Cerebrovascular Disease Hospitalization Rates in End-Stage Kidney Disease Patients with Kidney Transplant and Peripheral Vascular Disease: Analysis Using the National Inpatient Sample (2005–2019) (original) (raw)
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PLOS ONE, 2017
Patients with kidney disease (KD) are at increased risk for cerebrovascular disease (CVD) and CVD patients with KD have worse outcomes. We aimed to determine the representation of KD patients in major randomized controlled trials (RCTs) of CVD interventions. We searched MEDLINE for reports of major CVD trials published through February 9, 2017. We excluded trials that did not report mortality outcomes, enrolled fewer than 100 participants, or were subgroup, follow-up, or post-hoc analyses. Two independent reviewers performed study selection and data extraction. We included 135 RCTs randomizing 194,977 participants. KD patients were excluded in 48 (35.6%) trials, but were less likely to be excluded from trials of class I/II recommended interventions (n = 7; 15.9%; p = 0.001) and more likely to be excluded in trials with registered protocols (45.5% vs. 22.4%; p = 0.007). Exclusion was lower in trials supported by academic or governmental grants compared to industry or combined funding (21.2% vs. 42.0% and 47.8%; p = 0.033 and 0.028, respectively). Among trials excluding KD patients, 24 (50.0%) used serum creatinine, 7 (14.6%) used estimated glomerular filtration rate or creatinine clearance, 7 (14.6%) used renal replacement therapy, and 19 (39.6%) used non-specific kidney-related criteria. Only 4 (3.0%) trials reported baseline renal function. No trials prespecified or reported subgroup analyses by baseline renal function. Although 19 (14.1%) trials reported the incidence of acute kidney injury, no trial examined adverse event rates according to renal function. In summary, more than one third of major CVD trials excluded patients with KD, primarily based on serum creatinine or nonspecific criteria, and outcomes were not stratified by renal parameters. Therefore, purposeful efforts to increase inclusion of KD patients in CVD trials and evaluate the impact of renal function on efficacy and safety are needed to improve the quality of evidence for interventions in this vulnerable population.
Transplantation Proceedings, 2016
Background. Reports from the United States Renal Data System (USRDS) indicated that kidney transplantation, whether from a living donor (LD) or deceased donor (DD), offers survival advantage over being on the waiting list. Whether this is true for patients with peripheral arterial disease (PAD) is unknown given that patients with PAD have significant comorbidities. Methods. We used a cohort of USRDS incident dialysis patients from 2001 to 2007, with follow-up through 2008. Patients with PAD younger than the age of 70 were included and divided into 3 groups; PAD waitlisted, PAD patients who received a first transplant from a DD, or PAD patients who received a first transplant from a LD. Time-dependent Cox regression models were used to compare differences in mortality. Results. In this study, 23,699 incident dialysis patients met inclusion criteria; only 16.7% (n ¼ 3964) were waitlisted, of which 8.9 % (n ¼ 2121) underwent transplantation. Patient survival in the LD group at any time point was significantly better than being on the waiting list (P < .001). For DD, mortality was higher in the first year compared with waitlisted patients (P < .001), however, after 1 year survival did not differ as compared with remaining on the waiting list. After adjusting for confounders, the relative risk (RR) of dying was significantly higher for patients with history of severe vascular disease requiring amputation (RR, 1.45; 95% confidence interval [CI], 1.15e1.84) in the DD group. Conclusions. Kidney transplantation from a DD did not offer survival advantage over being on the waiting list, in part due to a higher rate of severe vascular disease. Careful patient selection may improve outcomes in the DD group. The views expressed in this article are those of the authors and do not reflect the official policy of the Department of Army, the Department of Defense, or the United States government. The data reported here have been supplied by the United States Renal Data System. The interpretation and reporting of these data are the responsibility of the authors(s) and in no way should be seen as an official policy or interpretation of the U.S. government.
Risk factors and outcome of Stroke in renal transplant recipients
Clinical transplantation, 2016
Stroke incidence is high in end-stage renal disease and risk factors differ between the dialysis and general populations. However, risk factors and outcomes following renal transplantation remain unclear. We analysed all adult patients with a functioning renal transplant from 01/01/2007 to 31/12/2012. Data were extracted from the electronic patient record. Variables associated with stroke were identified by survival analyses; demographic, clinical, imaging and laboratory variables were assessed and case-fatality determined. Follow-up was until 05/12/2013. 956 patients were identified (median age 40.1 years, 59.9% male). Atrial fibrillation prevalence was 9.2% and 38.2% received a transplant during follow-up. 26 (2.7%) experienced a stroke during 4409 patient-years of follow-up (84.6% ischemic). Stroke incidence was 5.96/1000 patient-years. Factors associated with stroke on regression analysis were prior stroke, diabetes, age, systolic hypertension and hemoglobin. Atrial fibrillation...
