Dialysis & Transplantation最新文献

{"title":"The D&T Report","authors":"","doi":"10.1002/dat.20543","DOIUrl":"https://doi.org/10.1002/dat.20543","url":null,"abstract":"<p>The disparity in the burden and outcomes of chronic kidney disease (CKD) between whites and racial and ethnicminorities in the United States is well documented.<span>1</span> There are several factors that may contribute to this discrepancy among specific groups. Blacks and Hispanics have genetic predispositions toward hypertension and diabetes, respectively. These populations as a whole, when compared with whites, are often comprised of a higher number of low-income families, more isolated or impoverished neighborhoods, and they often have less education and poorer access to healthcare. As a result, there are nearly 33% more minorities who receive renal replacement therapy than there are whites.<span>2</span></p><p>Socioeconomic status may be even more important than racial or ethnic factors. In an analysis of data from the National Health and Nutrition Examination Survey, Rajnish Mehrotra, MD, a nephrologist and professor of medicine at the University of California, LosAngeles School of Medicine, and colleagues found that black and Hispanic patients with endstage renal disease (ESRD) who were younger than 65 had a significantly higher risk of mortality than their white counterparts. However, the difference became insignificant when the authors adjusted their calculations for socioeconomic and access- to-care variables.<span>3</span> “What this tells me is that the higher risk for death [among black and Hispanic patients] is related to issues that can be summarized in terms of socioeconomic characteristics,” says Dr. Mehrotra. In other words, a large part of the difference relates to sociology rather than biology, he says.</p><p>Poverty may take a greater toll on blacks than on whites. Deidra Crews, MD, a nephrologist and associate professor of medicine at Johns Hopkins School of Medicine in Baltimore, and colleagues found that the prevalence of CKD was 27% higher among Baltimore residents with family incomes below the federal poverty level, as compared with those above it. However, blacks living below the poverty level were 33% more likely to have CKD than whites of similar income. <span>4</span> “Poverty may have a different impact on black than white patients in determining who's at risk for CKD,” says Dr. Crews. “One possible explanation is that, in an urban setting like ours, there may be some factors that affect blacks differentially over whites.”</p><p>In another study from Johns Hopkins, senior author L. Ebony Boulware, MD, MPH, and colleagues at the university's School of Public Health examined racial differences in sources of healthcare, health insurance, and incidence of CKD in 3,883 white and 1,607 black participants. The black patients were significantly less likely to have access to healthcare, and significantly more likely to have CKD. Adjustment for demographic, socioeconomic, lifestyle, and clinical factors accounted for 64% of that increased risk, and limited access to healthcare accounted for an additional 10%. Their conclu","PeriodicalId":51012,"journal":{"name":"Dialysis & Transplantation","volume":"40 2","pages":"54-58"},"PeriodicalIF":0.0,"publicationDate":"2011-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/dat.20543","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137685845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The three‐signal hypothesis of lymphocyte activation/targets for immunosuppression","authors":"S. Goral","doi":"10.1002/DAT.20527","DOIUrl":"https://doi.org/10.1002/DAT.20527","url":null,"abstract":"Kidney transplantation is the preferred mode of renal replacement therapy for most patients with end-stage renal disease. Despite the increasing success of transplantation over the years, allograft rejection remains a major problem. Recently, there has been considerable improvement in understanding the role of the immune system in rejection. In the setting of transplantation, T cells have proved to be crucial players in the immune response, and their activation has been shown to be a very tightly regulated process involving numerous interactions of receptors including the T-cell receptor (TCR):CD3 complex, co-stimulatory receptors, and appropriate signaling molecules, resulting in production of cytokines as well as clonal expansion and differentiation of effector T lymphocytes. In this review, current knowledge of the mechanisms of lymphocyte activation as well as potential targets for various immunosuppressive agents are discussed.","PeriodicalId":51012,"journal":{"name":"Dialysis & Transplantation","volume":"40 1","pages":"14-16"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/DAT.20527","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51498082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of mTOR inhibition in renal transplant immune suppression","authors":"S. Patel, K. Dawson, R. Knight, A. Abdellatif, K. Achkar, L. Gaber, A. Gaber","doi":"10.1002/DAT.20530","DOIUrl":"https://doi.org/10.1002/DAT.20530","url":null,"abstract":"The mammalian target of rapamycin inhibitors (mTOR-Is) sirolimus and everolimus represent a class of proliferation signal inhibitors with a wide spectrum of activities, including suppression of T-cell proliferation and reduction of tumor growth. In solid-organ transplantation, mTOR inhibitors are an option for maintenance immune suppression due to their relative lack of nephrotoxicity compared with the current backbone of most regimens, the calcineurin inhibitors (CNIs). This property, in conjunction with their unique pharmacology, allows mTOR-Is to be used as an adjunct or alternative to CNIs. Earlier studies of their use in de novo renal transplantation have delineated potential strategies for use of this class of drugs in groups of patients in whom mTOR inhibition may be useful. From recent kidney studies it appears that the time for introduction of mTOR-I therapy may be prior to the development of proteinuria or significant graft deterioration. Consideration should also be given to the use of mTOR-Is in patients with or at high risk of post-transplant malignancy. Due to potential toxicities, knowledge of the adverse effects and pharmacokinetic profiles of mTOR-Is is necessary for proper management of patients receiving these agents.","PeriodicalId":51012,"journal":{"name":"Dialysis & Transplantation","volume":"40 1","pages":"23-29"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/DAT.20530","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51498201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New targets for immunosuppression in kidney transplantation: Focus on recent clinical trials","authors":"D. Wojciechowski, F. Vincenti","doi":"10.1002/DAT.20528","DOIUrl":"https://doi.org/10.1002/DAT.20528","url":null,"abstract":"Significant advances have been made in post-kidney transplantation immunosuppression. The introduction of calcineurin inhibitors (CNIs) has led to a reduction in acute rejection and improved 1-year outcomes. However, long-term allograft survival has not improved. This may in part be due to the chronic nephrotoxicity of CNIs and negative effects on the cardiovascular and metabolic risk profile via worsening hypertension, diabetes, and dyslipidemia. New drug development now focuses on maintaining low rejection rates but maximizing long-term allograft survival and modulating the cardio-metabolic side effects seen with CNIs. Two small molecules are currently undergoing Phase 2 investigation. CP-690550 (tasocitinib) is a JAK 3 inhibitor, and AEB-071 (sotrastaurin) is a protein kinase C inhibitor. Two biologic agents are also undergoing development. Belatacept is a humanized antibody that blocks the T-cell co-stimulation pathway and has had promising results in both Phase 2 and 3 investigation. Alefacept is a humanized antibody that inhibits T-cell adhesion and is currently undergoing Phase 2 investigation. This article will review the mechanisms of these drugs and outline the available trial data results.","PeriodicalId":51012,"journal":{"name":"Dialysis & Transplantation","volume":"40 1","pages":"18-22"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/DAT.20528","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51498110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Generic substitution for immunosuppressive drugs","authors":"J. Helderman","doi":"10.1002/DAT.20526","DOIUrl":"https://doi.org/10.1002/DAT.20526","url":null,"abstract":"The advent of generic alternatives for transplant immunosuppressant drugs has engendered concern and discussion. The process by which the food and drug administration (FDA) approves generic substitutes is reviewed. A category of medicines defined as narrow therapeutic index (NTI) drugs is defined with evidence that many (but not all) of the commonly used transplant medications fall into this category. It is demonstrated that the current FDA standards are inadequate to vet NTI agents. Outcomes data are presented that show generic switching for NTI drugs can be successfully accomplished with careful blood level monitoring, but clinical and financial negative consequences can flow from unregulated switching. Recommendations are made for provider use of generic immunsuppressants, for recipient education and response to switching, and for pharmacy shandling of generic alternatives.","PeriodicalId":51012,"journal":{"name":"Dialysis & Transplantation","volume":"40 1","pages":"37-40"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/DAT.20526","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51497925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When life gives you lemons, make lemonade†","authors":"P. Jackson","doi":"10.1002/DAT.20529","DOIUrl":"https://doi.org/10.1002/DAT.20529","url":null,"abstract":"","PeriodicalId":51012,"journal":{"name":"Dialysis & Transplantation","volume":"40 1","pages":"48-48"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/DAT.20529","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51498161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Belatacept in renal transplantation","authors":"Sarah E. Yost, K. Ranga, B. Kaplan","doi":"10.1002/DAT.20531","DOIUrl":"https://doi.org/10.1002/DAT.20531","url":null,"abstract":"Belatacept is a novel agent that prevents CD28 signaling and inhibits T-cell activation by costimulation blockade. It was developed from abatacept (CTLA-4 Ig), the first recombinant immunoglobulin fusion protein that contains extracellular portion of CTLA-4, and the Fc domain of IgG. Early studies have shown that belatacept recipients show comparable patient and graft survival, superior renal function and renal biopsy data compared with cyclo-sporine-treated