In 1995, Ratner, Kavoussi, and colleagues at Johns Hopkins University revolutionized live kidney donor transplantation through the development of the laparoscopic donor nephrectomy (1). Since then, the number of live donor transplants in the United States doubled, the number of live donors who are not biologically related to the recipient rose by more than fivefold, and the proportion of donor nephrectomies performed laparoscopically (or laparoscopically assisted) neared 100 percent. Today, approximately one-third of donor nephrectomies are performed using pure laparoscopic techniques, and approximately two-thirds are performed with the additional insertion of one of the surgeon’s hands into the
Transplantation from a living kidney donor provides the best outcomes in recipients with end stage renal disease. However, our knowledge regarding the effects of kidney donation on long-term mental and physical health of the living donor remains incomplete. Published data are largely derived from single-center retrospective studies in young, healthy, and mostly white populations (1), whereas donors in today’s environment are increasingly older, larger, racially diverse, and medically complex (2).
We also suffer from a paucity of information on the psychological and socioeconomic consequences of donation, including the long-term health-related quality of life, financial consequences of
As donor nephrectomy is entirely performed for the beneficence of the recipient, minimizing surgical morbidity and preserving long-term mortality is a priority. Currently, laparoscopic nephrectomy is associated with less pain, shorter hospital stay and faster return to work, and a calculated mortality rate of 3.1 per 10,000 donors, controlled for age, race, and sex (1,2).
Does kidney donation, with its associated loss of glomerular mass, impart a risk profile similar to that of patients with chronic kidney disease (CKD)? Many studies have demonstrated no significant increase in mortality among donors in comparison to variably matched controls
The expansion of kidney transplantation from living donors over the last several decades has included greater racial and ethnic diversification of the donor population. In the United States, the fraction of non-white living kidney donors rose from 24 percent in 1988 to 30 percent in 2011, representing more than 1700 donors. Currently, 12 percent of living kidney donors in the United States are African American and 13 percent are Hispanic. Because most countries, including the United States, do not currently maintain national registries that effectively track long-term donor outcomes, much of the information on postdonation health has been drawn from
The use of living donors for kidney transplantation in the United States has become increasingly common, with recipients of a living donor kidney demonstrating better outcomes and shorter waiting times. Substantial differences exist between transplant centers in their choice of protocols and exclusion criteria for potential living donors. Nevertheless, certain trends in living donation practices over the past 20 years, reflecting a relaxation of some acceptance criteria and a tightening of others, have become apparent from surveys of transplant programs (1) and analysis of registry data collected by the United Network for Organ Sharing (UNOS) (2).
The World Health Organization defines anemia in adults and children older than 15 years as a hemoglobin concentration (Hb) <13.0 g/dL in male individuals and <12.0 g/dL in female individuals. In children aged 1.5 to 5 years anemia is defined as Hb <11 g/dL, in those 5 to 12 years as <11.5 g/dL, and in those 12 to 15 years as <12 g/dL (1).
The Hb falls as GFR falls, but the relationship is nonlinear. In hemodialysis patients, Hb often falls below 8 g/dL if anemia is untreated, whereas in nondialysis patients with chronic kidney disease (CKD) patients,
During the 1980s and 1990s, the focus of dealing with disorders of bone and mineral metabolism was predominantly “bone centric,” with parathyroid hormone (PTH) the main culprit and calcium the primary regulator of PTH. The term “renal osteodystrophy” was generally used to encompass these disorders. The focus of therapy was to maintain relatively high serum calcium concentrations in order to suppress PTH, which would presumably result in normal bone. This strategy did result in decreased PTH concentrations with the use of relatively high dialysate calcium baths, calcium-based phosphate binders and calcitriol; however, this practice resulted in hypercalcemia. As a result,
When Kidney Disease: Improving Global Outcomes (KDIGO) was first announced in 2004, I was confused. We had Kidney Disease Outcomes Quality Initiative (KDOQI), which seemed reasonably successful and had been well integrated into nephrology. I had learned and was teaching the KDOQI chronic kidney disease (CKD) stages. Researchers were using the CKD stages to define populations and create prognostic models. Dialysis providers were adopting the renal osteodystrophy guidelines as treatment targets and directing their nurses, dietitians, and social workers to empower patients to achieve these goals. Additional guidelines seemed superfluous. When I looked into KDIGO, however, I saw something very
Kidney disease is truly a global epidemic and the Philippines is no exception, with tens of thousands of Filipinos diagnosed and likely even more left unrecognized. The availability of guidelines to assist in the proper management of these patients is truly invaluable and, in the appropriate situation, allows for the further improvement of patient care as well as the amelioration of certain deficiencies in health care delivery. It brings us one step closer to bridging the gap between one’s own personal practice and the implementation of true evidence-based medicine.
The objective of this commentary is not to criticize individual KDIGO
The KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients was the third Kidney Disease: Improving Global Outcomes (KDIGO) guideline, published in November 2009 as a supplement to the American Journal of Transplantation. This guideline addressed a broader set of issues than did the previous two guidelines (for hepatitis C and bone and mineral disease). The guideline was written for clinicians (doctors, nurses, coordinators, and pharmacists) providing care to patients who have received a transplant. It was also aimed at a diverse audience, including those in both the developed and the developing worlds. To