Advances in chronic kidney disease最新文献_第8页

Kidney Transplantation: Improving Access, Allocation, and Outcomes 肾移植:改善获取、分配和结果。

IF 2.9 3区医学

Advances in chronic kidney disease Pub Date : 2021-11-01 DOI: 10.1053/j.ackd.2022.02.005

Scott G. Westphal MD, Anju Yadav MD, FASN

引用次数: 0

A Cascade of Structural Barriers Contributing to Racial Kidney Transplant Inequities 一连串的结构性障碍导致了种族间的肾脏移植不平等

IF 2.9 3区医学

Advances in chronic kidney disease Pub Date : 2021-11-01 DOI: 10.1053/j.ackd.2021.10.009

Dinushika Mohottige , Lisa M. McElroy , L. Ebony Boulware

{"title":"A Cascade of Structural Barriers Contributing to Racial Kidney Transplant Inequities","authors":"Dinushika Mohottige , Lisa M. McElroy , L. Ebony Boulware","doi":"10.1053/j.ackd.2021.10.009","DOIUrl":"10.1053/j.ackd.2021.10.009","url":null,"abstract":"<div><p>Stark racial disparities in access to and receipt of kidney transplantation, especially living donor and pre-emptive transplantation, have persisted despite decades of investigation and intervention. The causes of these disparities are complex, are inter-related, and result from a cascade of structural barriers to transplantation which disproportionately impact minoritized individuals and communities. Structural barriers contributing to racial transplant inequities have been acknowledged but are often not fully explored with regard to transplant equity. We describe longstanding racial disparities in transplantation, and we discuss contributing structural barriers which occur along the transplant pathway including pretransplant health care, evaluation, referral processes, and the evaluation of transplant candidates. We also consider the role of multilevel socio-contextual influences on these processes. We believe focused efforts which apply an equity lens to key transplant processes and systems are required to achieve greater structural competency and, ultimately, racial transplant equity.</p></div>","PeriodicalId":7221,"journal":{"name":"Advances in chronic kidney disease","volume":"28 6","pages":"Pages 517-527"},"PeriodicalIF":2.9,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1548559521001300/pdfft?md5=d3613b44ebe05396049b5f453bc2e567&pid=1-s2.0-S1548559521001300-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9428067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 9

Kidney Allocation Policy: Past, Present, and Future 肾脏分配政策:过去、现在和未来。

IF 2.9 3区医学

Advances in chronic kidney disease Pub Date : 2021-11-01 DOI: 10.1053/j.ackd.2022.01.006

Jaime M. Glorioso

引用次数: 6

The Scope of Telemedicine in Kidney Transplantation: Access and Outreach Services 远程医疗在肾移植中的应用范围:获取和推广服务。

IF 2.9 3区医学

Advances in chronic kidney disease Pub Date : 2021-11-01 DOI: 10.1053/j.ackd.2021.10.003

Fawaz Al Ammary , Beatrice P. Concepcion , Anju Yadav

{"title":"The Scope of Telemedicine in Kidney Transplantation: Access and Outreach Services","authors":"Fawaz Al Ammary , Beatrice P. Concepcion , Anju Yadav","doi":"10.1053/j.ackd.2021.10.003","DOIUrl":"10.1053/j.ackd.2021.10.003","url":null,"abstract":"<div><p>Access to transplant centers is a key barrier for kidney transplant evaluation and follow-up care for both the recipient and donor. Potential kidney transplant recipients and living kidney donors may face geographic, financial, and logistical challenges in engaging with a transplant center and maintaining post-transplant continuity of care. Telemedicine via synchronous video visits has the potential to overcome the access barrier to transplant centers. Transplant centers can start the evaluation process for potential recipients and donors via telemedicine, especially for those who have challenges to come for an in-person visit or when there are restrictions on clinic capacities, such as during a pandemic. Similarly, transplant centers can use telemedicine to sustain post-transplant follow-up care while avoiding the burden of travel and its associated costs. However, expansion to telemedicine-based kidney transplant services is substantially dependent on telemedicine infrastructure, insurer policy, and state regulations. In this review, we discuss the practice of telemedicine in kidney transplantation and its implications for expanding access to kidney transplant services and outreach from pretransplant evaluation to post-transplant follow-up care for the recipient and donor.</p></div>","PeriodicalId":7221,"journal":{"name":"Advances in chronic kidney disease","volume":"28 6","pages":"Pages 542-547"},"PeriodicalIF":2.9,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S154855952100104X/pdfft?md5=91f790e02fdde768d273147d9a5daad4&pid=1-s2.0-S154855952100104X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43297827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 4

