Transplantation in older individuals: is it really better than dialysis?

Transplantation in older individuals: is it really better than dialysis? Curr Opin Organ Transplant. 2019 Dec 10;: Authors: Hellemans R, Jager KJ, Abramowicz D Abstract PURPOSE OF REVIEW: The kidney transplantation landscape has changed dramatically over the last 2 decades. First, transplantation is performed in patients previously considered ineligible for transplantation, including older patients and patients with multiple comorbidities. Second, organ shortages have increased the use of less-than-optimal donor kidneys, like organs from expanded criteria donors or donors after cardiac death. Third, improvements in managing chronic kidney disease and dialysis have improved survival on dialysis. Therefore, the question arises: does transplantation currently benefit older transplant candidates? RECENT FINDINGS: The current review describes important changes in transplantation over the last 20 years. We review recent data on survival with dialysis versus transplantation in older individuals. Finally, we consider methodological issues that might influence conclusions drawn in current studies. SUMMARY: Limited data are available to assess the potential survival benefit of kidney transplantations in older individuals. The available evidence suggests that transplantation might provide survival benefit in older individuals, even with aged kidney donors, but risks vary widely with donor quality and recipient health status. More research is needed to mak...
Source: Current Opinion in Organ Transplantation - Category: Transplant Surgery Authors: Tags: Curr Opin Organ Transplant Source Type: research

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The objectives of the conservative treatment for chronic kidney disease are to slow down the progression of kidney dysfunction, treat complications (anemia, bone diseases, cardiovascular diseases), vaccination for hepatitis B, and preparation for kidney replacement therapy.
Source: Revista da Associacao Medica Brasileira - Category: General Medicine Source Type: research
Abstract Recent developments in US kidney-related healthcare policy have made chronic kidney disease (CKD) a societal focus in the United States. In the biggest policy change since the 1972 Social Security Amendments that extended Medicare coverage to patients with kidney failure regardless of age, a 2019 presidential executive order pledged to reduce end-stage kidney disease, slow CKD progression, increase kidney transplants, and focus on home dialysis care. This manuscript seeks to outline key factors that can enable this milestone moment to evolve a policy framework that improves the health of society while bei...
Source: Seminars in Dialysis - Category: Urology & Nephrology Authors: Tags: Semin Dial Source Type: research
CONCLUSIONS: Our study demonstrated that changes in the w/i PTH ratio were associated with kidney function, abnormal mineral metabolism, and renal outcome. PMID: 31919783 [PubMed - as supplied by publisher]
Source: Journal of Nephrology - Category: Urology & Nephrology Authors: Tags: J Nephrol Source Type: research
Abstract In 2015, Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA), a policy intended to transition Medicare away from pure fee-for-service care to value-based care. MACRA does this by evaluating the cost and quality of providers, resulting in financial bonuses and penalties in Medicare reimbursement. MACRA offers two tracks for participation, the Merit-based Incentive Payment System and the Advanced Alternative Payment Models. Although the payment rules are different for each of the tracks, common to both is an emphasis on holding providers accountable for high-quality, cost-efficient care...
Source: Seminars in Dialysis - Category: Urology & Nephrology Authors: Tags: Semin Dial Source Type: research
Purpose of review The kidney transplantation landscape has changed dramatically over the last 2 decades. First, transplantation is performed in patients previously considered ineligible for transplantation, including older patients and patients with multiple comorbidities. Second, organ shortages have increased the use of less-than-optimal donor kidneys, like organs from expanded criteria donors or donors after cardiac death. Third, improvements in managing chronic kidney disease and dialysis have improved survival on dialysis. Therefore, the question arises: does transplantation currently benefit older transplant candid...
Source: Current Opinion in Organ Transplantation - Category: Surgery Tags: RENAL TRANSPLANT: Edited by Uwe Heeman Source Type: research
The risk of coronary artery disease (CAD) increases as chronic kidney disease (CKD) advances, despite adjustment for traditional cardiovascular risk factors.1 Conventional therapies have failed to improve these outcomes, especially in patients with end-stage kidney disease (ESKD).2 The abrupt decline in CAD risk after kidney transplant, despite years of exposure to traditional CAD risk factors, suggests a role for reversible factors associated with ESKD and dialysis. Here, we briefly highlight select topics from the recent Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference on CAD in CKD.
Source: Kidney International - Category: Urology & Nephrology Authors: Tags: Nephrology Digest Source Type: research
ConclusionsThis study highlights the degree to which perceived physical health is lower in the setting of CKD than in the general population, even in the absence of kidney failure, and calls for greater attention to CKD-related quality of life.
Source: American Journal of Kidney Diseases - Category: Urology & Nephrology Source Type: research
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Source: American Journal of Kidney Diseases - Category: Urology & Nephrology Source Type: research
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Source: Pediatric Nephrology - Category: Urology & Nephrology Source Type: research
AbstractBackgroundEnteral feeding by tube in chronic kidney disease (CKD) before 2 years of age improves growth. Whether it is effective after this age is unknown. We assessed whether height and weight SDS changed after tube feeding was started in children with CKD above 2 years of age.MethodsRetrospective study of pre-transplant, pre-pubertal children (
Source: Pediatric Nephrology - Category: Urology & Nephrology Source Type: research
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