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Advances in Chronic Kidney Disease

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https://www.readbyqxmd.com/read/27742389/do-federal-regulations-have-an-impact-on-kidney-transplant-outcomes
#1
Kenneth J Woodside, Randall S Sung
Transplantation is one of the most highly regulated fields in health care. An important component of transplant oversight is the performance assessment of transplant centers as measured by 1-year patient and graft survival outcomes. The use of the Organ Procurement and Transplantation Network and Scientific Registry of Transplant Recipients flagging mechanism for quality improvement as criteria for Center for Medicare and Medicaid Services certification has resulted in greater importance in transplant program operations...
September 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27742388/protocol-biopsies-utility-and-limitations
#2
Yihung Huang, Evan Farkash
As both T cell and antibody-mediated rejection can have a subclinical phase, protocol biopsies provide an early opportunity to intervene before the onset of clinical allograft dysfunction. Protocol biopsies are usually done after reperfusion to establish baseline, between 3 and 6 months to identify subclinical rejection, and at 6-12 months to assess chronicity and persistent inflammation that have prognostic implication. Treatment of both subclinical T cell and antibody-mediated rejection prevents progression of rejection and development of interstitial fibrosis/tubular atrophy or transplant glomerulopathy...
September 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27742387/donor-specific-antibody-monitoring-where-is-the-beef
#3
Jeffrey Ma, Anita Patel, Kathryn Tinckam
This review paper discusses the impact of de novo donor-specific antibodies (DSA) to donor HLA antigens in kidney transplantation and summarizes the benefits and challenges that exist with DSA monitoring. Post-transplant DSA is associated with worse allograft outcomes and its detection may precede or coincide with clinical, biochemical, and histologic allograft dysfunction. There are no absolute features of DSA testing results that perfectly discriminate between states of disease and health. In a state of antibody-associated graft dysfunction, removal or reduction in DSA may only provide clinical benefit for some...
September 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27742386/the-bad-and-the-good-news-on-cancer-immunotherapy-implications-for-organ-transplant-recipients
#4
Umberto Maggiore, Julio Pascual
Cancer immunotherapy, especially the use of checkpoint inhibitors, is expanding and can be efficacious in organ transplant recipients with malignant neoplasia. In this review, we summarize clinical findings and evolution of several patients treated with CTL4-4 or PD-1 inhibitors reported in the literature. The CTL-4 inhibitor ipilimumab has been safely used in several liver and kidney allograft recipients. PD1-inhibitors look promising for tumor shrinking, but acute rejection is the rule, so they should be avoided in recipients of life-saving organs...
September 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27742385/costimulatory-blockade-and-use-of-mtor-inhibitors-avoiding-injury-part-2
#5
David Wojciechowski, Flavio Vincenti
Kidney transplantation immunosuppression relies on a calcineurin inhibitor backbone. Calcineurin inhibitors have reduced early-acute rejection rates but failed to improve long-term allograft survival. Their nephrotoxicity has shifted the focus of investigation to calcineurin inhibitor-free regimens. Costimulation blockade with belatacept, a second generation, higher avidity variant of CTLA4-Ig, has emerged as part of a calcineurin inhibitor-free regimen. Belatacept has demonstrated superior glomerular filtration rate compared with calcineurin inhibitors albeit with an increased risk of early and histologically severe rejection...
September 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27742384/costimulatory-blockade-and-use-of-mammalian-target-of-rapamycin-inhibitors-avoiding-injury-part-1
#6
Joshua Augustine, Donald E Hricik
Although calcineurin inhibitor drugs have been the mostly used therapy in modern immunosuppression in kidney transplantation, their effect on kidney allograft dysfunction has been suboptimal as far as preservation of kidney function is concerned. Additionally, there are metabolic and other nonmetabolic effects including increased risk of malignancy that has necessitated the use of mammalian target of rapamycin inhibitors to reduce exposure to calcineurin inhibitors. Mammalian target of rapamycin inhibitors, both sirolimus and everolimus, have been studied in several trials to facilitate preservation of kidney function with variable effects on kidney allograft function and immunogenicity...
