Short Duration Of Dialysis Research Articles

Trends in Patient Characteristics on the Japanese Waiting Lists for Deceased-Donor Kidney Transplantation. Are There no Eligibility or Ineligibility Criteria for Registration and Renewal?

BackgroundControversial issues in registering candidates for deceased-donor kidney transplantation (DDKT) comprise various factors, including age, life expectancy, and dialysis duration. We investigated patient characteristics on the waiting list and discussed suitable criteria in Japan, which has a long waiting period. MethodsThis study included 592 patients on the waiting list for DDKT at our institute between 1982 and 2023. We retrospectively reviewed patients’ medical charts and obtained their clinical information. Patient characteristics according to outcomes and eligibility criteria for applying for or renewing registration were investigated. No prisoners were used in the study, and the participants were neither coerced nor paid. ResultsApproximately 70%, 45%, and 14.5% of the registered patients were aged >60, >70, and 80 years, respectively. The number of patients aged ≥70 years gradually decreased over time. The median waiting periods of patients who underwent and interrupted DDKT were 13 and 7 years, respectively. Patients in their 70s with a >15-year dialysis period tended to have opportunities for DDKT. Living-donor kidney transplantation was performed in patients aged <60 years. Waiting patients were significantly younger and had a shorter dialysis duration. Advanced age at registration was associated with a significantly high risk of interruption. ConclusionsAdvanced age and longer dialysis periods were considered at registration because patients with these factors tended to experience interruptions despite the long waiting period and high cost. Although older patients can undergo DDKT, factors including surgical cost and risks are considered. Eligibility/ineligibility criteria should be established for DDKT waiting lists in Japan.

Renal Transplantation Enhances the Sildenafil Citrate Effectiveness in Patients with Erectile Dysfunction. A Single-Center Perspective

ObjectiveTo assess the efficacy and safety of Sildenafil citrate in the treatment of ED in (HD) compared to post-RT patients. Patients and methodsA concurrent cohort prospective study to evaluate the efficacy of Sildenafil in the treatment of ED in 24 HD patients (Group A) and 13 patients with persistent ED one-year post-RT (Group B). The initial dose of Sildenafil was 25 mg, increased to 50 mg if there is an adequate response. An Arabic-translated International Index of Erectile Function (IIEF) questionnaire was completed one week before and after Sildenafil treatment. An IIEF erectile function score of 26 or an improvement of at least 10 points for the total IIEF score was considered a favorable response to Sildenafil. ResultsGroup A included 22 patients with a mean age of 47.32 ± 7.013 years, whereas Group B included 13 patients with a mean age of 56.87 ± 9.612 years. The overall efficacy rate of Sildenafil was 40.9% and 76.9% in groups A and B, respectively. The post-treatment IIEF5-15 score increased from 11.1 ± 5.99 to 12.5 ± 6.41 (p = .458) and from 11.82 ± 7.534 to 21.91 ± 5.700 (p = .002) in groups A and B, respectively. In both groups, the duration of HD had no impact on ED improvement except in the post-RT non-responder subgroup. Hypertension, gastrointestinal symptoms, and flushing were both groups' most common side effects. ConclusionRT could enhance the response to sildenafil in treating patients with ED. The outcome is better in younger post-RT patients with moderate and severe erectile dysfunction and shorter dialysis duration.

Willingness of Patients With End-Stage Renal Disease to Accept a Kidney Transplant and Related Factors.

The prevalence of end-stage renal disease (ESRD) in Taiwan is among the highest in the world. Although kidney transplant is the most effective treatment for ESRD, the willingness of patients with ESRD to undergo kidney transplantation is low in Taiwan. The factors associated with willingness to accept kidney transplantation remain unclear, and studies on kidney transplant willingness and associated factors among Taiwanese patients with ESRD are scarce. The aim of this study was to assess willingness to undergo a kidney transplant and related factors among patients with ESRD in Taiwan. A cross-sectional design was employed. Two hundred fourteen participants from a single medical center in Taiwan were recruited, and 209 valid questionnaires were collected (valid response rate: 97.7%). The study instruments included a kidney transplant knowledge scale, a kidney transplant attitude scale, and a kidney transplant willingness scale. Data were analyzed using Pearson's product-moment correlations, t tests, one-way analyses of variance, and multiple regressions. The mean kidney transplant willingness in the sample was 13.23 (out of 20). Being male, younger, married, or employed; having a college education or above; and having a shorter dialysis duration were all associated with higher kidney transplant willingness. Sociodemographics, dialysis duration, knowledge, and attitudes explained 45.4% of the variance in kidney transplant willingness, with two of these, kidney transplant attitudes (β = .61, p < .001) and dialysis duration (β = -.11, p = .041), identified as significant. The findings support the important role of cultivating positive attitudes in patients with ESRD to increasing willingness to undergo kidney transplantation interventions.

#3075 Itch and ache on dialysis: the impact on the quality of life in Tunisian hemodialysis patients

Abstract Background and Aims Pruritus associated with chronic kidney disease (CKD-aP) is a common condition. However, although pruritus seriously affects the physical and mental health of patients, clinicians tend to underestimate this condition. The aim of this study is to determine the prevalence of Pa-MRC and its impact on the quality of life (QOL) in the Tunisian hemodialysis population. Method This is a prospective observational study conducted at the hemodialysis unit at Taher Sfar University Hospital (February - May 2022). The presence and severity of Pa-MRC were documented based on a 5-D pruritus questionnaire, demographic and clinico-biological data were extracted from the dialysis unit register. Results A total of 63 chronic hemodialysis patients (CHD) were recruited in this study, 68.3% of whom presented pruritus, most often generalized (2/3 cases). More than half of the patients reported pruritus throughout the day. Thirty patients reported moderate to severe Pa-CKD. Patients were not treated for pruritus in 72% of cases, but 92% of those treated were satisfied with their treatment. Patients reporting a more severe Pa-CKD had a shorter duration of dialysis, higher phosphate and parathormone levels and more frequent diabetes (p = 0.03). The QOL deteriorated when the severity of pruritus increased (p = 0.01). Patients reported having difficulty falling asleep (52%), irritability (61.4%), concentration disorders (31.8%). In addition, pruritus limits the daily life of patients in 59.1% of cases with an impact on nutritional status in 13.6%. Conclusion This study reveals that Pa-CKD is a distressing condition with a huge impact on the QOL of CHD patients. However, there is an unmet need for treatment, hence the need for new therapeutic approaches.

Regional variation in pre-dialysis blood pressure and its association with cardiovascular mortality rates in Japanese patients undergoing dialysis.

Adequate blood pressure (BP) management poses a significant challenge in improving the prognosis of patients undergoing dialysis. We aimed to investigate the relationship between pre-dialysis systolic blood pressure (SBP) and underlying disease in Japanese patients undergoing dialysis, based on prefectural location, and assess the association between pre-dialysis SBP and cardiovascular disease (CVD) mortality rate. We extracted the basic information of 336,182 patients who were undergoing dialysis in 2021 from the Web-based Analysis of Dialysis Data Archives database. Data on average pre-dialysis SBP were analyzed according to sex, prefectural location, and diabetic status, and the CVD mortality rate for each prefecture was calculated. The mean pre-dialysis SBP of the patients (males, 66.3%; mean age, 69.7 ± 12.5 years) was 151.9 ± 24.7 mmHg. Overall, 133,037 patients had underlying diabetic kidney disease (DKD). The patients with DKD were younger, had a shorter dialysis duration, and a higher pre-dialysis SBP than those with non-DKD comorbidities. The prefecture-based mean pre-dialysis SBP values were all higher than 140 mmHg. At the prefectural level, CVD mortality rate was positively correlated with pre-dialysis SBP (r = 0.3127, p = 0.0324) and diastolic blood pressure (r = 0.3378, p = 0.0202) among female patients. At the prefectural level, pre-dialysis SBP is >140 mmHg in Japanese patients undergoing dialysis, especially in those with DKD. The positive association between pre-dialysis SBP and CVD mortality rate suggests that optimal BP management at the prefectural level may reduce CVD mortality rates. At the prefectural level, pre-dialysis SBP is higher than 140 mmHg in Japanese patients undergoing dialysis, especially higher in those with DKD.

DXA-derived advanced hip analysis and the trabecular bone score in end-stage kidney disease secondary to type 1 diabetes.

