BACKGROUND Kidney transplantation(KT)and end-stage renal disease(ESRD)requiring hemodialysis(HD)increase the incidence of morbidity and mortality associated with coronavirus disease 2019(COVID-19)infection.The COVID-1...BACKGROUND Kidney transplantation(KT)and end-stage renal disease(ESRD)requiring hemodialysis(HD)increase the incidence of morbidity and mortality associated with coronavirus disease 2019(COVID-19)infection.The COVID-19 pandemic has had a negative effect on the psychological well-being of COVID-19 patients,especially those with a high-risk of infectious complications.The prevalence of anxiety and depression is known to be higher in ESRD patients undergoing HD than in the general population.On the other hand,KT recipients have different treatment requirements compared to HD patients,including adherence to complex immunosuppressive regimens and compliance with follow-up appointments.We hypothesized that psychosocial difficulties and stressors would differ between ESRD patients undergoing HD and KT recipients during the COVID-19 pandemic.If so,each group may require different interventions to maintain their psychosocial well-being.AIM To measure and compare the levels of stress,anxiety,depression,concerns related to the pandemic,and coping skills in ESRD patients undergoing HD and KT recipients during the COVID-19 pandemic.METHODS This cross-sectional study was performed at a training and research hospital.The study included ESRD patients undergoing HD(HD group)and KT recipients(with stable graft function for≥6 mo prior to the study)(KT group).Patients completed a demographics form,the impact of events scale,the hospital anxiety and depression scale,and the Connor-Davidson resilience scale.Laboratory findings at the last clinical follow-up were recorded.Theχ^(2)test was used to assess the relationship between the HD and KT groups and the categorical variables.The relationships between the scale scores were analyzed using Pearson’s correlation test,and differences between the groups were analyzed using the independent groups t-test.RESULTS The study included 125 patients,of which 89(71.2%)were in the HD group and 36(28.8%)were in the KT group.The levels of anxiety and depression were higher in the HD group than in the KT group[9.36±4.38 vs 6.89±4.06(P=0.004)and 8.78±4.05 vs 6.42±4.26(P=0.004),respectively],whereas the post-traumatic stress score was higher in the KT group[46.75±13.98 vs 37.66±18.50(P=0.009)].The concern with the highest intensity in the HD group was transmission of COVID-19 to family and friends(93.3%)and in the KT group was loss of caregiver and social support(77.8%).Concerns regarding financial hardship,stigmatization,loneliness,limited access to health care services,failure to find medical supplies,and transmission of COVID-19 to family and friends were more prevalent in the HD group.Connor-Davidson resilience scale tenacity and personal competence,tolerance,and negative affect scores were higher in the KT group than in the HD group[43.47±11.39 vs 33.72±12.58,15.58±4.95 vs 11.45±5.05,and 68.75±17.39 vs 55.39±18.65(P<0.001),respectively].Biochemical parameters,such as creatine,urea,phosphorus,parathyroid hormone,and calcium,were lower,and the albumin and hemoglobin values were higher in the KT group than in the HD group(P<0.001).CONCLUSION Psychosocial difficulties and the level of stress differ in ESRD patients undergoing HD and KT recipients;therefore,psychosocial interventions should be tailored for each patient group.展开更多
BACKGROUND Vitamin D deficiency occurs in more than 80%of kidney transplant recipients.Its immunomodulatory effects can predispose transplant recipients to rejection and chronic allograft nephropathy(CAN).This study d...BACKGROUND Vitamin D deficiency occurs in more than 80%of kidney transplant recipients.Its immunomodulatory effects can predispose transplant recipients to rejection and chronic allograft nephropathy(CAN).This study determined the association between serum 25(OH)vitamin D,biopsy-proven allograft rejection,and CAN rates.AIM To determine the relationship between serum 25(OH)vitamin D level and biopsy-proven allograft rejection and CAN rate in renal transplant recipients.METHODS Adult renal transplant recipients followed at the clinic between January 2013 and 2018 were included.Recipients requiring graft biopsy due to declined function,hematuria,and proteinuria were reviewed.The two groups were compared regarding collected data,including the biopsy results,immunologic parameters,vitamin D,parathyroid hormone(PTH),phosphorus,albumin levels,and graft function tests.RESULTS Fifty-two recipients who underwent graft biopsy met the inclusion criteria.In all,14 recipients had a vitamin D level>15 ng/mL(group 1)vs≤15 ng/mL(group 2)in 38.In total,27 patients had biopsy-proven rejection,and 19 had CAN.There was only 1 recipient with biopsyproven rejection in group 1,whereas there were 24 patients with rejection in group 2.The rejection rate was significantly higher in group 2 than in group 1(P<0.001).Four patients were diagnosed with CAN in group 1 vs fifteen in group 2.There was no significant difference in the CAN rate between the two groups.PTH was higher at the time of graft biopsy(P=0.009,P=0.022)in group 1 with a mean of 268 pg/mL.Donor-specific antibodies were detected in 14(56.0%)of the recipients with rejection.Vitamin D level was 9.7±3.4 ng/mL in the rejection group vs 14.7±7.2 in the non-rejection group;this difference was statistically significant(P=0.003).The albumin levels were significantly lower in patients with rejection than in those without rejection(P=0.001).In univariate regression analysis of risk factors affecting rejection,sex,serum vitamin D,phosphorus and albumin were found to have an impact(P=0.027,P=0.007,P=0.023,P=0.008).In multivariate regression analysis,the same factors did not affect rejection.CONCLUSION The serum 25(OH)vitamin D level in kidney transplant recipients remained low.Although low serum vitamin D level emerged as a risk factor for rejection in univariate analysis,this finding was not confirmed by multivariate analysis.Prospective studies are required to determine the effect of serum vitamin D levels on allograft rejection.展开更多