Mitigating Risk Associated With the Transition From Pediatric to Adult Kidney Transplant Care: Strategies to Promote Success 降低从儿童到成人肾移植护理过渡的风险:促进成功的策略。

IF 2.9 3区医学

Advances in chronic kidney disease Pub Date : 2021-11-01 DOI: 10.1053/j.ackd.2021.10.002

Ashton Chen

{"title":"Mitigating Risk Associated With the Transition From Pediatric to Adult Kidney Transplant Care: Strategies to Promote Success","authors":"Ashton Chen","doi":"10.1053/j.ackd.2021.10.002","DOIUrl":"10.1053/j.ackd.2021.10.002","url":null,"abstract":"<div><p>Young adult kidney transplant recipients experience poorer outcomes. Specifically worse allograft survival has been reported in the United States and worldwide. Pediatric to adult transition–related research has focused predominantly on medication nonadherence. However, the cause of worse graft outcomes in young adults is likely due to a multitude of complex factors. Consensus guidelines were issued to guide pediatric and adult transplant teams during the transition process. To what extent these transition guidelines are utilized and their impact on improving outcomes for young adult patients is unclear. The consensus guidelines serve as a useful resource, but investigation of the potential barriers to putting these transition guidelines into practice is lacking. One must consider the unique needs of medically complex patients, financial disincentives to transition programs, paucity of evidence-based data to support individual aspects of a transition program and their impact on transition success, and absence of strategies to address health care disparities, all of which can have a multiplicative risk for this population. Key transition research is needed to yield evidence-based data to support transition practices that are successful and truly improve outcomes in this high-risk transplant population. It will also allow better stewardship of transplant organs by optimizing outcomes and allograft longevity.</p></div>","PeriodicalId":7221,"journal":{"name":"Advances in chronic kidney disease","volume":"28 6","pages":"Pages 570-576"},"PeriodicalIF":2.9,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1548559521001038/pdfft?md5=63db5a9f0e72321df561c936630f6cbe&pid=1-s2.0-S1548559521001038-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45672499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Diabetes in Kidney Transplantation 肾移植中的糖尿病。

IF 2.9 3区医学

Advances in chronic kidney disease Pub Date : 2021-11-01 DOI: 10.1053/j.ackd.2021.10.004

Maria P. Martinez Cantarin

{"title":"Diabetes in Kidney Transplantation","authors":"Maria P. Martinez Cantarin","doi":"10.1053/j.ackd.2021.10.004","DOIUrl":"10.1053/j.ackd.2021.10.004","url":null,"abstract":"<div><p>Diabetes mellitus (DM) is one of the most common complications after kidney transplantation and is associated with unfavorable outcomes including death. DM can be present before transplant but post-transplant DM (PTDM) refers to diabetes that is diagnosed after solid organ transplantation. Despite its high prevalence, optimal treatment to prevent complications of PTDM is unknown. Medical therapy of pre-existent DM or PTDM after transplant is challenging because of frequent interactions between antidiabetic and immunosuppressive agents. There is also frequent need for medication dose adjustments due to residual kidney disease and a higher risk of medication side effects in patients treated with immunosuppressive agents. Sodium-glucose cotransporter 2 inhibitors have demonstrated a favorable cardio-renal profile in patients with DM without a transplant and hence hold great promise in this patient population although there is concern about the higher risk of urinary tract infections. The significant gaps in our understanding of the pathophysiology, diagnosis, and management of DM after kidney transplantation need to be urgently addressed.</p></div>","PeriodicalId":7221,"journal":{"name":"Advances in chronic kidney disease","volume":"28 6","pages":"Pages 596-605"},"PeriodicalIF":2.9,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1548559521001051/pdfft?md5=613dbf3d94574e45c89e0703149b3ac5&pid=1-s2.0-S1548559521001051-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41730666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Approach to Highly Sensitized Kidney Transplant Candidates and a Positive Crossmatch 高敏感肾移植候选人的方法和阳性交叉配型。

IF 2.9 3区医学

Advances in chronic kidney disease Pub Date : 2021-11-01 DOI: 10.1053/j.ackd.2021.09.004

Supreet Sethi, Noriko Ammerman, Ashley Vo, Stanley C. Jordan

引用次数: 0

Obesity Management in Kidney Transplant Candidates: Current Paradigms and Gaps in Knowledge 肾移植候选人的肥胖管理:目前的范例和知识差距。

IF 2.9 3区医学

Advances in chronic kidney disease Pub Date : 2021-11-01 DOI: 10.1053/j.ackd.2021.09.009