Amer J Kidney Dis, 2004
Background: Pulmonary embolism (PE) is the most common preventable cause of death in hospitalized patients. Patients with severe chronic kidney disease (CKD) may be at increased risk for PE in comparison to the general population. Whether severe CKD is associated with increased risk for late venous thromboembolism (VTE) in a population of renal transplant recipients has not been determined. Methods: Using the US Renal Data System database, we studied 28,924 patients receiving a kidney transplant from January 1, 1996, to July 31, 2000, with Medicare as primary payer, followed up until December 31, 2000. Cox proportional hazards regression models were used to calculate the association of transplant recipient estimated glomerular filtration rate (eGFR; by the Modification of Diet in Renal Disease formula) less than 30 mL/min/1.73 m 2 (versus >30 mL/min/1.73 m 2) 1 year after renal transplantation with Medicare claims for VTE (either deep-venous thrombosis or PE/infarction) 1.5 to 3 years after renal transplantation. Results: The rate of VTE occurring 1.5 to 3 years after transplantation was 2.9 episodes/1,000 person-years. eGFR less than 30 mL/min/1.73 m 2 versus higher at the end of the first year after renal transplantation was associated with significantly increased risk for later VTE (adjusted hazard ratio, 2.05; 95% confidence interval, 1.08 to 3.89). Conclusion: Patients with severe CKD after renal transplantation should be regarded as high risk for late VTE, which is a potentially preventable cause of death in this population. Am J Kidney Dis 43:120-130. This is a US government work. There are no restrictions on its use.
Waiting List and Kidney Transplant Vascular Risk: An Ongoing Unmet Concern
Kidney and Blood Pressure Research
Background: Chronic kidney disease (CKD) is an important independent risk factor for adverse cardiovascular events in patients waitlisted for kidney transplantation (KT). Although KT reduces cardiovascular risk, these patients still have a higher all-cause and cardiovascular mortality than the general population. This concerning situation is due to a high burden of traditional and nontraditional risk factors as well as uremia-related factors and transplant-specific factors, leading to 2 differentiated processes under the framework of CKD, atherosclerosis and arteriosclerosis. These can be initiated by insults to the vascular endothelial endothelium, leading to vascular calcification (VC) of the tunica media or the tunica intima, which may coexist. Several pathogenic mechanisms such as inflammation-related endothelial dysfunction, mineral metabolism disorders, activation of the renin-angiotensin system, reduction of nitric oxide, lipid disorders, and the fibroblast growth factor 23-k...
QJM, 2014
Background: Patients with atherosclerotic cardiocerebrovascular disease are at high risk of kidney dysfunction because of the overlap of several risk factors. The purpose of this study is to examine the prevalence and characteristics and risk factors for kidney dysfunction in the cardio-cerebrovascular disease population. Methods: Renal functions of 1012 patients with the cardio-cerebrovascular disease were evaluated with the purpose of evaluating characteristics of the incidence, risk factors for kidney dysfunction in the cardio-cerebrovascular disease population. Results: In the univariate analysis, the major risk factors for kidney dysfunction in the patients with the cardio-cerebrovascular disease were age, gender, hypertension, diabetes mellitus, dyslipidemia and serum uric acid. In the patients with both hypertension and diabetes mellitus the percentages of significantly decreased eGFR were 25.6%. Results of multivariable analysis showed that diabetes mellitus (odds ratio (OR) 1.609, 95% confidence intervals (CI) 1.08-2.398, P = 0.019), hypertension (OR 1.547, 95% CI 1.049-2.281, P = 0.028) and serum uric acid (OR 1.009, 95% CI 1.007-1.010, P < 0.001) were independent risk factors for reduced kidney function. Conclusions: In the context of the cardio-cerebrovascular disease kidney dysfunction is common and has a high prevalence. Patients with both cardio-cerebrovascular disease and kidney dysfunction at any stage should be recognized as high-risk population.
Life, 2021
Background: Patients with chronic kidney disease (CKD) have markedly increased rates of end stage renal disease, major adverse cardiovascular/cerebrovascular events (MACCEs), and mortality. Endothelial dysfunction (ED) is an early marker of atherosclerosis that is emerging as an increasingly important non-traditional cardiovascular risk factor in CKD. There is a lack of clinical studies examining the association between ED and both cardiovascular and renal endpoints in patients with CKD. Aims: We examined the association between reactive hyperemia index (RHI), a validated measure of endothelial function measured by peripheral arterial tonometry (PAT), with traditional cardiovascular risk factors in pre-dialysis CKD patients and prospectively evaluated the role of RHI as predictor of renal and cardiovascular outcomes in this population. Methods: One hundred and twenty pre-dialysis patients with CKD stages 1 to 5 (CKD group) and 18 healthy kidney donor candidates (control group) were ...