September 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27742383/immunosuppression-minimization-and-avoidance-protocols-when-less-is-not-more
#7
Rohini Prashar, K K Venkat
Kidney transplantation is well established as the best treatment option for end-stage kidney disease. It confers not only a better quality of life but also a significant survival advantage compared to dialysis. However, despite significant improvement in short-term kidney transplant graft survival over the past three decades, long-term graft survival remains suboptimal. Concerns about the possible contribution of chronic calcineurin inhibitor (CNI) nephrotoxicity to late allograft failure and other serious adverse effects of currently used immunosuppressive agents (especially corticosteroids) have led to increasing interest in developing regimens which may better preserve kidney allograft function and minimize other immunosuppression-related problems without increasing the risk of rejection...
September 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27742382/is-kidney-transplantation-a-better-state-of-ckd-impact-on-diagnosis-and-management
#8
REVIEW
Sandesh Parajuli, Dana F Clark, Arjang Djamali
Patients with CKD are at increased risk for cardiovascular events, hospitalizations, and mortality. Kidney transplantation (KTx) is the preferred treatment for end-stage kidney disease. Although comorbidities including anemia and bone and mineral disease improve or are even halted after KTx, kidney transplant recipients carry higher cardiovascular mortality risk than the general population, as well as an increased risk of infections, malignancies, fractures, and obesity. When comparing CKD with CKD after transplantation (CKD-T), the rate of decline of estimated glomerular filtration rate (eGFR) is significantly lower in CKD-T...
September 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27742381/current-status-of-kidney-transplant-outcomes-dying-to-survive
#9
REVIEW
Jeffrey H Wang, Melissa A Skeans, Ajay K Israni
Kidney transplantation is associated with improved survival compared with maintenance dialysis. In the United States, post-transplant outcomes have steadily improved over the last several decades, with current 1-year allograft and patient survival rates well over 90%. Although short-term outcomes are similar to those in the international community, long-term outcomes appear to be inferior to those reported by other countries. Differences in recipient case mix, allocation polices, and health care coverage contribute to the long-term outcome disparity...
September 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27742380/the-struggle-for-optimization-of-long-term-outcomes-after-kidney-transplantation
#10
EDITORIAL
Anita K Patel, Millie Samaniego
No abstract text is available yet for this article.
September 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27742379/increasing-access-to-kidney-transplantation-easy-as-a-b-o
#11
Jerry Yee
No abstract text is available yet for this article.
September 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27324681/preparation-of-the-dialysis-access-in-stages-4-and-5-ckd
#12
REVIEW
Louise M Moist, Ahmed A Al-Jaishi
Patients with Stages 4 and 5 CKD are optimally managed within a multidisciplinary care setting. This provides an opportunity to create a "patient centered" approach to renal replacement modality options and conservative care. The care team engages with the patient and caregivers to assist with the understanding of their health status, modality and vascular access selection, and overall living with the comorbidity of chronic illness. A systematic approach to provision of education, modality, and access selection, are in part, driven by the patient's expected survival and need for dialysis, the risks and benefits with different modalities, and access and adaptation to their preferences and home situations...
July 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27324680/ckd-mineral-bone-disorder-in-stage-4-and-5-ckd-what-we-know-today
#13
REVIEW
Michal L Melamed, Rupinder Singh Buttar, Maria Coco
Patients with CKD stages 4 and 5 experience biochemical derangements associated with CKD-mineral bone disorder. Some of the key abnormalities are hyperparathyroidism, hyperphosphatemia, hypocalcemia, and metabolic acidosis. We review the available treatments for these conditions and the evidence behind the treatments. We conclude that there is greater evidence for treating hyperphosphatemia than hyperparathyroidism. Treatment of metabolic acidosis in small clinical trials appears to be safe. We caution the reader about side effects associated with some of these treatments that differ in patients with CKD Stages 4 and 5 compared with patients on dialysis...
July 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27324679/hypertension-management-in-transition-from-ckd-to-esrd
#14
REVIEW
Aziz Valika, Aldo J Peixoto
Hypertension is present in ∼90% of patients in late-stage CKD. There are scarce data focusing on the transition period between CKD Stages 4 and 5 (end-stage kidney disease) as it relates to hypertension evaluation and management. Here, we propose that a combination of the principles used in the management of patients with CKD Stages 4 and 5 be applied to patients in this transition. These include the use of out-of-office blood pressure (BP) monitoring (eg, home BP), avoidance of excessively tight BP goals, emphasis of sodium restriction, preferential use of blockers of the renin-angiotensin system and diuretics, and consideration of the use of beta blockers...