Patients with end-stage kidney disease (ESKD) caused by type 1 diabetes mellitus (T1DM) have a heightened fracture risk. Bone mineral density (BMD) may predict fracture less accurately in ESKD than in patients with chronic kidney disease (CKD) stages 1-3b or the general population. Alternate, readily available imaging modalities are needed to improve ESKD fracture risk assessment. This study aimed to assess dual-energy X-ray absorptiometry (DXA)-derived BMD, the trabecular bone score (TBS) and advanced hip analysis parameters in patients with ESKD due to T1DM and to compare their results with those of patients with ESKD from other causes. We compared the DXA-derived TBS, hip cortical thickness (CT) and femoral neck (FN) buckling ratio (BR), an index of FN stability, of patients with T1DM and ESKD undergoing simultaneous pancreas kidney transplantation, patients with ESKD from other causes receiving kidney transplants and population reference ranges. Of 227 patients with ESKD, 28% had T1DM and 65% were male. Compared with other ESKD patients, patients with T1DM were younger (42 ± 7.7 vs 51 ± 13.8 years), had shorter dialysis duration (24.4 ± 21 vs 42.6 ± 40 months), had higher HbA1c (7.9 ± 1.57% vs 5.4 ± 0.95%) and had lower BMI (25 ± 6 vs 27 ± 5 kg/m2). They had lower spine, hip and UD radius BMD Z-scores (all P ≤ 0.001), TBS (1.33 ± 0.12 vs 1.36 ± 0.12; P = 0.05), CT at the FN (P = 0.03), calcar (P = 0.006) and shaft (P < 0.001) and higher BR (10.1±7.1 vs 7.7±4; P = 0.006). All ESKD parameters were lower than population-based reference ranges (P < 0.001). Adjusting for age, sex, dialysis vintage and weight, prevalent vertebral fractures in patients with T1DM and ESKD were associated with higher BR (odds ratio (OR): 3.27 (95% CI: 1.19-8.92), P = 0.002) and lower FN CT (OR: 3.70 (95% CI: 1.13-12.50)). Patients with ESKD and T1DM have reduced TBS, reduced CT and increased BR compared with other ESKD patients. Prospective study of these parameters is warranted to determine their utility in fracture risk prediction and management. Patients with ESKD and T1DM have an elevated fracture risk due to decreased bone strength. As an adjunct to BMD, evaluating dual-energy X-ray absorptiometry parameters that incorporate structural change may have greater value in patients with ESKD and T1DM than in the general population. In this study, patients with ESKD due to T1DM had lower BMD, lower trabecular bone scores, more severe loss of CT and higher BR than other patients with ESKD and people from the general population. Both lower CT and higher BR were associated with prevalent vertebral fractures in patients with T1DM and ESKD. Changes to these parameters should be evaluated for incident fracture prediction.

Prevalence and Predisposing Factors of Post Renal Transplant Erythrocytosis

Objective: Aim of current study was to determine the factors and prevalence of post-transplant erythrocytosis after kidney transplantation. Study Design: Retrospective study Place and Duration: Institute of Kidney Diseases Hayatabad Peshawar during June 2021 to December 2021. Methods: Total 118 patients of renal transplant were presented. Participants' full demographic information was recorded after getting written consent from each participant. Association of risk factors and prevalence of post-transplant erythrocytosis were recorded. Hematocrit (Ht) above 52% and haemoglobin (Hb) over 18 g/dl in males and Ht over 50% and Hb over 17 g /dl in females were considered to be indicative of true PTE. We used SPSS 18.0 to analyze all data. Results: The mean age of the patients was 50.6±2.31 years with mean BMI 27.4±11.52 kg/m2. There were majority 76 (64.4%) patients were males and 42 (35.6%) patients were females. Frequency of PTE was found in 23 (19.5%) cases and 95 (80.5%) cases were without PTE. Most common factors for PTE development were endogenous erythropoietin, local renal hypoxia, endogenous androgens, insulin-like growth factors and the renin-angiotensin- aldosterone system. Mean duration of dialysis in PTE group was 25.1±7.48 months and duration of patients without PTE was 51.9±6.75 months. Frequency of diabetes, hypertension, glomerulonephritis, polycystic kidney disease and graft failure were higher in PTE patients as compared to non-PTE. We found higher number of acute rejection in PTE patients as compared to non PTE cases with p value &lt;0.009. Conclusion: We concluded in this study that the shorter duration of dialysis and higher number of acute rejection before kidney transplant were the risk factors for post transplant erythrocytosis. Most common factor for PTE development was renin-angiotensin- aldosterone system. Keywords: Erythrocytosis, Transplantation, Kidney, Dialysis

