Gender aspects in kidney transplantation

Successful kidney transplantation is the best treatment for patients with end stage renal disease and graft survival is one of the most important measures of success in kidney transplantation. The majority of the patients with end stage renal disease is men while the majority of living donors is women. Gender related issues in the demographics of the living donor population and outcomes in the transplant recipients are elucidated in this thesis. When evaluating the gender distribution in living donors and graft survival in first time living donor kidney transplant recipients, data was retrieved from the Norwegian Renal Registry during two different time periods. Gender demographics of living donors and outcomes were evaluated in 1319 first time transplantations performed in the period 1985-2002. Death censored graft survival and acute rejection episodes were investigated in 739 first time living donor transplantations in recipients 18 years of age or older performed between 1994 and 2004. Gender differences in cardiovascular events and total mortality in recipients of a kidney transplant was evaluated in the placebo arm of the ALERT (Assessment of LEscol in Renal Transplantation) study (n=1052), The aim of this thesis was to increase our knowledge about gender related issues in kidney transplantation. The main results are that in Norway there is no predominance of female-to-male donations among first time living donor kidney transplantations. Donor age up to 65 years provided excellent long term results in living donor transplantation. Furthermore, female donor sex may convey superior long term graft survival compared to male donor sex. No gender difference in cardiac events or total mortality was found in a relatively low risk population of transplant recipients. This result suggests that the female gender advantage regarding cardiovascular heart disease is not restored by transplantation

Peritoneal Dialysis-Associated Peritonitis Caused by Dermabacter hominis

Dermabacter hominis was the cause of a peritoneal dialysis-associated peritonitis. D. hominis was identified by phenotypic criteria and by sequencing the 16S rRNA gene. Clinical cure was achieved with cefuroxime treatment despite the isolate's reduced susceptibility to this drug (MIC, 12 mg/liter) on in vitro testing. The successful treatment was probably due to the high concentrations attained by intraperitoneal administration of the drug

A meta-analysis of the association of estimated GFR, albuminuria, age, race, and sex with acute kidney injury

BACKGROUND: Acute kidney injury (AKI) is a serious global public health problem. We aimed to quantify the risk of AKI associated with estimated glomerular filtration rate (eGFR), albuminuria (albumin-creatinine ratio [ACR]), age, sex, and race (African American and white). STUDY DESIGN: Collaborative meta-analysis. SETTING & POPULATION: 8 general-population cohorts (1,285,049 participants) and 5 chronic kidney disease (CKD) cohorts (79,519 participants). SELECTION CRITERIA FOR STUDIES: Available eGFR, ACR, and 50 or more AKI events. PREDICTORS: Age, sex, race, eGFR, urine ACR, and interactions. OUTCOME: Hospitalized with or for AKI, using Cox proportional hazards models to estimate HRs of AKI and random-effects meta-analysis to pool results. RESULTS: 16,480 (1.3%) general-population cohort participants had AKI over a mean follow-up of 4 years; 2,087 (2.6%) CKD participants had AKI over a mean follow-up of 1 year. Lower eGFR and higher ACR were strongly associated with AKI. Compared with eGFR of 80mL/min/1.73m(2), the adjusted HR of AKI at eGFR of 45mL/min/1.73m(2) was 3.35 (95% CI, 2.75-4.07). Compared with ACR of 5mg/g, the risk of AKI at ACR of 300mg/g was 2.73 (95% CI, 2.18-3.43). Older age was associated with higher risk of AKI, but this effect was attenuated with lower eGFR or higher ACR. Male sex was associated with higher risk of AKI, with a slight attenuation in lower eGFR but not in higher ACR. African Americans had higher AKI risk at higher levels of eGFR and most levels of ACR. LIMITATIONS: Only 2 general-population cohorts could contribute to analyses by race; AKI identified by diagnostic code. CONCLUSIONS: Reduced eGFR and increased ACR are consistent strong risk factors for AKI, whereas associations of AKI with age, sex, and race may be weaker in more advanced stages of CKD

A Meta-analysis of the Association of Estimated GFR, Albuminuria, Diabetes Mellitus, and Hypertension With Acute Kidney Injury

BackgroundDiabetes mellitus and hypertension are risk factors for acute kidney injury (AKI). Whether estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (ACR) remain risk factors for AKI in the presence and absence of these conditions is uncertain.Study designMeta-analysis of cohort studies.Setting & population8 general-population (1,285,045 participants) and 5 chronic kidney disease (CKD; 79,519 participants) cohorts.Selection criteria for studiesCohorts participating in the CKD Prognosis Consortium.PredictorsDiabetes and hypertension status, eGFR by the 2009 CKD Epidemiology Collaboration creatinine equation, urine ACR, and interactions.OutcomeHospitalization with AKI, using Cox proportional hazards models to estimate HRs of AKI and random-effects meta-analysis to pool results.ResultsDuring a mean follow-up of 4 years, there were 16,480 episodes of AKI in the general-population and 2,087 episodes in the CKD cohorts. Low eGFRs and high ACRs were associated with higher risks of AKI in individuals with or without diabetes and with or without hypertension. When compared to a common reference of eGFR of 80mL/min/1.73m(2) in nondiabetic patients, HRs for AKI were generally higher in diabetic patients at any level of eGFR. The same was true for diabetic patients at all levels of ACR compared with nondiabetic patients. The risk gradient for AKI with lower eGFRs was greater in those without diabetes than with diabetes, but similar with higher ACRs in those without versus with diabetes. Those with hypertension had a higher risk of AKI at eGFRs>60mL/min/1.73m(2) than those without hypertension. However, risk gradients for AKI with both lower eGFRs and higher ACRs were greater for those without than with hypertension.LimitationsAKI identified by diagnostic code.ConclusionsLower eGFRs and higher ACRs are associated with higher risks of AKI among individuals with or without either diabetes or hypertension