Educational Level as a Determinant of Access to and Outcomes After Kidney Transplantation in the United States
, 04 April 2008
Elke S. Schaeffner, Jyotsna Mehta, Wolfgang C. Winkelmayer
American Journal of Kidney Diseases
May 2008 (Vol. 51, Issue 5, Pages 811-818) Abstract |
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Do You Need to Stay in School to Get a Kidney Transplant?
Jeffrey C. Fink
American Journal of Kidney Diseases
May 2008 (Vol. 51, Issue 5, Pages 717-718) Full Text |
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Oral Calcitriol for the Treatment of Persistent Proteinuria in Immunoglobulin A Nephropathy: An Uncontrolled Trial
, 04 April 2008
Cheuk-Chun Szeto, Kai-Ming Chow, Bonnie Ching-Ha Kwan, Kwok-Yi Chung, Chi-Bon Leung, Philip Kam-Tao Li
American Journal of Kidney Diseases
May 2008 (Vol. 51, Issue 5, Pages 724-731) Abstract |
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Targeting Proteinuria as a Valid Surrogate for Individualized Kidney Protective Therapy
Dick de Zeeuw
American Journal of Kidney Diseases
May 2008 (Vol. 51, Issue 5, Pages 713-716) Full Text |
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Depressive Disorder in Renal Transplantation: An Analysis of Medicare Claims
, 25 March 2008
Fabienne Dobbels, Melissa A. Skeans, Jon J. Snyder, Anne V. Tuomari, J. Ross Maclean, Bertram L. Kasiske
American Journal of Kidney Diseases
May 2008 (Vol. 51, Issue 5, Pages 819-828) Abstract |
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Pharmacodynamics of Unfractionated Heparin During and After a Hemodialysis Session
Philippe Brunet, Nicolas Simon, Adriana Opris, Valérie Faure, Anne-Marie Lorec-Penet, Henri Portugal, Bertrand Dussol, Yvon Berland
American Journal of Kidney Diseases
May 2008 (Vol. 51, Issue 5, Pages 789-795) Abstract |
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Add-Ons
See Schaeffner et al, pages 811-818 and Fink et al, pages 717-718.
Barriers to both listing for and receipt of a kidney transplant remain. In this issue, Schaeffner et al study the relationship between predialysis educational level and access to and outcomes following kidney transplantation in 670 patients. In adjusted analyses, college graduates were approximately 3 times more likely to both be listed for a transplant (HR, 2.81; 95% CI, 2.21 to 3.58) and to receive a transplant (HR, 3.06; 95% CI, 2.38 to 3.92) when compared to patients without a high school degree (P for trend across educational level for both outcomes <0.001). Additionally, rates of allograft loss increased as educational achievement dropped (P for trend = 0.03). An editorial by Dr Fink asks whether lower educational achievement can truly explain these findings or if it is another marker of socioeconomic status that influences access to kidney transplant.
Treatment of Proteinuria With Oral Calcitriol in IgA Nephropathy
See Szeto et al, pages 724-731 and de Zeeuw, pages 713-716.
The optimal therapy for patients with immunoglobulin A (IgA) nephropathy is unknown, and treatment with ACE inhibitors and ARBs alone may not be the most effective option for high-risk patients. In this issue, Szeto et al perform a small, open-label prospective uncontrolled trial studying the effects of calcitriol on proteinuria in 10 patients with IgA nephropathy. They found a significant overall decrease in proteinuria over the 12 week study period from 1.98 ± 0.74 to 1.48 ± 0.81 g/g (P = 0.007), in the absence of significant changes in blood pressure or renal function that could otherwise explain these results. This change was correlated with a simultaneous reduction in TGF-β level. An editorial by Dr de Zeeuw examines potential therapies for proteinuria, including calcitriol, where the anti-proteinuric effect is not mediated through blood pressure lowering and discusses future implications of these therapeutics.
Depression is common in kidney transplant patients and is associated with poor outcomes, yet little is known about the association between kidney transplantation and depression. In this issue, Dobbels et al conduct a retrospective observational study of Medicare claims of kidney transplant recipients who underwent transplantation between 1995 and 2003. They found that the cumulative incidence of depression was 5.1%, 7.3% and 9.1% at 1, 2, and 3 years post-transplant, respectively. Critically, depression in transplant recipients was associated with a 2-fold higher risk for graft failure, return to dialysis, and death.
Pharmacodynamics of Unfractionated Heparin During and After a Hemodialysis Session
See Brunet et al, pages 789-795.
While unfractionated heparin remains a mainstay of hemodialysis therapy, there are limited pharmacodynamic data evaluating its duration of effect on anti-Factor Xa activity. In this issue, Brunet et al evaluate the pharmacodynamics of heparin in a cross-sectional study of 35 long-term hemodialysis patients on a heparin protocol that delivered 50 IU/kg per 4 hour hemodialysis session (25 IU/kg during the 1st hour, 12.5 IU/kg during the 2nd and 3rd hours, and no heparin during the final hour). A single compartment pharmacokinetic model with first-order elimination and a half-life of 54 minutes best fit the data. Median anti-Xa activities peaked at 0.55 IU/mL and dropped to 0.25 IU/mL at the end of the 4-hour session. By 90 minutes postdialysis, anti-Xa levels were undetectable (<0.1 IU/mL). The authors conclude that unfractionated heparin administered as a 3-hour continuous infusion for hemodialysis anticoagulation provides an efficient and safe anticoagulant effect that quickly disappears following the hemodialysis session.
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