016 to December 2018. RESULTS: 507 patients underwent ambulatory and/or hospital hemodialysis during the study period. From these, 494 participants were included, comprising 383 who were still under treatment at the end of the study period and 111 who died during the study period. The majority of hemodialysis patients were male, with a mean age of 56.6 years, non-white (77.4%), in a stable relationship (51.6%), retired (54.9%), and with low education (73.9%). Most participants started hemodialysis with the use of a central venous catheter (83.3%), which was maintained for 43.8% of the treatment time. Participants used an average of 18.91 medications daily. More than half of the deaths occurred during the first two years of treatment, with 30.6% of these occurring in the first 12 months of hemodialysis. Evaluation of the results of the clinical outcome of death demonstrated a relationship between age (p= 0.003), number of comorbidities (p = 0.009), time using a central venous catheter (p = 0.025), and white ethnicity (p = 0.021). Septic shock was the main cause of death (56.8%). CONCLUSION: Some factors related to the prognosis of the disease cannot be changed, such as age and white ethnicity. However, greater attention to the management and adequate monitoring of comorbidities is necessary, as well as a reduction in the time spent using a central venous catheter. Due to polymedication, pharmacotherapeutic monitoring is indicated, both for the prevention of drug related problems and for discussions concerning drug discontinuation.

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The Role of the General Nephrologist in Evaluating Patients for Kidney Transplantation: Core Curriculum 2020

Cited by 4 publications

References 0 publications

What happens after graft loss? A large, long‐term, single‐center observation

What happens after graft loss? A large, long‐term, single‐center observation

Exploring the Knowledge, Attitude, and Practice of Sudanese Medical Doctors Towards Tacrolimus, at Ahmed Gasim Hospital, Kidney Transplant Center Unit, Khartoum, Sudan (2022 – 2023)

Chronic Kidney Disease: Clinical and Epidemiological Scenario of Patients in Hemodialysis

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