TRANSPLANTATION--Kidney Donors Face Higher ESRD Risk

Kidney Donors Face Higher ESRD Risk

by: Jody A. Charnow

Living kidney donors are at increased risk for end-stage renal disease (ESRD) and cardiovascular and all-cause mortality, according to a new study.Investigators led by Hallvard Holdaas, MD, of Oslo University Hospital in Oslo, Norway, compared 1,901 individuals who donated a kidney from 1963 to 2007 with a control group of 32,621 potentially eligible kidney donors. The median follow-up for the donors and controls was 15.1 and 24.9 years, respectively.

Compared with controls, kidney donors had a significant 11.4 times increased risk of ESRD, 1.4 times increased risk of cardiovascular death, and 1.3 times increased risk of death from any cause, after adjusting for potential confounders.ESRD developed in 9 donors (0.47%). The median time from donation was 18.7 years. 

ESRD was mainly caused by immunologic renal diseases.“Our findings raise some medical and ethical considerations regarding live-kidney donation,” the authors wrote in Kidney International(2014;86:162-167). “The present study indicates potential increased long-term risks for kidney failure and mortality in kidney donors. However, this has to be put into perspective.”

Living donor transplantation, they noted, has been a necessary and essential part of providing ESRD patients with freedom from dialysis and enabling transplant recipients to enjoy a superior quality of life. “Most potential living donors are willing to accept a degree of risk when the recipient is a family member of a close friend.”

Previous studies have suggested that living kidney donors maintain long-term renal function and have no increase in cardiovascular or all-cause mortality, Dr. Holdaas' group stated. Most investigations, however, have included control groups that were less healthy than the living donor population and have had relatively short follow-up periods, they pointed out.

The researchers said their findings will not change their opinion about promoting live kidney donation. “However,” they pointed out, “potential donors should be informed of increased risks, although small, associated with donation in short-term and long-term perspective.”

In an editorial accompanying the new report (pp. 20-22), Neil Boudville, MD, of the University of Western Australia in Perth, and Amit X. Garg, MD, of Western University in London, Ontario, pointed out that the elevated risk of ESRD in living kidney donors found by Dr. Holdaas and colleagues is comparable to that found in a study by Abimereki D. Muzaale, MD, MPH, of Johns Hopkins University School of Medicine in Baltimore, and colleagues.

The study, published in the Journal of the American Medical Association(2014;311:579-586), compared 96,217 living kidney donors with 20,024 participants in the Third National Health and Nutrition Examination Survey (NHANES III). In this study, the incidence rate of ESRD was 8-fold higher in the donor cohort.“The findings of these two studies are very important and should influence the information we provide to potential donors,” Drs. Boudville and Garg wrote.

They noted that the findings may impact criteria for donor selection. “We will likely want a higher level of pre-donation kidney function … for younger individuals who are expected to live 50 or more years with one kidney (recognizing we do not have ideal evidence to inform what is the optimal acceptance threshold),” they wrote.Related ArticlesKidney Donation Safe for Older DonorsKidney Remaining After Donor Nephrectomy Increases in SizeBiopsy-Based Discard of Donor Kidneys May Be Misguidedsed risk for end-stage renal disease (ESRD) and cardiovascular and all-cause mortality, according to a new study.Investigators led by Hallvard Holdaas, MD, of Oslo University Hospital in Oslo, Norway, compared 1,901 individuals who donated a kidney from 1963 to 2007 with a control group of 32,621 potentially eligible kidney donors. The median follow-up for the donors and controls was 15.1 and 24.9 years, respectively.Compared with controls, kidney donors had a significant 11.4 times increased risk of ESRD, 1.4 times increased risk of cardiovascular death, and 1.3 times increased risk of death from any cause, after adjusting for potential confounders.ESRD developed in 9 donors (0.47%). The median time from donation was 18.7 years. ESRD was mainly caused by immunologic renal diseases.“Our findings raise some medical and ethical considerations regarding live-kidney donation,” the authors wrote in Kidney International(2014;86:162-167). “The present study indicates potential increased long-term risks for kidney failure and mortality in kidney donors. However, this has to be put into perspective.”Living donor transplantation, they noted, has been a necessary and essential part of providing ESRD patients with freedom from dialysis and enabling transplant recipients to enjoy a superior quality of life. “Most potential living donors are willing to accept a degree of risk when the recipient is a family member of a close friend.”Previous studies have suggested that living kidney donors maintain long-term renal function and have no increase in cardiovascular or all-cause mortality, Dr. Holdaas' group stated. Most investigations, however, have included control groups that were less healthy than the living donor population and have had relatively short follow-up periods, they pointed out.The researchers said their findings will not change their opinion about promoting live kidney donation. “However,” they pointed out, “potential donors should be informed of increased risks, although small, associated with donation in short-term and long-term perspective.”In an editorial accompanying the new report (pp. 20-22), Neil Boudville, MD, of the University of Western Australia in Perth, and Amit X. Garg, MD, of Western University in London, Ontario, pointed out that the elevated risk of ESRD in living kidney donors found by Dr. Holdaas and colleagues is comparable to that found in a study by Abimereki D. Muzaale, MD, MPH, of Johns Hopkins University School of Medicine in Baltimore, and colleagues.The study, published in the Journal of the American Medical Association(2014;311:579-586), compared 96,217 living kidney donors with 20,024 participants in the Third National Health and Nutrition Examination Survey (NHANES III). In this study, the incidence rate of ESRD was 8-fold higher in the donor cohort.“The findings of these two studies are very important and should influence the information we provide to potential donors,” Drs. Boudville and Garg wrote.They noted that the findings may impact criteria for donor selection. “We will likely want a higher level of pre-donation kidney function … for younger individuals who are expected to live 50 or more years with one kidney (recognizing we do not have ideal evidence to inform what is the optimal acceptance threshold),” they wrote.Related ArticlesKidney Donation Safe for Older DonorsKidney Remaining After Donor Nephrectomy Increases in SizeBiopsy-Based Discard of Donor Kidneys May Be Misguided

Severe Erectile Dysfunction May Respond to Shockwave Therapy

Low-intensity extracorporeal shockwave therapy may benefit men with severe erectile dysfunction, researchers reported online ahead of print in the International Journal of Urology.Chi-Hang Yee, MD, and colleagues at The Chinese University of Hong Kong studied 58 men with ED who received either low-intensity shockwave therapy (30 patients) or a sham treatment (28 patients). The two groups did not differ significantly in baseline International Index of Erectile Function-Erectile Function (IIEF-EF) domain score and Erection Hardness Score.At week 13, the mean IIEF-EF domain score in the shockwave therapy and sham arms was 17.8 and 15.8, respectively. The mean Erection Hardness Score was 2.7 and 2.4. These differences were not statistically significant. The shockwave therapy, however, was superior to sham treatment in a subgroup of men with severe ED (mean IIEF-EF domain score 10.1 vs. 3.2).

Source: Renal & Urology News

Sejarah Batu Saluran Kemih

Batu Saluran Kemih (BSK) atau sering disebut juga urolitiasis  merupakan masa kristal terbentuk dari protein dan mineral, yang secara alami terjadi di saluran kemih. BSK merupakan penyakit saluran kemih terbanyak ketiga, setelah penyakit infeksi saluran kemih dan penyakit prostat. Penyakit ini sudah ada sejak awal peradaban manusia. Sejak zaman Mesir kuno hingga saat ini, batu ginjal tampaknya sudah membingungkan para pasien dan tenaga medis, namun perkembangan proses penanganan BSK sudah mengalami banyak sekali kemajuan, diawali dari pengambilan dengan cara yang sangat menyakitkan hingga saat ini dengan cara sangat memuaskan. Namun demikian, cara untuk mencegah kembali terjadi batu ini masih menjadi tantangan para urolog dan nefrolog.

            Sekitat 6.000 tahun yang lalu, sejak ditemukannya BSK pertama kali, pola munculnya penyakit ini sudah mengalami banyak perubahan, terutama seabad belakangan ini. Sebagai contoh, di dunia barat pada tahun 1900, kejadian BSK pada umumnya terjadi pada anak-anak terutama laki-laki, dan paling sering berlokasi di kandung kemih. BSK biasanya mengandung ammonium urate dan/atau calcium oxalate, dan biasanya disebabkan nutrisi yang tidak baik pada anak. Saat ini, kondisi tersebut masih ditemukan di daerah pedesaan, khususnya pada daerah “Sabuk Batu (Stone Belt)”, menyebar mulai dari Yordania, menuju Iraq, Iran, dan India hingga penghujung Asia Tenggara. Namun kondisi tersebut menghilang dengan cepat sejalan dengan ditingkatkannya pemberian nutrisi., seperti yang juga dilakukan oleh negara-negara berkembang sekitar 100 tahun yang lalu. Saat itu, kejadian batu kandung kemih pada anak mengalami penurunan, namun kejadian BSK pada dewasa mengalami peningkatan. Hal ini terjadi berkaitan dengan kondisi kemakmuran dan kemunduran suatu negara

Referensi:

1.      Robertson, WG. The Scientific Basis of Urinary Stone Formation. The Sientific Basis of Urology, 2010: 10:162

2.      Stoller, ML. Urinary Stone Disease. Smith’s General Urology-17th edition. 2007; 16:246

Introduction of Urinary Tract Stone

Urinary tract stones are crystialline masses that form from the minerals and proteins, which naturally occur in urinary tract. Urinary tract stone disease is sometimes called urinary calculus or urolithiasis. It is the third most common affliction of the urinary tract, exceeded only by urinary tract infection and pathologic condition of prostate. Urinary stones have plagued humans since the earliest records of civilization. From the days of predynastic Egyptians until the present time, kidney stones have perplexed patients and physicians alike and, although during that time the methods for removing stones have advanced from the crudely barbaric to the highly sophisticated, the problem of how successfully  to prevent the recurrent stones continiues to challenge urologist and nephrologist

During the six millennia since the formation of the earliest recorded stone, the pattern of urolithiasis has changed in many respect, particularly within the past century. For example, in Western countries before 1900, stones occurred commonly in children particularly in boys, and were form commonly in bladder. The stones usually consisted of ammonium urate and/or calcium oxalate and were caused by poor nutrition. Although this form of the disorder is still found today in rural areas within the “endemic stone belt”, stretching from Jordan, through Iraq, Iran, and the Indian subcontinent until to the furthest extremities of South-East Asia, is is rapidly disappearing with improving strandard of nutrition, as it did in most of developed countries about 100 years ago. As the incidence, the bladder stones in children has decreased, however the prevalence of stones in adults has increased, there have been peaks and troughs in incidence that coincide with period of economic prosperity and recession.

 

Reference:

1.  Robertson, WG. The Scientific Basis of Urinary Stone Formation. The Sientific Basis of Urology, 2010: 10:162

2.  Stoller, ML. Urinary Stone Disease. Smith’s General Urology-17th edition. 2007; 16:246