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Acute dialysis risk in living kidney donors.

https://arctichealth.org/en/permalink/ahliterature127475
Source
Nephrol Dial Transplant. 2012 Aug;27(8):3291-5
Publication Type
Article
Date
Aug-2012
Author
Ngan Lam
Anjie Huang
Liane S Feldman
John S Gill
Martin Karpinski
Joseph Kim
Scott W Klarenbach
Greg A Knoll
Krista L Lentine
Chris Y Nguan
Chirag R Parikh
G V Ramesh Prasad
Darin J Treleaven
Ann Young
Amit X Garg
Author Affiliation
Department of Medicine, Division of Nephrology, University of Western Ontario, London, Canada.
Source
Nephrol Dial Transplant. 2012 Aug;27(8):3291-5
Date
Aug-2012
Language
English
Publication Type
Article
Keywords
Acute Kidney Injury - etiology - therapy
Adult
Cohort Studies
Female
Follow-Up Studies
Humans
Kidney Transplantation
Living Donors
Male
Middle Aged
Nephrectomy - adverse effects
Ontario
Renal Dialysis
Risk factors
Tissue and Organ Procurement
Abstract
Reduced kidney function confers a higher risk of acute kidney injury at the time of an inciting event, such as sepsis. Whether the same is true in those with reduced renal mass from living kidney donation is unknown.
We conducted a population-based matched cohort study of all living kidney donors in the province of Ontario, Canada who underwent donor nephrectomy from 1992 to 2009. We manually reviewed the medical records of these living kidney donors and linked this information to provincial health care databases. Non-donors were selected from the healthiest segment of the general population.
There were 2027 donors and 20 270 matched non-donors. The median age was 43 years (interquartile range 34-50) and individuals were followed for a median of 6.6 years (maximum 17.7 years). The primary outcome was acute dialysis during any hospital stay. Reasons for hospitalization included infectious diseases, cardiovascular diseases and hematological malignancies. Only one donor received acute dialysis in follow-up (6.5 events per 100 000 person-years), a rate which was statistically no different than 14 non-donors (9.4 events per 100 000 person-years).
These results are reassuring for the practice of living kidney donation. Longer follow-up of this and other donor cohorts will provide more precise estimates about this risk.
Notes
Cites: Kidney Int. 2006 Nov;70(10):1801-1017003822
Cites: Transplantation. 2006 Dec 27;82(12):1646-817198252
Cites: Crit Care. 2007;11(2):R3117331245
Cites: J Clin Epidemiol. 2008 Apr;61(4):344-918313558
Cites: N Engl J Med. 2009 Jan 29;360(5):459-6919179315
Cites: Stat Med. 2009 Nov 10;28(25):3083-10719757444
Cites: Am J Transplant. 2009 Nov;9(11):2514-919681812
Cites: Am J Kidney Dis. 2010 Sep;56(3):486-9520557989
Cites: N Engl J Med. 2010 Aug 19;363(8):797-820818884
Cites: Am J Kidney Dis. 2011 Jan;57(1):29-4321184918
Cites: Kidney Int. 2011 Jul;80(1):93-10421289597
Comment In: Nephrol Dial Transplant. 2012 Aug;27(8):3021-322619313
PubMed ID
22290988 View in PubMed
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Albuminuria and estimated GFR 5 years after Escherichia coli O157 hemolytic uremic syndrome: an update.

https://arctichealth.org/en/permalink/ahliterature158651
Source
Am J Kidney Dis. 2008 Mar;51(3):435-44
Publication Type
Article
Date
Mar-2008
Author
Amit X Garg
Marina Salvadori
Justin M Okell
Heather R Thiessen-Philbrook
Rita S Suri
Guido Filler
Louise Moist
Douglas Matsell
William F Clark
Author Affiliation
Division of Nephrology, University of Western Ontario, London, Canada. amit.garg@lhsc.on.ca
Source
Am J Kidney Dis. 2008 Mar;51(3):435-44
Date
Mar-2008
Language
English
Publication Type
Article
Keywords
Albuminuria - epidemiology
Child
Child, Preschool
Disease Outbreaks
Escherichia coli O157
Female
Follow-Up Studies
Glomerular Filtration Rate
Hemolytic-Uremic Syndrome - complications - etiology - microbiology
Humans
Infant
Kidney Function Tests
Male
Ontario
Prognosis
Prospective Studies
Water Microbiology
Water supply
Abstract
Knowledge of the long-term prognosis of patients with diarrhea-associated hemolytic uremic syndrome (HUS) is important for patient counseling and follow-up. Estimates in the literature are highly variable, and previous studies did not use a healthy control group to establish outcomes attributable to HUS.
Prospective cohort study.
19 children who recovered from HUS after contamination of their municipal water supply by Escherichia coli O157:H7.
Outcomes of children who recovered from HUS were compared with a control group of 64 children who were healthy at the time of the outbreak. Both groups were similar in their demographics and follow-up testing.
Proteinuria, blood pressure, glomerular filtration rate (GFR) estimated by using serum creatinine or cystatin C level, and biochemical measures 5 years after the outbreak.
More children who recovered from HUS showed microalbuminuria than controls (20% versus 3%; relative risk, 6.0; 95% confidence interval, 1.1 to 32.8). There were no differences between groups in blood pressure or GFR when estimated by using serum creatinine level. GFR estimated by using cystatin C level was lower after HUS compared with controls (100 versus 110 mL/min/1.73 m(2); P = 0.02), but no child had a GFR less than 80 mL/min/1.73 m(2). Other results, including fasting glucose, albumin, and C-reactive protein levels, did not differ between groups.
Although the homogenous nature of this outbreak is a strength, long-term results may generalize less well to patients with other strains of toxigenic E coli or in other settings.
The prognosis of patients with HUS in this cohort was better than in other studies. Ongoing follow-up will clarify the clinical relevance of microalbuminuria and mild decreases in GFR 5 years after HUS recovery.
PubMed ID
18295059 View in PubMed
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An outbreak of acute bacterial gastroenteritis is associated with an increased incidence of irritable bowel syndrome in children.

https://arctichealth.org/en/permalink/ahliterature145256
Source
Am J Gastroenterol. 2010 Apr;105(4):933-9
Publication Type
Article
Date
Apr-2010
Author
Marroon Thabane
Marko Simunovic
Noori Akhtar-Danesh
Amit X Garg
William F Clark
Stephen M Collins
Marina Salvadori
John K Marshall
Author Affiliation
Division of Gastroenterology, Department of Medicine, and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Source
Am J Gastroenterol. 2010 Apr;105(4):933-9
Date
Apr-2010
Language
English
Publication Type
Article
Keywords
Acute Disease
Campylobacter Infections - epidemiology - microbiology
Campylobacter jejuni - isolation & purification
Chi-Square Distribution
Child
Disease Outbreaks
Escherichia coli - isolation & purification
Escherichia coli Infections - epidemiology - microbiology
Female
Gastroenteritis - epidemiology - microbiology
Humans
Incidence
Irritable Bowel Syndrome - epidemiology - microbiology
Logistic Models
Male
Ontario - epidemiology
Questionnaires
Risk factors
Abstract
Acute bacterial gastroenteritis is associated with subsequent post-infectious irritable bowel syndrome (PI-IBS) in adults. Less is known about this relationship in children. In May 2000, contamination of municipal water by Escherichia coli 0157:H7 and Campylobacter species caused a large outbreak of acute gastroenteritis in Walkerton, Ontario. We assessed this association among a cohort of children enrolled in the Walkerton Health Study (WHS).
WHS participants who were under age 16 at the time of the outbreak but who reached age 16 during the 8-year study follow-up were eligible for the pediatric PI-IBS study cohort. Eligibility also required no diagnosis of IBS or inflammatory bowel disease before the outbreak and permanent residency in the Walkerton postal code at the time of the outbreak. Validated criteria were used to classify subjects as having had no gastroenteritis (unexposed controls), self-reported gastroenteritis, or clinically suspected gastroenteritis during the outbreak. From 2002 to 2008, standardized biennial interviews used a modified Bowel Disease Questionnaire to diagnose IBS by Rome I criteria. Risk factors for IBS were identified by logistic regression.
In all, 467 subjects were eligible for the pediatric PI-IBS study cohort (47.1% female; mean age 11.6+/-2.44 years at the time of the outbreak). Of these, 305 were exposed to GE (130 clinically suspected and 175 self-reported) and 162 were unexposed controls. The cumulative incidence of IBS was significantly increased among exposed subjects vs. controls (10.5% vs. 2.5%; odds ratio 4.6, 95% confidence interval (1.6, 13.3)). In an unadjusted risk factor analysis, IBS was associated with a shorter time interval from exposure to assessment of IBS symptoms, female gender, diarrheal illness lasting more than 7 days, weight loss >10 lb, and antibiotic use during the outbreak. In adjusted analyses, both female gender and time interval to assessment of IBS symptoms remained independent predictors of PI-IBS.
Acute bacterial gastroenteritis is associated with subsequent IBS in children as in adults. Risk factors for PI-IBS in children are similar to those identified among adults. Confirmation of these findings in similar cohorts is needed.
PubMed ID
20179687 View in PubMed
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The association between renal replacement therapy modality and long-term outcomes among critically ill adults with acute kidney injury: a retrospective cohort study*.

https://arctichealth.org/en/permalink/ahliterature105976
Source
Crit Care Med. 2014 Apr;42(4):868-77
Publication Type
Article
Date
Apr-2014
Author
Ron Wald
Salimah Z Shariff
Neill K J Adhikari
Sean M Bagshaw
Karen E A Burns
Jan O Friedrich
Amit X Garg
Ziv Harel
Abhijat Kitchlu
Joel G Ray
Author Affiliation
1Division of Nephrology, St. Michael's Hospital and University of Toronto, Toronto, ON, Canada. 2Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. 3Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. 4Department of Critical Care Medicine and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 5Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada. 6Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. 7Departments of Critical Care and Medicine, St. Michael's Hospital, Toronto, ON, Canada. 8Division of Nephrology, London Health Sciences Centre, London, ON, Canada. 9Division of General Internal Medicine, St. Michael's Hospital, Toronto, ON, Canada.
Source
Crit Care Med. 2014 Apr;42(4):868-77
Date
Apr-2014
Language
English
Publication Type
Article
Keywords
Acute Kidney Injury - epidemiology - mortality
Age Factors
Aged
Comorbidity
Critical Illness - epidemiology - mortality
Female
Humans
Male
Middle Aged
Ontario - epidemiology
Outcome Assessment (Health Care)
Patient Acuity
Proportional Hazards Models
Renal Replacement Therapy - statistics & numerical data
Respiration, Artificial - statistics & numerical data
Retrospective Studies
Risk assessment
Sex Factors
Abstract
Among critically ill patients with acute kidney injury, the impact of renal replacement therapy modality on long-term kidney function is unknown. Compared with conventional intermittent hemodialysis, continuous renal replacement therapy may promote kidney recovery by conferring greater hemodynamic stability; yet continuous renal replacement therapy may not enhance patient survival and is resource intense. Our objective was to determine whether continuous renal replacement therapy was associated with a lower risk of chronic dialysis as compared with intermittent hemodialysis, among survivors of acute kidney injury.
Retrospective cohort study.
Linked population-wide administrative databases in Ontario, Canada.
Critically ill adults who initiated dialysis for acute kidney injury between July 1996 and December 2009. In the primary analysis, we considered those who survived to at least 90 days after renal replacement therapy initiation.
Initial receipt of continuous renal replacement therapy versus intermittent hemodialysis.
Continuous renal replacement therapy recipients were matched 1:1 to intermittent hemodialysis recipients based on a history of chronic kidney disease, receipt of mechanical ventilation, and a propensity score for the likelihood of receiving continuous renal replacement therapy. Cox proportional hazards were used to evaluate the relationship between initial renal replacement therapy modality and the primary outcome of chronic dialysis, defined as the need for dialysis for a consecutive period of 90 days. We identified 2,315 continuous renal replacement therapy recipients of whom 2,004 (87%) were successfully matched to 2,004 intermittent hemodialysis recipients. Participants were followed over a median duration of 3 years. The risk of chronic dialysis was significantly lower among patients who initially received continuous renal replacement therapy versus intermittent hemodialysis (hazard ratio, 0.75; 95% CI, 0.65-0.87). This relation was more prominent among those with preexisting chronic kidney disease (p value for interaction term = 0.065) and heart failure (p value for interaction term = 0.035).
