Dataset Information

Impact of preoperative renal replacement therapy on the clinical outcome of heart transplant patients.

ABSTRACT: Renal dysfunction is considered as a relative contraindication for heart transplantation (HTx). However, in the real world setting, many patients with advanced heart failure (HF) experience worsening of renal function and some even require renal replacement therapy (RRT) by the time they undergo HTx. We aimed to investigate the prognosis and clinical outcomes of HTx patients who required RRT during the perioperative period. The Korean Organ Transplant Registry (KOTRY) is a nationwide organ transplant registry in Korea. A total of 501 HTx patients had been prospectively enrolled in the KOTRY registry during 2014-2018. Among the 501 patients, 13 underwent combined heart and kidney transplantation (HKTx). The 488 patients who underwent isolated HTx were grouped according to their pre- and postoperative RRT status. The primary outcome was progression to dialysis-dependent end-stage renal disease (ESRD) after HTx. The secondary outcome was all-cause mortality after HTx. The median follow-up was 22 months (9-39 months). Patients who needed preoperative RRT but were free from postoperative RRT showed comparable overall survival and renal outcome to patients who were free from both pre- and postoperative RRT. In multivariable analysis, preoperative RRT was not associated with progression to ESRD or all-cause mortality after HTx; however, postoperative RRT was a significant predictor for both progression to ESRD and all-cause mortality after HTx. Preoperative creatinine or estimated glomerular filtration rate (eGFR) were not predictive of progression to ESRD after HTx. The present analysis suggests that preoperative RRT requirement does not indicate irreversible renal dysfunction in patients waiting for HTx. However, postoperative RRT was associated with progression to ESRD and mortality after HTx.

SUBMITTER: Kim D

PROVIDER: S-EPMC8239032 | biostudies-literature | 2021 Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Impact of preoperative renal replacement therapy on the clinical outcome of heart transplant patients.

Kim Darae D Choi Jin-Oh JO Cho Yang Hyun YH Sung Kiick K Oh Jaewon J Cho Hyun Jai HJ Jung Sung-Ho SH Lee Hae-Young HY Park Jin Joo JJ Choi Dong-Ju DJ Kang Seok-Min SM Kim Jae-Joong JJ Jeon Eun-Seok ES

Scientific reports 20210628 1

Renal dysfunction is considered as a relative contraindication for heart transplantation (HTx). However, in the real world setting, many patients with advanced heart failure (HF) experience worsening of renal function and some even require renal replacement therapy (RRT) by the time they undergo HTx. We aimed to investigate the prognosis and clinical outcomes of HTx patients who required RRT during the perioperative period. The Korean Organ Transplant Registry (KOTRY) is a nationwide organ trans ...[more]

PMID: 34183719

Similar Datasets

Project description:Background: Renal replacement therapy (RRT) was often needed by some severe burn patients with acute kidney injury (AKI). The primary aim of this study was to review incidence rate and mortality of RRT in severe burn patients. Second aims were to review RRT complications and renal outcome. Methods: We searched multiple databases for studies published between 1 January 1960 and 31 December 2019. Studies about adult populations with burn injury, providing epidemiologic data on prevalence or mortality of RRT, were included. Results: A total of selected 57 studies, including 27,437 patients were enrolled in our analysis. The prevalence rates of RRT were 8.34% (95% CI 7.18-9.5%) in all burn patients and 37.05% (95% CI 29.85-44.24%) in AKI patients. The mortality of all burn patients with RRT was 65.52% (95% CI 58.41-72.64%). The prevalence rates of RRT in sample size≥100 group were 6.86% (95% CI 5.70-8.03%), which was lower than that of <100 group (17.61%, 95% CI 13.39-21.82%). With the increase of TBSA, the prevalence of RRT may have the increasing trend. The prevalence rates of RRT in Asian group was 12.75% (95% CI 9.50-16.00%), which was higher than that of European (10.45%, 95% CI 7.30-13.61%) and North America group (5.61%, 95% CI 4.27-6.95%). The prevalence rates of RRT in 2010-2019 group was 12.22% (95% CI 10.09-14.35%), which was higher than that of 2009-2000 group (5.17%, 95% CI 2.88-7.46%). The prevalence rates of RRT in 1989 and before group was the lowest, which was 1.56% (95% CI 0-3.68%). However, there was no significant correlation between the year of publication and the mortality of burn patients with RRT. Dialysis-requiring AKI in burn patients could increases the risk of chronic kidney disease progression and end-stage renal disease. About 35% of RRT patients need to maintain haemodialysis temporarily, even if they survive and leave hospital. Conclusions: The prevalence rate of RRT is about 6-8%; approximately, one-third of burn patients with AKI need RRT. The prevalence rate of RRT increased over time, but the mortality did not change. The prevalence rates of RRT in Asian group was higher than that of European and North America group.