patients. Newer biologic agents such as belatacept offer the promise of real change—due to their lack of mechanism-related toxic effects—and help monitor drug administration, thereby improving compliance. Belatacept is a potential option for maintenance biologic therapy without a calcineurin inhibitor, accompanied by excellent mid-term results with yet unknown long-term safety and efficacy. The increased rate of TCMR and possibly central nervous system post-transplantation lymphoproliferative disorder are worrisome and need to be further elucidated.","PeriodicalId":51012,"journal":{"name":"Dialysis & Transplantation","volume":"40 1","pages":"33-36"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/DAT.20531","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51498214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening of proteinuria in young adults: Is it worthwhile?","authors":"M. El-Tayeb MD,&nbsp;M. El Setouhy MD,&nbsp;H. El Sayed MD,&nbsp;Y. Elshahawy MD,&nbsp;D. Sany MD,&nbsp;W. Bichari MD,&nbsp;A. Shaban MSC","doi":"10.1002/dat.20516","DOIUrl":"10.1002/dat.20516","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> BACKGROUND</h3>\u0000 \u0000 <p>The prevalence of chronic kidney disease is increasing rapidly worldwide, and recent data indicate that overt disease is the tip of the iceberg of covert disease. Data on the prevalence and incidence of proteinuria in young adults are scarce. This lack of knowledge is an obstacle to the establishment of prevention programs for chronic kidney disease, especially in developing countries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> SETTING AND PARTICIPANTS</h3>\u0000 \u0000 <p>Urine screening for proteinuria was carried out in a cohort of young adults in a student hostel of Ain Shams University, Cairo, Egypt. Fresh morning urine samples were collected and tested for proteinuria by dipstick analysis. Participants with persistent proteinuria were referred to the university hospital for further evaluation for the presence of kidney disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> RESULTS</h3>\u0000 \u0000 <p>Of 1,260 apparent healthy students screened, 67.7% were males and 32.3% were females. Their mean age was 20.2 ± 1.2 years. 3.3% were hypertensive, and proteinuria was detected in 47 (3.7%) in the first screening test. At the second screening test, persistent proteinuria was found in 10 students (0.8% of the original cohort). Of these, 4 (0.3%) had proteinuria more than 0.5 g/24 h, but all of them refused renal biopsy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> CONCLUSIONS</h3>\u0000 \u0000 <p>Urine dipstick is an inexpensive way to screen for proteinuria in developing countries, but it must be done twice to exclude transient and intermittent proteinuria. Routine screening for proteinuria in this particular young adult population is not recommended due to its low diagnostic yield.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51012,"journal":{"name":"Dialysis & Transplantation","volume":"39 12","pages":"522-526"},"PeriodicalIF":0.0,"publicationDate":"2010-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/dat.20516","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51497448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Growth in children after renal transplantation: An update","authors":"Vinai M. Modini MD,&nbsp;Mouin G. Seikaly MD","doi":"10.1002/dat.20523","DOIUrl":"10.1002/dat.20523","url":null,"abstract":"<p>Improving general health, sense of well-being, and quality of life are the primary objectives of renal transplanta-tion in children with chronic kidney disease (CKD). Final adult height achieved has a significant impact on medical, psychological, and social aspects of these patients. Growth is an important indicator of health in children with CKD. It seems intuitive then to expect improvement in growth after renal transplantation. Unfortunately, even with a functioning renal allograft, optimal growth remains elusive at times. Optimizing growth prior to transplant, early identification of growth delay, and timely intervention are essential in achieving optimal final adult height. Multiple factors lead to stunted growth in children after renal transplant.</p>","PeriodicalId":51012,"journal":{"name":"Dialysis & Transplantation","volume":"39 12","pages":"516-521"},"PeriodicalIF":0.0,"publicationDate":"2010-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/dat.20523","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51497727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"World's oldest donor‐recipient solid organ transplantation?","authors":"B. Mistry, B. McKeever, Gautam Phadke, A. Mahale","doi":"10.1002/DAT.20505","DOIUrl":"https://doi.org/10.1002/DAT.20505","url":null,"abstract":"The incidence of chronic kidney disease is rising rapidly among the elderly. Improved results have been noted among the elderly when a living donor is available. We report on the world's oldest donor-recipient solid organ transplantation, with a combined age of 167 years and 337 days.","PeriodicalId":51012,"journal":{"name":"Dialysis & Transplantation","volume":"39 1","pages":"534-535"},"PeriodicalIF":0.0,"publicationDate":"2010-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/DAT.20505","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51496701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}