Compared with intermittent hemodialysis, initiation of continuous renal replacement therapy in critically ill adults with acute kidney injury is associated with a lower likelihood of chronic dialysis.
Notes
Comment In: Crit Care Med. 2014 Jul;42(7):e540-124933070
Comment In: Crit Care Med. 2014 Apr;42(4):990-124633101
Comment In: Crit Care Med. 2014 Jul;42(7):e54124933071
PubMed ID
24275513 View in PubMed
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Attitudes to sharing personal health information in living kidney donation.

https://arctichealth.org/en/permalink/ahliterature144792
Source
Clin J Am Soc Nephrol. 2010 Apr;5(4):717-22
Publication Type
Article
Date
Apr-2010
Author
Patricia Hizo-Abes
Ann Young
Peter P Reese
Phil McFarlane
Linda Wright
Meaghan Cuerden
Amit X Garg
Author Affiliation
London Kidney Clinical Research Unit, Room ELL-101, Westminster, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario N6A 4G5, Canada.
Source
Clin J Am Soc Nephrol. 2010 Apr;5(4):717-22
Date
Apr-2010
Language
English
Publication Type
Article
Keywords
Access to Information - legislation & jurisprudence
Adult
Aged
Attitude of Health Personnel
Confidentiality - legislation & jurisprudence - psychology
Cross-Sectional Studies
Female
Health Knowledge, Attitudes, Practice
Health Policy
Health Records, Personal
Humans
Informed Consent - legislation & jurisprudence - psychology
Kidney Transplantation - legislation & jurisprudence - psychology
Living Donors - legislation & jurisprudence - psychology
Male
Middle Aged
Ontario
Patient Education as Topic
Practice Guidelines as Topic
Questionnaires
Abstract
In living kidney donation, transplant professionals consider the rights of a living kidney donor and recipient to keep their personal health information confidential and the need to disclose this information to the other for informed consent. In incompatible kidney exchange, personal health information from multiple living donors and recipients may affect decision making and outcomes.
We conducted a survey to understand and compare the preferences of potential donors (n = 43), potential recipients (n = 73), and health professionals (n = 41) toward sharing personal health information (in total 157 individuals).
When considering traditional live-donor transplantation, donors and recipients generally agreed that a recipient's health information should be shared with the donor (86 and 80%, respectively) and that a donor's information should be shared with the recipient (97 and 89%, respectively). When considering incompatible kidney exchange, donors and recipients generally agreed that a recipient's information should be shared with all donors and recipients involved in the transplant (85 and 85%, respectively) and that a donor's information should also be shared with all involved (95 and 90%, respectively). These results were contrary to attitudes expressed by transplant professionals, who frequently disagreed about whether such information should be shared.
Future policies and practice could facilitate greater sharing of personal health information in living kidney donation. This requires a consideration of which information is relevant, how to put it in context, and a plan to obtain consent from all concerned.
Notes
Cites: Am J Transplant. 2003 Jul;3(7):830-412814474
Cites: Am J Transplant. 2009 Jul;9(7):1558-7319459792
Cites: Transplantation. 2004 Aug 27;78(4):491-215446304
Cites: Lancet. 1992 Oct 3;340(8823):807-101357243
Cites: Can J Surg. 2004 Dec;47(6):408-1315646438
Cites: Transplantation. 2005 Mar 27;79(6 Suppl):S53-6615785361
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Cites: Ann Intern Med. 2006 Aug 1;145(3):185-9616880460
Cites: J Pers Assess. 2006 Dec;87(3):305-1617134338
Cites: Clin J Am Soc Nephrol. 2006 Nov;1(6):1148-5317699340
Cites: Am J Transplant. 2008 Sep;8(9):1878-9018671676
Cites: Nephrol Dial Transplant. 2008 Oct;23(10):3316-2418599559
Cites: N Engl J Med. 2009 Mar 12;360(11):1096-10119279341
Cites: J Med Ethics. 2009 Apr;35(4):270-119332587
Cites: Kidney Int. 2009 May;75(10):1088-9819225540
Cites: Am J Transplant. 2004 Oct;4(10):1553-415367208
PubMed ID
20299371 View in PubMed
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Beta-blockers and cardiovascular outcomes in dialysis patients: a cohort study in Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature131822
Source
Nephrol Dial Transplant. 2012 Apr;27(4):1591-8
Publication Type
Article
Date
Apr-2012
Author
Abhijat Kitchlu
Kristin Clemens
Tara Gomes
Daniel G Hackam
David N Juurlink
Muhammad Mamdani
Michael Manno
Matthew J Oliver
Robert R Quinn
Rita S Suri
Ron Wald
Andrew T Yan
Amit X Garg
Author Affiliation
Department of Medicine, University of Western Ontario, London, Ontario, Canada.