Project description:BackgroundThe survival of critically ill patients with acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT) is highly dependent on their nutritional status.ObjectivesThe prognostic nutritional index (PNI) is an indicator used to assess nutritional status and is calculated as: PNI = (serum albumin in g/dL) × 10 + (total lymphocyte count in/mm3) × 0.005. In this retrospective study, we investigated the correlation between this index and clinical outcomes in critically ill patients with AKI receiving CRRT.MethodsWe analyzed data from 2076 critically ill patients admitted to the intensive care unit at Changhua Christian Hospital, a tertiary hospital in central Taiwan, between January 1, 2010, and April 30, 2021. All these patients met the inclusion criteria of the study. The relationship between PNI and renal replacement therapy-free survival (RRTFS) and mortality was examined using logistic regression models, Cox proportional hazard models, and propensity score matching. High utilization rate of parenteral nutrition (PN) was observed in our study. Subgroup analysis was performed to explore the interaction effect between PNI and PN on mortality.ResultsPatients with higher PNI levels exhibited a greater likelihood of achieving RRTFS, with an adjusted odds ratio of 2.43 (95% confidence interval [CI]: 1.98-2.97, p-value < 0.001). Additionally, these patients demonstrated higher survival rates, with an adjusted hazard ratio of 0.84 (95% CI: 0.72-0.98) for 28-day mortality and 0.80 (95% CI: 0.69-0.92) for 90-day mortality (all p-values < 0.05), compared to those in the low PNI group. While a high utilization rate of parenteral nutrition (PN) was observed, with 78.86% of CRRT patients receiving PN, subgroup analysis showed that high PNI had an independent protective effect on mortality outcomes in AKI patients receiving CRRT, regardless of their PN status.ConclusionsPNI can serve as an easy, simple, and efficient measure of lymphocytes and albumin levels to predict RRTFS and mortality in AKI patients with require CRRT.

Project description:Fabry disease (FD) is an X-linked lysosomal storage disorder caused by a deficiency in the enzyme α-galactosidase A due to mutations in the GLA gene. This leads to an accumulation of globotriaosylceramide (GL-3) in many tissues, which results in progressive damage to the kidneys, heart, and nervous system. We present the molecular and clinical characteristics and long-term outcomes of FD patients from a multidisciplinary clinic at the University of California, Irvine treated with agalsidase beta enzyme replacement therapy (ERT) for 2-20 years. This cohort comprised 24 adults (11 males, 13 females) and two male children (median age 45; range 10-68 years). Of the 26 patients in this cohort, 20 were on ERT (12 males, 8 females). We describe one novel variant not previously reported in the literature in a patient with features of 'classic' FD. The vast majority of patients in this cohort presented with symptoms of 'classic' FD including peripheral neuropathic pain, some form of cardiac involvement, angiokeratomas, corneal verticillata, hypohidrosis, tinnitus, and gastrointestinal symptoms, primarily abdominal pain. The majority of males had clinically evident renal involvement. An annual eGFR reduction of -1.88 mL/min/1.73 m2/yr during the course of ERT was seen in this cohort. The most common renal presentation was proteinuria, and one individual required a renal transplant. Other common findings were pulmonary involvement, lymphedema, hearing loss, and significantly, three patients had strokes. Notably, there was a high prevalence of endocrine dysfunction and low bone mineral density, including several with osteoporosis. While enzyme replacement therapy (ERT) cleared plasma GL-3 in this cohort, there was limited improvement in renal function or health-related quality of life based on the patient-reported SF-36 Health Survey. Physical functioning significantly declined over the course of ERT treatment, which may be, in part, due to the late initiation of ERT in several patients. Further delineation of the phenotypic and genotypic spectrum in patients with FD and the long-term outcome of ERT will help improve management and treatment options for this disease.

Dataset Information

Impact of preoperative renal replacement therapy on the clinical outcome of heart transplant patients.

Publications

Impact of preoperative renal replacement therapy on the clinical outcome of heart transplant patients.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets