IJERPH, Vol. 17, Pages 7318: Quantifying the Treatment Effect of Kidney Transplantation Relative to Dialysis on Survival Time: New Results Based on Propensity Score Weighting and Longitudinal Observational Data from Sweden

This study applied the propensity score weighting approach in order to address the treatment selection bias of kidney transplantation on survival time compared with dialysis for patients on the waitlist. We included 2676 adult waitlisted patients who started renal replacement therapy in Sweden between 1 January 1995, and 31 December 2012. Weibull and logistic regression models were used for the outcome and treatment models, respectively. The potential outcome mean and the average treatment effect were estimated using an inverse-probability-weighted regression adjustment approach. The estimated survival times from start of renal replacement therapy were 23.1 years (95% confidence interval (CI): 21.2−25.0) and 9.3 years (95% CI: 7.8−10.8) for kidney transplantation and dialysis, respectively. The survival advantage of kidney transplantation compared with dialysis was estimated to 13.8 years (95% CI: 11.4−16.2). There was no significant difference in the survival advantage of transplantation between men and women. Controlling for possible immortality bias reduced the survival advantage to 9.1–9.9 years. Our results suggest that kidney transplantation substantially increases survival time compared with dialysis in Sweden and that this consequence of treatment is equally distributed over sex.
Source: International Journal of Environmental Research and Public Health - Category: Environmental Health Authors: Tags: Article Source Type: research

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The COVID-19 pandemic presents significant challenges for health systems globally, including substantive ethical dilemmas that may pose specific concerns in the context of care for people with kidney disease. Ethical concerns may arise as changes to policy and practice impact on the ability of all health professionals to fulfil their ethical duties towards their patients in providing best practice care. In this paper we briefly describe such concerns and elaborate on issues of particular ethical complexity in kidney care: equitable access to dialysis during pandemic surges; balancing the risks and benefits of different kid...
Source: Kidney International - Category: Urology & Nephrology Authors: Tags: review Source Type: research
AbstractDiabetic kidney disease (DKD) occurs in approximately 20 –40% of patients with type 2 diabetes mellitus. Patients with DKD have a higher risk of cardiovascular and all-cause mortality. Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and antihyperglycemic drugs form the mainstay of DKD management and aim to restrict progression to more severe stages of DKD. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) control hyperglycemia by blocking renal glucose reabsorption in addition to preventing inflammation, thereby improving endothelial function and reducing oxidative stress; consequen...
Source: Diabetes Therapy - Category: Endocrinology Source Type: research
Purpose of review With the aging population of kidney transplant candidates, a history of malignancy is an increasingly prevalent finding. Tumors can constitute a contraindication for transplantation or can lead to a delay of acceptance to the waiting-list. Current waiting time guidelines mainly refer to early data collected nearly 30 years ago, when the knowledge on tumors was, by current standards, still limited. Recent findings Today, cancers can usually be divided into many different biological subtypes, according to histological and molecular subclassification and the availability of genetic testing. A more preci...
Source: Current Opinion in Nephrology and Hypertension - Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by David J. Cohen Source Type: research
Purpose of review To summarize the current state of evidence regarding the role of apolipoprotein L1 (APOL1) genotyping in evaluating donors for kidney transplantation. Recent findings African ancestry is associated with an increased risk of kidney failure following living donation. Moreover, kidney transplants from African ancestry deceased donors have an increased risk of graft failure. Preliminary evidence suggests that APOL1 genotype may mediate at least a portion of this racial variation, with high-risk APOL1 genotypes defined by presence of two renal risk variants (RRVs). A pilot study 136 African ancestry livin...
Source: Current Opinion in Nephrology and Hypertension - Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by David J. Cohen Source Type: research
Purpose of review The clinical significance and treatment of borderline changes are controversial. The lowest detectable margin for rejection on histology is unclear. We review recent evidence about borderline changes and related biomarkers. Recent findings Borderline change (Banff ≥ t1i1) is associated with progressive fibrosis, a greater propensity to form de-novo DSA, and reduced graft survival. Isolated tubulitis appears to have similar kidney allograft outcomes with normal controls, but this finding should be validated in a larger, diverse population. When borderline change was treated, a higher chance of kidn...
Source: Current Opinion in Nephrology and Hypertension - Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by David J. Cohen Source Type: research
Purpose of review Accumulating evidence supports the important contribution of volume-related metrics to morbidity and mortality in patients receiving chronic haemodialysis. The purpose of this review is to summarize recent advances in the understanding and management of volume status in this high-risk group. Recent findings Delivery of optimal volume management involves three key components: accurate estimation of volume status, correction of extracellular fluid overload and prevention of intradialytic instability. The lack of a gold standard for assessing volume status makes accurate estimation difficult to achieve;...
Source: Current Opinion in Nephrology and Hypertension - Category: Urology & Nephrology Tags: DIALYSIS AND TRANSPLANTATION: Edited by David J. Cohen Source Type: research
Abstract Kidney transplantation is the ideal treatment option for patients with end-stage kidney disease (ESKD). Since there is clear mortality benefit to receiving a transplant regardless of comorbidities and age, the gold standard of care should focus on attaining kidney transplantation and minimizing, or better yet eliminating, time on dialysis. Unfortunately, only a small percentage of patients with ESKD receive a kidney transplant. Several barriers to kidney transplantation have been identified. Barriers can largely be grouped into three categories: patient-related, physician/provider-related, and system-rela...
Source: Seminars in Dialysis - Category: Urology & Nephrology Authors: Tags: Semin Dial Source Type: research
CONCLUSION: The observed high rate of AVF at the start of hemodialysis and of the switch from CVC to AVF in the first year, although declining since 2008, is a positive outcome. However, over one-third of patients maintain the CVC as vascular access for the first year because of unmodifiable factors, such as gender, age, comorbidity. The present study suggests that logistics/management and assistance/welfare problems may contribute to the delay or lack of AVF placement in incident hemodialysis patients or within the first year of dialysis. PMID: 32993439 [PubMed - as supplied by publisher]
Source: The Journal of Vascular Access - Category: Surgery Tags: J Vasc Access Source Type: research
Early kidney transplantation (KT) is the best option for patients with end-stage kidney disease, but little is known about dialysis access strategy in this context. We studied practice patterns of dialysis acc...
Source: BMC Nephrology - Category: Urology & Nephrology Authors: Tags: Research article Source Type: research
CONCLUSIONS: The benefits of CCBs over other antihypertensives on predialysis blood pressure levels and intradialytic hypotension among people with CKD who required haemodialysis were uncertain. Effects of CCBs on other side effects and cardiovascular death also remain uncertain. Dihydropyridine CCBs may decrease predialysis systolic and diastolic blood pressure level compared to placebo or no treatment. No studies were identified in children or peritoneal dialysis. Available studies have not been designed to measure the effects on costs. The shortcomings of the studies were that they recruited very few participants, had f...
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
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