Source
Nephrol Dial Transplant. 2012 Apr;27(4):1591-8
Date
Apr-2012
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Aged
Aged, 80 and over
Calcium Channel Blockers - therapeutic use
Cardiovascular Diseases - etiology - prevention & control
Female
Follow-Up Studies
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Kidney Failure, Chronic - complications
Male
Ontario
Prognosis
Renal Dialysis - adverse effects
Retrospective Studies
Abstract
Beta-blockers may be cardioprotective in patients receiving chronic dialysis. We examined cardiovascular outcomes among incident dialysis patients receiving beta-blocker therapy.
We conducted a retrospective cohort study employing linked healthcare databases in Ontario, Canada. We studied all consecutive chronic dialysis patients aged=66 years who initiated dialysis between 1 July 1991 and 31 July 2007. Patients were divided into three groups according to new medication use after the initiation of chronic dialysis. The three groups were patients initiated on beta-blockers, calcium channel blockers and statins only. Patients in the beta-blocker and calcium channel blocker groups could also be concurrently receiving a statin. The primary outcome was time to a composite endpoint of death, myocardial infarction, stroke or coronary revascularization.
There were a total of 1836 patients (504 beta-blocker, 570 calcium channel blocker and 762 statin-only users). Compared to statin-only use, beta-blocker use was not associated with improved cardiovascular outcomes [adjusted hazard ratio (aHR) 1.07, 95% confidence interval (CI) 0.92-1.23]. As expected, calcium channel blocker use was also not associated with improved cardiovascular outcomes (aHR 0.91, 95% CI 0.79-1.06). Among all subgroup analyses by beta-blocker attributes, only high-dose beta-blocker therapy was associated with better cardiovascular outcomes as compared to low-dose beta-blockers (aHR 0.50, 95% CI 0.29-0.88).
We observed no beneficial effect of beta-blocker use among patients receiving chronic dialysis relative to our comparator groups. Given current uncertainty around the cardioprotective benefits of beta-blockers in patients receiving dialysis, a large randomized clinical trial is warranted.
PubMed ID
21873621 View in PubMed
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Cardiovascular disease after Escherichia coli O157:H7 gastroenteritis.

https://arctichealth.org/en/permalink/ahliterature118823
Source
CMAJ. 2013 Jan 8;185(1):E70-7
Publication Type
Article
Date
Jan-8-2013
Author
Patricia Hizo-Abes
William F Clark
Jessica M Sontrop
Ann Young
Anjie Huang
Heather Thiessen-Philbrook
Peter C Austin
Amit X Garg
Author Affiliation
Division of Nephrology, Department of Medicine, Western University, London, Ont., Canada.
Source
CMAJ. 2013 Jan 8;185(1):E70-7
Date
Jan-8-2013
Language
English
Publication Type
Article
Keywords
Cardiovascular Diseases - etiology - microbiology
Chi-Square Distribution
Disease Outbreaks
Escherichia coli Infections - complications - epidemiology - microbiology
Escherichia coli O157
Female
Gastroenteritis - complications - epidemiology - microbiology
Heart Failure - etiology - microbiology
Humans
Male
Middle Aged
Myocardial Infarction - etiology - microbiology
Ontario - epidemiology
Risk factors
Statistics, nonparametric
Stroke - etiology - microbiology
Abstract
Escherichia coli O157:H7 is one cause of acute bacterial gastroenteritis, which can be devastating in outbreak situations. We studied the risk of cardiovascular disease following such an outbreak in Walkerton, Ontario, in May 2000.