Joanna H. Lee , Elysia O. McDonald , Meera N. Harhay

{"title":"Obesity Management in Kidney Transplant Candidates: Current Paradigms and Gaps in Knowledge","authors":"Joanna H. Lee , Elysia O. McDonald , Meera N. Harhay","doi":"10.1053/j.ackd.2021.09.009","DOIUrl":"10.1053/j.ackd.2021.09.009","url":null,"abstract":"<div><p>In this review, we discuss the increasing prevalence of obesity among people with chronic and end-stage kidney disease (ESKD) and implications for kidney transplant (KT) candidate selection and management. Although people with obesity and ESKD receive survival and quality-of-life benefits from KT, most KT programs maintain strict body mass index (BMI) cutoffs to determine transplant eligibility. However, BMI does not distinguish between visceral adiposity, which confers higher cardiovascular risks and risks of perioperative and adverse posttransplant outcomes, and muscle mass, which is protective in ESKD. Furthermore, requirements for patients with obesity to lose weight before KT should be balanced with the findings of numerous studies that show weight loss is a risk factor for death among patients with ESKD, independent of starting BMI. Data suggest that KT is associated with survival benefits relative to remaining on dialysis for candidates with obesity although recipients without obesity have higher delayed graft function rates and longer transplant hospitalization durations. Research is needed to determine the optimal body composition metrics for KT candidacy assessments and risk stratification. In addition, ESKD-specific obesity management guidelines are needed that will address the neurologic, behavioral, socioeconomic, and physical underpinnings of this increasingly common disease.</p></div>","PeriodicalId":7221,"journal":{"name":"Advances in chronic kidney disease","volume":"28 6","pages":"Pages 528-541"},"PeriodicalIF":2.9,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1548559521000987/pdfft?md5=7bc8f82ed3285d8904abae05628b1904&pid=1-s2.0-S1548559521000987-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42758868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 5

Kidney Disease After Nonkidney Solid Organ Transplant 非肾脏实体器官移植后的肾脏疾病。

IF 2.9 3区医学

Advances in chronic kidney disease Pub Date : 2021-11-01 DOI: 10.1053/j.ackd.2021.10.010

Christina Mejia , Anju Yadav

引用次数: 0

Noninvasive Assessment of the Alloimmune Response in Kidney Transplantation 肾移植中同种免疫反应的无创评估。

IF 2.9 3区医学

Advances in chronic kidney disease Pub Date : 2021-11-01 DOI: 10.1053/j.ackd.2021.08.002

Edward J. Filippone , Rakesh Gulati , John L. Farber

{"title":"Noninvasive Assessment of the Alloimmune Response in Kidney Transplantation","authors":"Edward J. Filippone , Rakesh Gulati , John L. Farber","doi":"10.1053/j.ackd.2021.08.002","DOIUrl":"10.1053/j.ackd.2021.08.002","url":null,"abstract":"<div><p>Transplantation remains the optimal mode of kidney replacement therapy, but unfortunately long-term graft survival after 1 year remains suboptimal. The main mechanism of chronic allograft injury is alloimmune, and current clinical monitoring of kidney transplants includes measuring serum creatinine, proteinuria, and immunosuppressive drug levels. The most important biomarker routinely monitored is human leukocyte antigen (HLA) donor-specific antibodies (DSAs) with the frequency based on underlying immunologic risk. HLA-DSA should be measured if there is graft dysfunction, immunosuppression minimization, or nonadherence. Antibody strength is semiquantitatively estimated as mean fluorescence intensity, with titration studies for equivocal cases and for following response to treatment. Determination of in vitro C1q or C3d positivity or HLA-DSA IgG subclass analysis remains of uncertain significance, but we do not recommend these for routine use. Current evidence does not support routine monitoring of non-HLA antibodies except anti-angiotensin II type 1 receptor antibodies when the phenotype is appropriate. The monitoring of both donor-derived cell-free DNA in blood or gene expression profiling of serum and/or urine may detect subclinical rejection, although mainly as a supplement and not as a replacement for biopsy. The optimal frequency and cost-effectiveness of using these noninvasive assays remain to be determined. We review the available literature and make recommendations.</p></div>","PeriodicalId":7221,"journal":{"name":"Advances in chronic kidney disease","volume":"28 6","pages":"Pages 548-560"},"PeriodicalIF":2.9,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1548559521000768/pdfft?md5=faf6d4052c63d0c14fa2f26a70ccc5f7&pid=1-s2.0-S1548559521000768-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41408875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 4