27-LB: Prevalence and Severity of Diabetic Retinopathy in African Americans with End-Stage Kidney Disease

Background and Methods: This cross-sectional study determined the prevalence of diabetic retinopathy (DR) in non-Hispanic African Americans (AA) with end-stage-kidney disease (ESKD) and their impact on quality of life. A total of 95 adults with type 1 (n= 10) and type 2 (n= 85) on dialysis diabetes were assessed for DR using portable hand-held (Optomed Aurora) with artificial intelligence report with AEYE Diagnostic System (AEYE-DS) , visual acuity using a Snellen chart, and social determents of health, and standardized questionnaires (Kidney Disease Quality of Life (KDQoL) , depression screening (Patient health Questionaire-9) and food insecurity. Results: Among the 95 participants (female 51%, mean age 59.5 ±12.3 years, duration of diabetes (DM) 18.2 ± 12.0 years and duration of dialysis 4.5±3.6 years) . A total of 55% of patients had a diagnosis of (DR+) , who had a longer duration of DM (18.8±9.5 vs. 15.8±12.2 years, p=0.20 and shorter duration of dialysis (3.6±2.7 vs. 5.9±5.0 years compared to DR negative (DR-) , p=0.09. Kidney Disease Quality of Life score on symptoms/problems related to ESKD and greater effect of kidney disease in daily life were lower compared to the general US, AA population with ESKD, p &amp;lt;.0001) . DR+ had worse physical health (p: 0.09) , greater rate of severe vision impact on quality of life (p= 0.01) , similar rates below the federal poverty level per household income (25% vs. 30%) , non-statistically significantly higher Ph-Q9 depression (6.9±5.3 vs. 4.8±4.1, p=0.16) , and food insecurity scores compared to without DR (1.07±1.51 vs. 0.83±1.56, p=0.33) . Overall, the prevalence of diabetic retinopathy was 55% based on the AEYE artificial intelligence system. Diabetic retinopathy was associated with poor quality of life and physical health, higher rates of poverty, and greater impact of vision impairment on quality of life compared to DR negative. Our preliminary finding highlights the increased disease burden of DR in AAs with ESKD, indicating an alarming gap in care. Disclosure M. Egeolu: None. G. E. Umpierrez: Research Support; AstraZeneca, Dexcom, Inc., Novo Nordisk. E. Manishimwe: None. Z. E. Zabala: None. B. Moazzami: None. R. L. Caleon: None. R. J. Galindo: Advisory Panel; Sanofi, WW International, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Novo Nordisk. J. E. Navarrete: None. A. Y. G. Gerges: None. L. Peng: None.

Distinct Phenotypes of Kidney Transplant Recipients in the United States with Limited Functional Status as Identified through Machine Learning Consensus Clustering.

Background: There have been concerns regarding increased perioperative mortality, length of hospital stay, and rates of graft loss in kidney transplant recipients with functional limitations. The application of machine learning consensus clustering approach may provide a novel understanding of unique phenotypes of functionally limited kidney transplant recipients with distinct outcomes in order to identify strategies to improve outcomes. Methods: Consensus cluster analysis was performed based on recipient-, donor-, and transplant-related characteristics in 3205 functionally limited kidney transplant recipients (Karnofsky Performance Scale (KPS) < 40% at transplant) in the OPTN/UNOS database from 2010 to 2019. Each cluster’s key characteristics were identified using the standardized mean difference. Posttransplant outcomes, including death-censored graft failure, patient death, and acute allograft rejection were compared among the clusters Results: Consensus cluster analysis identified two distinct clusters that best represented the clinical characteristics of kidney transplant recipients with limited functional status prior to transplant. Cluster 1 patients were older in age and were more likely to receive deceased donor kidney transplant with a higher number of HLA mismatches. In contrast, cluster 2 patients were younger, had shorter dialysis duration, were more likely to be retransplants, and were more likely to receive living donor kidney transplants from HLA mismatched donors. As such, cluster 2 recipients had a higher PRA, less cold ischemia time, and lower proportion of machine-perfused kidneys. Despite having a low KPS, 5-year patient survival was 79.1 and 83.9% for clusters 1 and 2; 5-year death-censored graft survival was 86.9 and 91.9%. Cluster 1 had lower death-censored graft survival and patient survival but higher acute rejection, compared to cluster 2. Conclusion: Our study used an unsupervised machine learning approach to characterize kidney transplant recipients with limited functional status into two clinically distinct clusters with differing posttransplant outcomes.