In this community-based cohort study, we linked data from the Walkerton Health Study (2002-2008) to Ontario's large healthcare databases. We included 4 groups of adults: 3 groups of Walkerton participants (153 with severe gastroenteritis, 414 with mild gastroenteritis, 331 with no gastroenteritis) and a group of 11 263 residents from the surrounding communities that were unaffected by the outbreak. The primary outcome was a composite of death or first major cardiovascular event (admission to hospital for acute myocardial infarction, stroke or congestive heart failure, or evidence of associated procedures). The secondary outcome was first major cardiovascular event censored for death. Adults were followed for an average of 7.4 years.
During the study period, 1174 adults (9.7%) died or experienced a major cardiovascular event. Compared with residents of the surrounding communities, the risk of death or cardiovascular event was not elevated among Walkerton participants with severe or mild gastroenteritis (hazard ratio [HR] for severe gastroenteritis 0.74, 95% confidence interval [CI] 0.38-1.43, mild gastroenteritis HR 0.64, 95% CI 0.42-0.98). Compared with Walkerton participants who had no gastroenteritis, risk of death or cardiovascular event was not elevated among participants with severe or mild gastroenteritis.
There was no increase in the risk of cardiovascular disease in the decade following acute infection during a major E. coli O157:H7 outbreak.
Notes
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PubMed ID
23166291 View in PubMed
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Cardiovascular disease and hypertension risk in living kidney donors: an analysis of health administrative data in Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature155698
Source
Transplantation. 2008 Aug 15;86(3):399-406
Publication Type
Article
Date
Aug-15-2008
Author
Amit X Garg
G V Ramesh Prasad
Heather R Thiessen-Philbrook
Li Ping
Magda Melo
Eric M Gibney
Greg Knoll
Martin Karpinski
Chirag R Parikh
John Gill
Leroy Storsley
Meghan Vlasschaert
Muhammad Mamdani
Author Affiliation
1Division of Nephrology, University of Western Ontario, London, Canada. amit.garg@lhsc.on.ca
Source
Transplantation. 2008 Aug 15;86(3):399-406
Date
Aug-15-2008
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cardiovascular Diseases - epidemiology - etiology
Female
Humans
Hypertension - epidemiology - etiology
Kidney Transplantation
Living Donors
Male
Medical Records Systems, Computerized
Middle Aged
Nephrectomy - adverse effects - mortality
Ontario - epidemiology
Retrospective Studies
Risk assessment
Risk factors
Time Factors
Abstract
Knowledge of any harm associated with living kidney donation guides informed consent and living donor follow-up. Risk estimates in the literature are variable, and most studies did not use a healthy control group to assess outcomes attributable to donation.
We observed a retrospective cohort using health administrative data for donations which occurred in Ontario, Canada between the years 1993 and 2005. There were a total of 1278 living donors and 6359 healthy adults who acted as a control group. Individuals were followed for a mean of 6.2 years (range, 1-13 years) after donation. The primary outcome was a composite of time to death or first cardiovascular event (myocardial infarction, stroke, angioplasty, and bypass surgery). The secondary outcome was time to a diagnosis of hypertension.
There was no significant difference in death or cardiovascular events between donors and controls (1.3% vs. 1.7%; hazard ratio 0.7, 95% confidence interval 0.4-1.2). Donors were more frequently diagnosed with hypertension than controls (16.3% vs. 11.9%, hazard ratio 1.4, 95% confidence interval 1.2-1.7) but were also seen more often by their primary care physicians (median [interquartile range] 3.6 [1.9-6.1] vs. 2.6 [1.4-4.3] visits per person year, P
Notes
Comment In: Nat Clin Pract Nephrol. 2009 Mar;5(3):126-719153566
PubMed ID
18698242 View in PubMed
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Cardiovascular disease in kidney donors: matched cohort study.

https://arctichealth.org/en/permalink/ahliterature126545
Source
BMJ. 2012;344:e1203
Publication Type
Article
Date
2012
Author
Amit X Garg
Aizhan Meirambayeva
Anjie Huang
Joseph Kim
G V Ramesh Prasad
Greg Knoll
Neil Boudville
Charmaine Lok
Philip McFarlane
Martin Karpinski
Leroy Storsley
Scott Klarenbach
Ngan Lam
Sonia M Thomas
Christine Dipchand
Peter Reese
Mona Doshi
Eric Gibney
Ken Taub
Ann Young
Author Affiliation
Division of Nephrology, Department of Medicine, University of Western Ontario, London, ON, Canada. amit.garg@lhsc.on.ca
Source
BMJ. 2012;344:e1203
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
Cardiovascular Diseases - epidemiology
Child
Cohort Studies
Comorbidity
Female
Humans
Kidney Transplantation - statistics & numerical data
Living Donors - statistics & numerical data
Male
Middle Aged
Ontario - epidemiology
Outcome Assessment (Health Care) - statistics & numerical data
Retrospective Studies
Risk factors
Abstract
To determine whether people who donate a kidney have an increased risk of cardiovascular disease.