BACKGROUND Solid organ transplant recipients are considered to be at high-risk of developing coronavirus disease 2019(COVID-19)-related complications.The optimal treatment for this patient group is unknown.Consequentl...BACKGROUND Solid organ transplant recipients are considered to be at high-risk of developing coronavirus disease 2019(COVID-19)-related complications.The optimal treatment for this patient group is unknown.Consequently,the treatment of COVID-19 in kidney transplant recipients should be determined individually,considering patient age and comorbidities,as well as graft function,time of transplant,and immunosuppressive treatment.Immunosuppressive treatments may give rise to severe COVID-19.On the contrary,they may also lead to a milder and atypical presentation by diminishing the immune system overdrive.CASE SUMMARY A 50-year old female kidney transplant recipient presented to the transplant clinic with a progressive dry cough and fever that started three days ago.Although the COVID-19 test was found to be negative,chest computed tomography images showed consolidation typical of the disease;thus,following hospital admission,anti-bacterial and COVID-19 treatments were initiated.However,despite clinical improvement of the lung consolidation,her creatinine levels continued to increase.Ultrasound of the graft showed no pathology.The tacrolimus blood level was determined and the elevation in creatinine was found to be related to an interaction between tacrolimus and azithromycin.CONCLUSION During the COVID-19 pandemic,various single or combination drugs have been utilized to find an effective treatment regimen.This has increased the possibility of drug interactions.A limited number of studies published in the literature have highlighted some of these pharmacokinetic interactions.Treatments used for COVID-19 therapy;azithromycin,atazanavir,lopinavir/ritonavir,remdesivir,favipiravir,chloroquine,hydroxychloroquine,nitazoxanide,ribavirin,and tocilizumab,interact with immunosuppressive treatments,most importantly with calcineurin inhibitors.Thus,their levels should be frequently monitored to prevent toxicity.展开更多
文摘BACKGROUND Kidney transplantation(KT)and end-stage renal disease(ESRD)requiring hemodialysis(HD)increase the incidence of morbidity and mortality associated with coronavirus disease 2019(COVID-19)infection.The COVID-19 pandemic has had a negative effect on the psychological well-being of COVID-19 patients,especially those with a high-risk of infectious complications.The prevalence of anxiety and depression is known to be higher in ESRD patients undergoing HD than in the general population.On the other hand,KT recipients have different treatment requirements compared to HD patients,including adherence to complex immunosuppressive regimens and compliance with follow-up appointments.We hypothesized that psychosocial difficulties and stressors would differ between ESRD patients undergoing HD and KT recipients during the COVID-19 pandemic.If so,each group may require different interventions to maintain their psychosocial well-being.AIM To measure and compare the levels of stress,anxiety,depression,concerns related to the pandemic,and coping skills in ESRD patients undergoing HD and KT recipients during the COVID-19 pandemic.METHODS This cross-sectional study was performed at a training and research hospital.The study included ESRD patients undergoing HD(HD group)and KT recipients(with stable graft function for≥6 mo prior to the study)(KT group).Patients completed a demographics form,the impact of events scale,the hospital anxiety and depression scale,and the Connor-Davidson resilience scale.Laboratory findings at the last clinical follow-up were recorded.Theχ^(2)test was used to assess the relationship between the HD and KT groups and the categorical variables.The relationships between the scale scores were analyzed using Pearson’s correlation test,and differences between the groups were analyzed using the independent groups t-test.RESULTS The study included 125 patients,of which 89(71.2%)were in the HD group and 36(28.8%)were in the KT group.The levels of anxiety and depression were higher in the HD group than in the KT group[9.36±4.38 vs 6.89±4.06(P=0.004)and 8.78±4.05 vs 6.42±4.26(P=0.004),respectively],whereas the post-traumatic stress score was higher in the KT group[46.75±13.98 vs 37.66±18.50(P=0.009)].The concern with the highest intensity in the HD group was transmission of COVID-19 to family and friends(93.3%)and in the KT group was loss of caregiver and social support(77.8%).Concerns regarding financial hardship,stigmatization,loneliness,limited access to health care services,failure to find medical supplies,and transmission of COVID-19 to family and friends were more prevalent in the HD group.Connor-Davidson resilience scale tenacity and personal competence,tolerance,and negative affect scores were higher in the KT group than in the HD group[43.47±11.39 vs 33.72±12.58,15.58±4.95 vs 11.45±5.05,and 68.75±17.39 vs 55.39±18.65(P<0.001),respectively].Biochemical parameters,such as creatine,urea,phosphorus,parathyroid hormone,and calcium,were lower,and the albumin and hemoglobin values were higher in the KT group than in the HD group(P<0.001).CONCLUSION Psychosocial difficulties and the level of stress differ in ESRD patients undergoing HD and KT recipients;therefore,psychosocial interventions should be tailored for each patient group.
文摘BACKGROUND Vitamin D deficiency occurs in more than 80%of kidney transplant recipients.Its immunomodulatory effects can predispose transplant recipients to rejection and chronic allograft nephropathy(CAN).This study determined the association between serum 25(OH)vitamin D,biopsy-proven allograft rejection,and CAN rates.AIM To determine the relationship between serum 25(OH)vitamin D level and biopsy-proven allograft rejection and CAN rate in renal transplant recipients.METHODS Adult renal transplant recipients followed at the clinic between January 2013 and 2018 were included.Recipients requiring graft biopsy due to declined function,hematuria,and proteinuria were reviewed.The two groups were compared regarding collected data,including the biopsy results,immunologic parameters,vitamin D,parathyroid hormone(PTH),phosphorus,albumin levels,and graft function tests.RESULTS Fifty-two recipients who underwent graft biopsy met the inclusion criteria.In all,14 recipients had a vitamin D level>15 ng/mL(group 1)vs≤15 ng/mL(group 2)in 38.In total,27 patients had biopsy-proven rejection,and 19 had CAN.There was only 1 recipient with biopsyproven rejection in group 1,whereas there were 24 patients with rejection in group 2.The rejection rate was significantly higher in group 2 than in group 1(P<0.001).Four patients were diagnosed with CAN in group 1 vs fifteen in group 2.There was no significant difference in the CAN rate between the two groups.PTH was higher at the time of graft biopsy(P=0.009,P=0.022)in group 1 with a mean of 268 pg/mL.Donor-specific antibodies were detected in 14(56.0%)of the recipients with rejection.Vitamin D level was 9.7±3.4 ng/mL in the rejection group vs 14.7±7.2 in the non-rejection group;this difference was statistically significant(P=0.003).The albumin levels were significantly lower in patients with rejection than in those without rejection(P=0.001).In univariate regression analysis of risk factors affecting rejection,sex,serum vitamin D,phosphorus and albumin were found to have an impact(P=0.027,P=0.007,P=0.023,P=0.008).In multivariate regression analysis,the same factors did not affect rejection.CONCLUSION The serum 25(OH)vitamin D level in kidney transplant recipients remained low.Although low serum vitamin D level emerged as a risk factor for rejection in univariate analysis,this finding was not confirmed by multivariate analysis.Prospective studies are required to determine the effect of serum vitamin D levels on allograft rejection.
文摘BACKGROUND Solid organ transplant recipients are considered to be at high-risk of developing coronavirus disease 2019(COVID-19)-related complications.The optimal treatment for this patient group is unknown.Consequently,the treatment of COVID-19 in kidney transplant recipients should be determined individually,considering patient age and comorbidities,as well as graft function,time of transplant,and immunosuppressive treatment.Immunosuppressive treatments may give rise to severe COVID-19.On the contrary,they may also lead to a milder and atypical presentation by diminishing the immune system overdrive.CASE SUMMARY A 50-year old female kidney transplant recipient presented to the transplant clinic with a progressive dry cough and fever that started three days ago.Although the COVID-19 test was found to be negative,chest computed tomography images showed consolidation typical of the disease;thus,following hospital admission,anti-bacterial and COVID-19 treatments were initiated.However,despite clinical improvement of the lung consolidation,her creatinine levels continued to increase.Ultrasound of the graft showed no pathology.The tacrolimus blood level was determined and the elevation in creatinine was found to be related to an interaction between tacrolimus and azithromycin.CONCLUSION During the COVID-19 pandemic,various single or combination drugs have been utilized to find an effective treatment regimen.This has increased the possibility of drug interactions.A limited number of studies published in the literature have highlighted some of these pharmacokinetic interactions.Treatments used for COVID-19 therapy;azithromycin,atazanavir,lopinavir/ritonavir,remdesivir,favipiravir,chloroquine,hydroxychloroquine,nitazoxanide,ribavirin,and tocilizumab,interact with immunosuppressive treatments,most importantly with calcineurin inhibitors.Thus,their levels should be frequently monitored to prevent toxicity.