Depression symptoms and quality of life in patients receiving renal replacement therapy in Jordan: A cross-sectional study

Patients with chronic illnesses, such as those with chronic kidney disease (CKD) that are undergoing renal replacement therapy (RRT), face significant psychological changes. This descriptive cross-sectional research was carried out to investigate the factors that influence depressive symptoms and quality of life (QoL) in patients with end-stage renal disease. Data were collected from 70 participants undergoing RRT using a self-reported questionnaire that included sociodemographic information, depressive symptoms, disease status, and QoL. The Beck Depression Inventory-II (BDI-II) screening scale was used to measure depressive symptoms and the SF-36 (Medical Outcome Survey-Short Form 36) was used to assess QoL. Participants in the study rated their depressive symptoms as ‘minimum (44.3%), ‘mild’ (20%), ‘moderate’ (21.4%), and ‘severe (14.3%). Furthermore, a shorter duration of dialysis and comorbid conditions were significantly associated with the development of depressive symptoms. Patients on RRT for a longer period of time had lower physical activity scores than patients on dialysis for a shorter period of time. Male participants have a higher mental QoL than female participants, suggesting that the mental aspect of renal disease is less impaired than the physical aspect. The findings of this study are expected to increase awareness of RRT therapy targets and enhance patient outcomes.

Evidence to support a drain-free strategy in kidney transplantation using a retrospective comparison of 500 consecutively transplanted cases at a single center

IntroductionRoutine placement of surgical drains at the time of kidney transplant has been debated in terms of its prognostic value.ObjectivesTo determine whether the placement of a surgical drain affects the incidence rate of developing wound complications and other clinical outcomes, particularly after controlling for other prognostic factors.MethodsRetrospective analysis of 500 consecutive renal transplant cases who did not (Drain-free, DF) vs. did (Drain, D) receive a drain at the time of transplant was performed. The primary outcome was the development of any wound complication (superficial or deep) during the first 12 months post-transplant. Secondary outcomes included the development of superficial wound complications, deep wound complications, DGF, and graft loss during the first 12 months post-transplant.Results388 and 112 recipients had DF/D, respectively. DF-recipients were significantly more likely to be younger, not have pre-transplant diabetes, receive a living donor kidney, receive a kidney-alone transplant, have a shorter duration of dialysis, shorter mean cold-ischemia-time, and greater pre-transplant use of anticoagulants/antiplatelets. Wound complications were 4.6% (18/388) vs. 5.4% (6/112) in DF vs. D groups, respectively (P = 0.75). Superficial wound complications were observed in 0.8% (3/388) vs. 0.0% (0/112) in DF vs. D groups, respectively (P = 0.35). Deep wound complications were observed in 4.1% (16/388) vs. 5.4% ((6/112) in DF vs. D groups, respectively (P = 0.57). Higher recipient body mass index and ≥ 1 year of pre-transplant dialysis were associated in multivariable analysis with an increased incidence of wound complications. Once the prognostic influence of these 2 factors were controlled, there was still no notable effect of drain use (yes/no). The lack of prognostic effect of drain use was similarly observed for the other clinical outcomes.ConclusionsIn a relatively large cohort of renal transplant recipients, routine surgical drain use appears to offer no distinct prognostic advantage.

Duration of hemodialysis associated with cardio-respiratory dysfunction and breathlessness: a multicenter study.

