The Annual Meeting of the American Society of Nephrology, Kidney Week 2018
Kidney Week, the annual meeting of the American Society of Nephrology, was held from Oct. 23 to 28 in San Diego and attracted approximately 13,000 participants from around the world, including nephrology specialists, researchers, scientists, and other health care professionals. The conference featured presentations focusing on the latest advances in the management of patients with kidney diseases and related disorders.
In one study, Bhavna Chopra, M.D., of Allegheny General Hospital in Pittsburgh, and colleagues used data (2006-2016) from the United Network for Organ Sharing to compare the outcomes of kidney transplantation in recipients at different levels of body mass index (BMI).
“In order to minimize the impact of donor variables on transplant outcomes, we used a paired kidney model in which kidneys from the same deceased donor were transplanted into recipients in different BMI categories. Recipient- and transplant-related factors were adjusted in a multivariate Cox model,” said Chopra.
The investigators found an increased risk for developing delayed graft function with increasing BMI. Patients with ideal BMI (18-25 kg/m2) had the best graft survival, but there were no significant differences in patient survival across different BMI groups. In particular, the investigators did not observe any differences in graft and patient outcomes between patients with BMI of 30 to 35 kg/m2 and those with BMI greater than 35 kg/m2.
“Our data support a more favorable consideration of obese patients for kidney transplantation and suggest that the use of a BMI cutoff between 30 and 40 for wait-listing, while common, is arbitrary and unfounded,” said Chopra. “The resulting increase in access to transplantation for many obese patients will have a significant impact on quality of life and longevity for these patients compared to staying on long-term dialysis.”
In another study, Jessica Kendrick, M.D., of the University of Colorado School of Medicine in Aurora, and colleagues found that acute kidney injury (AKI), even with complete renal recovery, is associated with an increased risk for dementia.
“The long-term neurological consequences of AKI are unknown. Patients with AKI had an increased risk of dementia compared to those without AKI (7 percent versus 2.3 percent),” said Kendrick. “Our data adds to the literature that AKI has long-term consequences. Clinicians need to be aware of the long-term risks, and these patients may need close follow-up.”
McAdams DeMarco, M.D., of Johns Hopkins Hospital in Baltimore, and colleagues found that frailty is associated with a lower likelihood of being put on a kidney transplant wait-list and receiving a transplant.
“Frail kidney transplant candidates were 38 percent less likely to be listed for transplantation, had nearly twofold increased risk of dying while on the transplant wait-list, and underwent transplantation at a 35 percent lower rate than non-frail participants,” said DeMarco. “Frail kidney transplant candidates may need pre-kidney-transplant interventions like prehabilitation to increase physiologic reserve and subsequently improve access to kidney transplantation.”
Monica Reynolds, M.D., of the University of North Carolina at Chapel Hill, and colleagues found that many nephrologists lack confidence across a broad range of women’s health issues that are closely related to kidney disease.
“Our patients expect us to be competent in women’s health as it relates to chronic kidney disease, yet our study identified low rates of counseling in both the U.S. and Canada. In addition, low confidence levels across the spectrum of women’s health issues may be a driver for poor counseling practices,” said Reynolds. “Interdisciplinary clinics, which are known to improve outcomes in other areas of chronic kidney disease and are associated with high patient satisfaction, were largely nonexistent. It is our hope that by highlighting these gaps, we can target future interventions to improve patient-centered care for women with chronic kidney disease.”
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