Retrospective population based matched cohort study.
All people who were carefully selected to become a living kidney donor in the province of Ontario, Canada, between 1992 and 2009. The information in donor charts was manually reviewed and linked to provincial healthcare databases. Matched non-donors were selected from the healthiest segment of the general population. A total of 2028 donors and 20,280 matched non-donors were followed for a median of 6.5 years (maximum 17.7 years). Median age was 43 at the time of donation (interquartile range 34-50) and 50 at the time of follow-up (42-58).
The primary outcome was a composite of time to death or first major cardiovascular event. The secondary outcome was time to first major cardiovascular event censored for death.
The risk of the primary outcome of death and major cardiovascular events was lower in donors than in non-donors (2.8 v 4.1 events per 1000 person years; hazard ratio 0.66, 95% confidence interval 0.48 to 0.90). The risk of major cardiovascular events censored for death was no different in donors than in non-donors (1.7 v 2.0 events per 1000 person years; 0.85, 0.57 to 1.27). Results were similar in all sensitivity analyses. Older age and lower income were associated with a higher risk of death and major cardiovascular events in both donors and non-donors when each group was analysed separately.
The risk of major cardiovascular events in donors is no higher in the first decade after kidney donation compared with a similarly healthy segment of the general population. While we will continue to follow people in this study, these interim results add to the evidence base supporting the safety of the practice among carefully selected donors.
Notes
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PubMed ID
22381674 View in PubMed
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Choosing peritoneal dialysis reduces the risk of invasive access interventions.

https://arctichealth.org/en/permalink/ahliterature133547
Source
Nephrol Dial Transplant. 2012 Feb;27(2):810-6
Publication Type
Article
Date
Feb-2012
Author
Matthew J Oliver
Mauro Verrelli
James M Zacharias
Peter G Blake
Amit X Garg
John F Johnson
Sanjay Pandeya
Jeffery Perl
Alex J Kiss
Robert R Quinn
Author Affiliation
Division of Nephrology, Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, Canada. matthew.oliver@sunnybrook.ca
Source
Nephrol Dial Transplant. 2012 Feb;27(2):810-6
Date
Feb-2012
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Catheterization - adverse effects - methods
Catheters, Indwelling - adverse effects
Cohort Studies
Female
Health Knowledge, Attitudes, Practice
Humans
Incidence
Kidney Failure, Chronic - diagnosis - therapy
Male
Ontario
Patient Preference - statistics & numerical data
Patient satisfaction
Peritoneal Dialysis - adverse effects - methods - statistics & numerical data
Prospective Studies
Renal Dialysis - adverse effects - methods - statistics & numerical data
Risk assessment
Sex Factors
Treatment Outcome
Abstract
Patients choosing between hemodialysis (HD) and peritoneal dialysis (PD) should be well informed of the risks and benefits of each modality. Invasive access interventions are important outcomes because frequent interventions lower patient's quality of life and consume limited resources. The objective of this study was to compare the risk of access interventions between the two modalities.
Three hundred and sixty-nine incident chronic dialysis patients were prospectively enrolled at four Canadian centers that were eligible for both modalities, received at least 4 months of pre-dialysis care and started dialysis electively as an outpatient. Two hundred and twenty-four (61%) chose PD and 145 (39%) chose HD. Patients were followed for an average of 1.3 years (range 0.07-3.6 years).
In the PD group, there were fewer access interventions (2.5 versus 3.1 interventions per patient, adjusted odds ratio of 0.79 for PD versus HD, P = 0.005) and a lower intervention rate (2.3 versus 1.9 per patient-year, adjusted rate ratio of 0.81 for PD versus HD, P = 0.04). PD catheters were less likely to experience primary failure (4.6 versus 32%, P
PubMed ID
21693682 View in PubMed
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