BackgroundPatients with hemodialysis suffer with protein-energy wasting and uremic myopathy lead to lack of physical activity and poor functional performance. However, ventilation abnormality in patients undergone hemodialysis remains controversial regarding the respiratory impairment. Therefore, the study aimed to determine the effect of duration of dialysis on respiratory function.MethodsA multicenter study with cross-sectional study was designed in four hemodialysis outpatient clinics. Respiratory muscle strength (i.e., maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP)) pulmonary function test (i.e., forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and FEV1/FVC ratio), functional capacity (6-minute walk test) and sensation of breathlessness were assessed prior to dialysis.ResultsA total of 100 hemodialysis patients were recruited with 38 females and 62 males. An average of duration of hemodialysis was 5.93± 4.96 years. Decreased MIP values, FEV1 values, FVC values, %FEV1 and %FVC were noted in patients with long duration of dialysis (defined as ≥ 5 years of dialysis) compared to those with short duration of dialysis (ps < .05). In addition, increased sensation of breathlessness was observed in patients with long duration of dialysis (p < .05). Furthermore, participants with long duration of dialysis had an increased risk of ventilatory restriction (OR 6.093, p = .007).

P1860PERIOPERATIVE CHANGES IN PHYSICAL FUNCTION AND ACCELEROMETER-MEASURED PHYSICAL ACTIVITY IN PRE-EMPTIVE OR POST-DIALYSIS KIDNEY TRANSPLANT RECEIPIENTS

Abstract Background and Aims Pre-emptive kidney transplant (PEKT) is known to have better graft survival, and thereby well established as the optimal treatment for end-stage renal disease patients. On the other hand, the delayed recovery of physical function and physical activity after KT reportedly occurs in approximately 20% of KT recipients, which leads to poor prognosis. However, it is less clear whether PEKT delays recovery of them after KT. We aimed to investigate any differences in perioperative changes in physical function and physical activity for PEKT versus non-PEKT. Method Consecutive 34 recipients who had received a living-donor KT from January 2016 to January 2019 were enrolled in this prospective cohort study. Patient characteristics including age, sex, body mass index, primary cause of kidney disease, smoking habits, and comorbidities were collected at baseline. Six-minute walk distance (6MWD), gait speed, isometric leg strength, accelerometer-measured physical activity (number of steps and moderate to vigorous activity time) and kidney function (eGFR) were assessed at before and 2 months after KT. We divided the recipients into 2 groups: PEKT (n=11) and non-PEKT (n=23), and compared outcomes between the 2 groups using ANCOVA adjusted for baseline patient characteristics. This study was approved by institute ethical committee. Results KT successfully improved eGFR of all the study participants from 6.1±4.6 to 35.4±15.3. PEKT group showed significant shorter dialysis duration as compared with non-PEKT group (mean duration: 0 months in PEKT vs 64.8±95.5 months in non-PEKT, P &amp;lt;0.001). The 6MWD significantly improved after KT in the PEKT group, but not in the non-PEKT group as compared with that of baseline (adjusted mean change [95% confidence interval]: 44.7 [8.2 to 81.2] vs. 8.80 [-32.8 to 15.2], P=0.025). We found a tendency toward improvement of gait speed (0.11 [-0.11 to 0.32] vs. -0.15 [-0.29 to -0.01], P=0.065), and moderate-to-vigorous activity time per day (7.19 [-2.84 to 17.23] vs. -5.60 [-12.97 to 1.77], P=0.057) in the PEKT group. Conclusion PEKT recipients showed higher perioperative changes in physical function and physical activity compared to non-PEKT. Our findings suggest that PEKT may have benefits on early recovery of physical function and physical activity after KT.

Frailty is associated with dialysis duration before transplantation in kidney transplant recipients: A Japanese single-center cross-sectional study.

To investigate the prevalence of frailty, and the relationship of frailty based on the Kihon Checklist criteria with dialysis duration before transplantation and time after transplantation in kidney transplant recipients. This study was a single-center, cross-sectional investigation carried out on kidney transplant recipients. To examine the association between the total Kihon Checklist score with time after transplant and dialysis duration before transplant, the multivariable proportional odds logistic regression model was used with adjustment for age, sex, body mass index, estimated glomerular filtration rate and serum albumin levels. Out of 205 kidney transplant recipients enrolled in this study, frail, prefrail and robust recipients accounted for 11.2%, 26.8% and 62.0%, respectively. Dialysis duration before transplantation was associated with frailty, but time after transplant was not associated with frailty. The prevalence of frailty in kidney transplant recipients is approximately 11%, and it is associated with the duration of pretransplant dialysis. These findings suggest that a shorter dialysis duration might be beneficial for preventing frailty in kidney transplant recipients.