July 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27324678/treatment-of-hyperlipidemia-changes-with-level-of-kidney-function-rationale
#15
REVIEW
Shubha Ananthakrishnan, George A Kaysen
Lipoprotein abnormalities such as low levels of high-density lipoprotein (HDL) and high triglycerides (TGs), associated with the metabolic syndrome, are also associated with subsequent decline in kidney function. Patients with end-stage kidney disease also exhibit low HDL and high TGs and a modest reduction in low-density lipoprotein (LDL), although the mechanisms responsible for these changes differ when patients with end-stage kidney disease are compared with those having metabolic syndrome with normal kidney function, as do lipoprotein structures...
July 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27324677/sodium-and-volume-disorders-in-advanced-chronic-kidney-disease
#16
REVIEW
Sana Khan, Matteo Floris, Antonello Pani, Mitchell H Rosner
The kidney has a remarkable ability to modulate sodium and water excretion to maintain homeostasis despite a widely varying dietary intake. However, as glomerular filtration rate falls to less than 30 mL/min, this ability can be compromised leading to an increased risk for disorders of serum sodium and extracellular volume. In all cases, these disorders are associated with an increased rate of morbidity and mortality. Management strategies to both prevent and treat these conditions are available but requiring special attention to the unique circumstance of advanced CKD to maximize therapeutic response and prevent complications...
July 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27324676/patient-education-and-support-during-ckd-transitions-when-the-possible-becomes-probable
#17
REVIEW
Jamie A Green, L Ebony Boulware
Patients transitioning from kidney disease to kidney failure require comprehensive patient-centered education and support. Efforts to prepare patients for this transition often fail to meet patients' needs due to uncertainty about which patients will progress to kidney failure, nonindividualized patient education programs, inadequate psychosocial support, or lack of assistance to guide patients through complex treatment plans. Resources are available to help overcome barriers to providing optimal care during this time, including prognostic tools, educational lesson plans, decision aids, communication skills training, peer support, and patient navigation programs...
July 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27324675/risk-prediction-in-ckd-the-rational-alignment-of-health-care-resources-in-ckd-4-5-care
#18
REVIEW
Peter Wojciechowski, Navdeep Tangri, Claudio Rigatto, Paul Komenda
CKD is a well-recognized global epidemic with consequences on patient morbidity, mortality, and health care resources. In the United States and Canada, a financial premium is often paid to programs and providers for caring for patients with Stage 4 to 5 CKD (not on dialysis) and is justified by the intensive care required by these patients, particularly in preparation for dialysis. About half of all patients with CKD Stages 3 and 4 never progress to kidney failure, and more than a quarter of them have stable kidney function for years...
July 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27324674/the-economics-of-late-stage-chronic-kidney-disease
#19
REVIEW
Robert Provenzano
Health care reimbursement is undergoing a fundamental change from volume-driven to value-driven care. The Patient Protection and Affordable Care Act is marshaling this change and empowering hospitals through Accountable Care Organizations to accept risk. ESRD care/nephrology was awarded the only disease-specific Accountable Care Organization, ESRD Seamless Care Organizations. Dialysis providers in partnership with nephrologists will be exploring how ESRD Seamless Care Organizations will drive improvement in care...
July 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27324673/epidemiology-and-challenges-to-the-management-of-advanced-ckd
#20
REVIEW
Azzour D Hazzan, Candice Halinski, Sofia Agoritsas, Steven Fishbane, Maria V DeVita
Advanced CKD is a period of CKD that differs greatly from earlier stages of CKD in terms of treatment goals. Treatment during this period presents particular challenges as further loss of kidney function heralds the need for renal replacement therapy. Successful management during this period increases the likelihood of improved transitions to ESRD. However, there are substantial barriers to optimal advanced CKD care. In this review, we will discuss advanced CKD definitions and epidemiology and outcomes.
July 2016: Advances in Chronic Kidney Disease
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