Beware: The femoral haemodialysis catheter – a surgeon’s perspective

The ability to identify and address factors that threaten the optimal utilisation of donor organs is quintessential in obtaining satisfactory transplant outcomes. We share our concerns regarding the prolonged use of femoral haemodialysis catheters and its potential to jeopardise successful renal transplantation. Despite a paucity of literature on the topic, we review relevant aspects related to this pernicious form of vascular access and clarify its limited role in the modern haemodialysis unit, particularly in patients who are still considered for transplantation

Beware: The femoral haemodialysis catheter – a surgeon’s perspective

The ability to identify and address factors that threaten the optimal utilisation of donor organs is quintessential in obtaining satisfactory transplant outcomes. We share our concerns regarding the prolonged use of femoral haemodialysis catheters and its potential to jeopardise successful renal transplantation. Despite a paucity of literature on the topic, we review relevant aspects related to this pernicious form of vascular access and clarify its limited role in the modern haemodialysis unit, particularly in patients who are still considered for transplantation

Renal transplantation between HIV-positive donors and recipients justified

HIV infection was previously an absolute contraindication to renal transplantation. However, with the advent of highly active antiretroviral therapy (HAART), renal transplantation using HIV-negative donor kidneys has successfully been employed for HIV-infected patients with end-stage renal failure. In resource-limited countries, places on dialysis programmes are severely restricted; HIV-infected patients, like many others with co-morbidity, are often denied treatment. Kidneys (and other organs) from HIV-infected deceased donors are discarded. The transplantation of HIV-positive donor kidneys to HIV-infected recipients is now a viable alternative to chronic dialysis or transplantation of HIV-negative donor kidneys. This significantly increases the pool of donor kidneys to the advantage of HIV-positive and -negative patients. Arguments are presented that led to our initiation of renal transplantation from HIV-positive deceased donors to HIV-positive recipients at Groote Schuur Hospital, Cape Town

Strategic plan for integrated care of patients with kidney failure

There is a huge gap between the number of patients worldwide requiring versus those actually receiving safe, sustainable, and equitable care for kidney failure. To address this, the International Society of Nephrology coordinated the development of a Strategic Plan for Integrated Care of Patients with Kidney Failure. Implementation of the plan will require engagement of the whole kidney community over the next 5-10 years

Increasing access to integrated ESKD care as part of Universal Health Coverage

The global nephrology community recognizes the need for a cohesive strategy to address the growing problem of end-stage kidney disease (ESKD). In March 2018, the International Society of Nephrology hosted a summit on integrated ESKD care, including 92 individuals from around the globe with diverse expertise and professional backgrounds. The attendees were from 41 countries, including 16 participants from 11 low- and lower-middle–income countries. The purpose was to develop a strategic plan to improve worldwide access to integrated ESKD care, by identifying and prioritizing key activities across 8 themes: (i) estimates of ESKD burden and treatment coverage, (ii) advocacy, (iii) education and training/workforce, (iv) financing/funding models, (v) ethics, (vi) dialysis, (vii) transplantation, and (viii) conservative care. Action plans with prioritized lists of goals, activities, and key deliverables, and an overarching performance framework were developed for each theme. Examples of these key deliverables include improved data availability, integration of core registry measures and analysis to inform development of health care policy; a framework for advocacy; improved and continued stakeholder engagement; improved workforce training; equitable, efficient, and cost-effective funding models; greater understanding and greater application of ethical principles in practice and policy; definition and application of standards for safe and sustainable dialysis treatment and a set of measurable quality parameters; and integration of dialysis, transplantation, and comprehensive conservative care as ESKD treatment options within the context of overall health priorities. Intended users of the action plans include clinicians, patients and their families, scientists, industry partners, government decision makers, and advocacy organizations. Implementation of this integrated and comprehensive plan is intended to improve quality and access to care and thereby reduce serious health-related suffering of adults and children affected by ESKD worldwide

Twenty four-hour urine collection is appropriate in a cohort of South African renal stone formers

Objectives: To report the prevalence of metabolic abnormalities found in an urban South African population of stone formers and thereby determine whether international guidelines on 24-hour urine collection should be recommended for South African stone formers.Methods: A retrospective folder review was conducted on patients who were admitted with renal stones or who had renal stone procedures between 1 November 2014 and 31 March 2020, with a confirmed history of renal calculi and who had 24-hour urine collection at a tertiary centre renal stone clinic. All confirmed stone formers were offered 24-hour urine collection once they were infection-free and stone-free. Demographics, 24-hour urine collection findings and stone analysis results (if available) were recorded. A 24-hour urine collection was performed once patients were stone-free while on their regular diet and routine lifestyle.Results: 175 patients with metabolic studies were included (65 females and 110 males). The mean age was 53.8 ±13.6 years. The commonest metabolic risk factors were hypocitraturia (61.0%), hypomagnesiuria (41.1%), mild hypercalciuria (22.0%), and hyperuricosuria (20.2%). Hyperuricaemia, high urinary sodium excretion, mild hypercalciuria and hyperuricosuria were more common in men. A total of 102 patients had both 24-hour urine collection and stone analysis for comparison. There were no differences between different stone types in the prevalence of metabolic risk factors except for hyperuricaemia and high urinary sodium excretion, which were both higher in uric acid predominant stone formers.Conclusion: The prevalence of risk factors was high and seemed similar to that of other populations, except for a higher prevalence of hypocitraturia. Internationally recommended guidelines for 24-hour urine studies are therefore applicable and appropriate for this population. Risk factors seem similar across stone types; however, a larger study is necessary to clarify whether metabolic risk factors are useful to predict stone composition

Infectious Complications of Transplant Tourism

To outline the impact of transplant tourism on the type and severity of post-transplant infections that may be seem in returning transplant tourists. This review outlines infections that might be expected and provides recommendations on screening tests that may assist in the diagnosis and management of such patients. Transplant tourists may develop unusual or resistant infections that pose a public health risk in their home country. The practice of transplant tourism is associated with a significantly increased risk of surgical and infectious complications after transplant. Returning transplant tourists require a thorough evaluation for active and latent infections. Transplant centers must be vigilant for new and emerging pathogens in this population