Opacity of big toenail predicts poor prognosis in patients with end-stage renal disease on hemodialysis.

The impact of nail abnormalities on prognosis in hemodialysis patients is unknown. This study investigated whether toenail opacity as a readout of nail abnormalities predicted prognosis in hemodialysis patients. In this observational study, 494 eligible hemodialysis patients who received hemodialysis at Oyokyo Kidney Research Institute between September 2010 and December 2015 were included. The presence of nail abnormalities was objectively evaluated by big toenail opacity ratio measurement. Primary endpoint was overall survival, and secondary endpoints were lower limb amputation and determination of risk factors for poor prognosis among patient demographics, comorbidities, blood tests, and big toenail opacity. Overall survival and lower limb survival were evaluated using the Kaplan-Meier method with log-rank test. Multivariate Cox regression analyses assessed predictors for poor prognosis. Big toenail opacity was found in 259 (52%) patients. Patients with big toenail opacity were significantly older, had shorter duration of dialysis, higher prevalence rates of diabetes mellitus (DM), cardiovascular disease (CVD), and higher mortality rates than those without opacity. Presence of big toenail opacity predicted poor prognosis for both overall and lower limb survival. Multivariate Cox regression analyses revealed serum albumin, the presence of DM and big toenail opacity were independent risk factors for both poor overall and lower limb survivals. The prevalence of big toenail opacity was high inhemodialysis patients. Despite the short observation period, our findings indicated that big toenail opacity had significant predictive power for poor overall and lower limb survival.

The effect of desensitization therapy in kidney transplantation.

Desensitization therapy may enable the patient to get allograft in sensitized recipient or solve the organ shortage in ABO-incompatible relationship in kidney transplantation (KT). However, the graft outcome and morbidity remains unclear. We retrospectively analyzed 845 KT patients from January 2010 to February 2016 at Seoul National University Hospital. The patients were divided into three groups as follows: HLA-incompatible (HLAi) group, ABO-incompatible (ABOi) group, and control group. The HLAi group comprised patients who received desensitization therapy due to the presence of donor-specific antibodies (DSAs) or high panel reactive antibodies (PRAs). The ABOi group is defined as those undergoing preoperative desensitization therapy for anti-ABO antibodies. Of the total of 845 recipients, 48 (5.6%) were HLAi KTs and 71 (13.9%) were ABOi KTs, respectively. Pre-emptive KT is done more frequently in ABOi group, therefore, they had shorter dialysis duration than the others. HLAi recipients had a higher proportion of women than the ABOi group and a higher proportion of re-transplantation. During the 38.4 (0.4-76.9) months of follow-up, there were more acute antibody-mediated rejections (AAMRs) in the HLAi (6.7%) and ABOi (8.5%) groups than in the control group (1.9%) (P=0.001). However, there was no difference in graft survival, patient survival, and annual allograft among three groups. Despite the higher incidence of AAMRs, HLAi and ABOi KTs showed a favorable graft and patient outcome after desensitization therapy.

Suitability of Patients with Autosomal Dominant Polycystic Kidney Disease for Renal Transcatheter Arterial Embolization.

In patients with autosomal dominant polycystic kidney disease (ADPKD), massive renal enlargement is a serious problem. Renal transcatheter arterial embolization (TAE) can reduce renal volume (RV), but effectiveness varies widely, and the reasons remain unclear. We investigated factors affecting renal volume reduction rate (RVRR) after renal TAE in all 449 patients with ADPKD who received renal TAE at Toranomon Hospital from January of 2006 to July of 2013, including 228 men and 221 women (mean age =57.0±9.1 years old). One year after renal TAE, the RVRR ranged from 3.9% to 84.8%, and the least squares mean RVRR calculated using a linear mixed model was 45.5% (95% confidence interval [95% CI], 44.2% to 46.8%). Multivariate analysis using the linear mixed model revealed that RVRR was affected by the presence of large cysts with wall thickening (regression coefficient [RC], -6.10; 95% CI, -9.04 to -3.16; P<0.001), age (RC, -0.82; 95% CI, -1.03 to -0.60; P<0.001), dialysis duration (RC, -0.10; 95% CI, -0.18 to -0.03; P<0.01), systolic BP (RC, 0.39; 95% CI, 0.19 to 0.59; P<0.001), and the number of microcoils used for renal TAE (RC, 1.35; 95% CI, 0.83 to 1.86; P<0.001). Significantly more microcoils were needed to achieve renal TAE in patients with younger age and shorter dialysis duration. In conclusion, cyst wall thickening had an important effect on cyst volume reduction. Renal TAE was more effective in patients who were younger, had shorter dialysis duration, or had hypertension, parameters that might associate with cyst wall stiffness and renal artery blood flow.

