The North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) is a research effort that was organized and initiated in 1987. The following manuscript is the 1994 NAPRTCS annual report which has summarized data that has been voluntarily contributed by 83 centers. The report includes data on 3,183 patients who have undergone a total of 3,445 renal transplants between 1 January 1987 and 18 February 1994 when the data set was closed. The report also contains data on 1,611 independent courses of dialysis which were initiated between 1 January 1992 and 18 February 1994. This report is meant to update the previous NAPRTCS annual reports as well as demonstrate how the NAPRTCS database has changed clinical practice since its inception. There have been 855 graft failures among the 3,438 transplants. Due to the maturing of the database, chronic rejection now accounts for 34% of graft failures which have occurred over the last year. Graft failure was increased in recipients if the recipients were 6 years did not have catch-up growth post transplant. Overall graft survival has improved markedly since the inception of this study. The dialysis database is just maturing and the data confirm that growth on dialysis continues to be very poor. The 1994 annual report of NAPRTCS extends previous findings of this valuable database. It is gratifying to know that early findings of NAPRTCS have led to changes in therapy which have led to improvement in the care of these very special children.
Peripheral arterial disease and vascular calcifications contribute significantly to the outcome of dialysis patients. The aim of this study was to evaluate the prognostic role of severity of abdominal aortic calcifications and peripheral arterial disease on outcome of peritoneal dialysis (PD) patients using methods easily available in everyday clinical practice.
We enrolled 249 PD patients (mean age 61 years, 67% male) in this prospective, observational, multicenter study from 2009 to 2013. The abdominal aortic calcification score (AACS) was assessed using lateral lumbar X ray, and the ankle-brachial index (ABI) using a Doppler device.
The median AACS was 11 (range 0 - 24). In 58% of the patients, all 4 segments of the abdominal aorta showed deposits, while 19% of patients had no visible deposits (AACS 0). Ankle-brachial index was normal in 49%, low ( 1.3) in 34% of patients. Altogether 91 patients (37%) died during the median follow-up of 46 months. Only 2 patients (5%) with AACS 0 died compared with 50% of the patients with AACS = 7 (p
Most dialysis patients are on 5 - 10 medications. The costs of these medications vary widely, ranging from pennies per day for water soluble multivitamins, to several thousand dollars per year for erythropoietin-stimulating agents. In Canada, public funding for drug therapies is undertaken by each province, with wide variability in coverage and on restriction criteria for expensive new drugs. For native Canadians and Inuit, access to drugs is superior to that of other Canadians through a federal program. The Canadian system for drug evaluation, where strict evidence-based medicine (EBM) and comparative effectiveness research (CER) is applied, is instructive and may provide clues to the future from an international perspective. Given the unique challenges in nephrology, it is predicted that access to new drugs and other therapies will be restricted by these evaluation methods. Indeed, it seems desirable for nephrology organizations to respond to this new threat in a pragmatic and balanced way. Part of that response might be a call for exceptional status for dialysis, with adjusted criteria of EBM and CER that would be more suitable, and stimulate innovation and research in nephrology.
Secondary hyperparathyroidism (SHPT) is a common problem among patients with chronic kidney disease (CKD) on haemodialysis. This study was conducted to assess the use, effectiveness and safety of intravenous paricalcitol in haemodialysis patients with various degrees of SHPT.
This observational, multicentre, prospective study was conducted in 14 Swedish dialysis centres from May 2007 to June 2008 and included 92 haemodialysis patients with a diagnosis of SHPT associated with CKD. The decision to initiate treatment with intravenous paricalcitol was made by the treating physician. No treatment algorithms were provided.
Mean patient age was 64 years. Of the 92 patients included, 74 had an intact parathyroid hormone (iPTH) level of >300 pg/ml at baseline. Median iPTH was 584 pg/ml in patients with a baseline PTH of >300 pg/ml. During follow-up there was a decrease in iPTH to 323 pg/ml at 6 months (-45%, p
Prevention in nephrology is only possible with the cooperation of patients and their families. The nurse plays a considerable role in working with patients and is a major player in the team, responsible for follow-up of the patient, where the earliest interventions can help delay and sometimes avoid dialysis. The hypertension clinic is the beginning of a continuum until dialysis. This paper describes three clinics that are managed in the renal service and indicates how they contribute to offering optimal care to a renal population.
We studied 275 renal replacement therapy (RRT) patients in a Danish county (population 329,000) from January 1st 1979 to June 30th 1994. Incidence, prevalence and age of new patients increased. The fraction of patients with diabetic nephropathy also increased. Patient survival remained constant (five-year survival 62% for patients observed for more than 90 days). The total number of new patients entering haemodialysis and peritoneal dialysis seemed to be reaching a constant level, that could be calculated using a logistic function. The fraction of patients leaving therapy remained constant over the years and was higher for peritoneal dialysis than for haemodialysis (32 vs. 20% per year). The future prevalence can be estimated by combining these two last findings.