Influence of dialysis modalities on patients undergoing parathyroidectomy for renal hyperparathyroidism

Summary Background/Introduction Dialysis modalities may influence parathyroid hormone (PTH) levels and renal osteodystrophy patterns. To date, no study has compared the effects of dialysis modality on surgical patients with renal hyperparathyroidism. Purpose/Aim This study evaluated the influence of different dialysis modalities on perioperative features among patients undergoing parathyroidectomy. Methods Overall, 386 patients who underwent initial parathyroidectomy for renal hyperparathyroidism were recruited. Biochemical data and relevant symptoms were compared between hemodialysis and peritoneal dialysis patients. Results Compared with the hemodialysis patients, the 40 (10%) peritoneal dialysis patients were younger (p = 0.002) and had a shorter duration of dialysis (p Conclusion Patients on different dialysis modalities had similar decreases in intact PTH and alkaline phosphatase levels after surgery. However, the peritoneal dialysis patients had higher postoperative calcium–phosphorus product levels and more severe residual symptoms.

Recurrent membranoproliferative glomerulonephritis type I after kidney transplantation: a 17-year single-center experience.

Most previously published studies of patients with membranoproliferative glomerulonephritis type I are small or have short follow-up period. We report the outcome of a fairly large cohort of patients followed up for nearly 10 years. Retrospective cohort study. Graft survival, recurrence rate and risk factors for recurrence were analyzed for 43 patients transplanted between the years 1995 and 2012. At a mean overall follow-up of 118 ± 61 months (median, 127.8; range, 4.9-217), 12 patients lost their graft (28%). Death-censored actuarial 15-year graft survival rate was 56%. Membranoproliferative glomerulonephritis recurred in eight patients (19%) at a median time of 15.4 months (range, 4.4-70 months). Recurrence led to graft loss in seven patients (88%) within a median of 11.6 months (range, 1.3-54 months) from diagnosis. Median graft survival was 30.5 months for recurrence (range, 7-86). Actuarial 15-year graft survival was 71% for nonrecurrent. The risk for recurrence was higher for patients with human leukocyte antigen (HLA) B49 (odds ratio, 16.9; 95% confidence interval, 1.1-246; P=0.038) and HLA DR4 (odds ratio, 15.9; 95% confidence interval, 1.07-237; P=0.044) alleles. A trend toward increased risk was found with shorter duration of dialysis before transplantation. Four of 16 (25%) living-related versus none of the living-unrelated donors' recipients recurred. The HLA B49, acute tubular necrosis after transplantation, previous transplantations, and Arab origin were all associated with decreased graft and patient survival. Patients without recurrence in the first years should expect an excellent graft survival. Nonrelated living donors should be preferred. The HLA B49 and DR4 alleles may increase the risk for recurrence.

Prevalence and Determinants of Parathyroid Dysfunction in Elderly Patients on Hemodialysis

Background: The goal of this study was to investigate underlying factors of parathyroid dysfunction in elderly patients undergoing maintenance hemodialysis. Methods: A total of 286 patients on maintenance hemodialysis were included. Hemoglobin, serum creatinine (Scr), blood urea nitrogen (BUN), serum calcium, serum phosphorus (P), intact parathyroid hormone (iPTH), and serum albumin (Alb) were measured and analyzed both before and after dialysis. Results: A higher incidence of low iPTH level (<150 pg/l) was observed in the elderly group than that in the non-elderly group (55.8 vs. 36.7%, p < 0.05). Elderly patients had a shorter dialysis duration, lighter dry weight, lower concentrations of BUN, Scr, P, iPTH, Alb and standard protein nitrogen present rate (nPNA) compared to that of non-elderly group patients (p < 0.05). Conclusions: Low iPTH level occurs more frequently in elderly hemodialysis patients. Furthermore, age, serum P, serum Alb and nPNA were independently associated with a low iPTH level.