Trends of elevated parathormone serum titers in hemodialysis patients on intensive therapy for bone disease: A multicenter study

To determine the prevalence of controlled parathyroid hormone (PTH) serum levels with intensified therapy for chronic kidney disease mineral and bone disorder (CKD-MBD) in the dialysis population, we studied 563 chronic hemodialysis patients recruited from three different dialysis centers from three different major cities in the Kingdom of Saudi Arabia. The trend of the routine monthly chemistries related to CKD-MBD was evaluated besides the whole-molecule PTH serum levels over 28 months (January 2011 to April 2013). The cost ratios of the medications to the estimated dialysis total cost were calculated. There were 323 (57.4%) males in the study, and the mean age of the patients was 50.2 ± 15.2 years; 371 (65.9%) patients were initiated on dialysis before 2011. The causes of the original kidney disease included diabetes mellitus in 163 (29%) patients. Parathyroidectomy was performed in 23 (4.1%) patients and only six (23%) patients underwent the operation during the study period; most of the parathyroidectomies (69%) were performed before 2011. The trend of the medians of monthly serum levels of calcium, phosphorus, albumin, bicarbonate, alkaline phosphatase, serum levels of PTH and vitamin D25 assays showed better control of the levels with time. The added cost of cinacalcet was more significant than the other drugs, including vitamin D and phosphate binders, but the cost was minimal in comparison with the whole dialysis bill. The ratios of the discontinuation rates to the total patient-months of treatment for the different drugs were in the range of 3-4% and mostly due to transient overdosing of medications. We conclude that the trends of the median serum levels of PTH and related minerals in the CKD patients in our dialysis patients suggested a good inclination toward control and prevention of the vascular calcifications prevalent in the CKD-MBD. The popularity of use of new drugs such as cinacalcet is promising and does not seem to add much to the current out-patient cost of chronic dialysis

The Reality of Inadequate Patient Care and the Need for a Global Action Framework in Organ Donation and Transplantation

Background. Transplant therapy is considered the best and often the only available treatment for thousands of patients with organ failure that results from communicable and noncommunicable diseases. The number of annual organ transplants is insufficient for the worldwide need. Methods. We elaborate the proceedings of the workshop entitled "The Role of Science in the Development of International Standards of Organ Donation and Transplantation,"organized by the Pontifical Academy of Sciences and cosponsored by the World Health Organization in June 2021. Results. We detail the urgency and importance of achieving national self-sufficiency in organ transplantation as a public health priority and an important contributor to reaching relevant targets of the United Nations Agenda for Sustainable Development. It details the elements of a global action framework intended for countries at every level of economic development to facilitate either the establishment or enhancement of transplant activity. It sets forth a proposed plan, by addressing the technical considerations for developing and optimizing organ transplantation from both deceased and living organ donors and the regulatory oversight of practices. Conclusions. This document can be used in governmental and policy circles as a call to action and as a checklist for actions needed to enable organ transplantation as treatment for organ failure.Fil: Domínguez Gil, Beatriz. Ministerio de Sanidad; EspañaFil: Ascher, Nancy L.. University of California; Estados UnidosFil: Fadhil, Riadh A.S.. Weill Cornell Medicine-qatar; QatarFil: Muller, Elmi. University of Cape Town; SudáfricaFil: Cantarovich, Marcelo. Centre Universitaire de Santé Mcgill; CanadáFil: Ahn, Curie. Asian Society of Transplantation; Corea del SurFil: Berenguer, Marina. La Fe University Hospital; España. Universidad de Valencia; EspañaFil: Bušić, Mirela. Ministry of Health of the Republic of Croatia; CroaciaFil: Egawa, Hiroto. Tokyo Women's Medical University; JapónFil: Gondolesi, Gabriel Eduardo. Fundación Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; ArgentinaFil: Haberal, Mehmet. Başkent University; TurquíaFil: Harris, David. The University Of Sydney; AustraliaFil: Hirose, Ryutaro. Scientific Registry of Transplant Recipients; ArgentinaFil: Ilbawi, André. Organizacion Mundial de la Salud; ArgentinaFil: Jha, Vivekanand. Imperial College London; Reino UnidoFil: López Fraga, Marta. Council Of Europe; FranciaFil: Andrés Madera, Sergio. Secretaria de Gobierno de Salud. Instituto Nacional Central Único Coordinador de Ablación e Implante; ArgentinaFil: Najafizadeh, Katayoun. Shahid Beheshti University Of Medical Sciences; IránFil: O'Connell, Philip J.. The University of Sydney; AustraliaFil: Rahmel, Axel. German Organ Transplantation Foundation; AlemaniaFil: Shaheen, Faissal A.M.. King Fahad Hospital; Arabia SauditaFil: Twahir, Ahmed. Aga Khan University Hospital; KeniaFil: Van Assche, Kristof. Universiteit Antwerp; BélgicaFil: Wang, Haibo. China Organ Transplant Response System; ChinaFil: Haraldsson, Boerje. University Goteborg; SueciaFil: Chatzixiros, Efstratios. Organizacion Mundial de la Salud; ArgentinaFil: Delmonico, Francis L.. Harvard Medical School; Estados Unido

The reality of inadequate patient care and the need for a global action framework in organ donation and transplantation

Background. Transplant therapy is considered the best and often the only available treatment for thousands of patients with organ failure that results from communicable and noncommunicable diseases. The number of annual organ transplants is insufficient for the worldwide need. Methods. We elaborate the proceedings of the workshop entitled "The Role of Science in the Development of International Standards of Organ Donation and Transplantation,"organized by the Pontifical Academy of Sciences and cosponsored by the World Health Organization in June 2021. Results. We detail the urgency and importance of achieving national self-sufficiency in organ transplantation as a public health priority and an important contributor to reaching relevant targets of the United Nations Agenda for Sustainable Development. It details the elements of a global action framework intended for countries at every level of economic development to facilitate either the establishment or enhancement of transplant activity. It sets forth a proposed plan, by addressing the technical considerations for developing and optimizing organ transplantation from both deceased and living organ donors and the regulatory oversight of practices. Conclusions. This document can be used in governmental and policy circles as a call to action and as a checklist for actions needed to enable organ transplantation as treatment for organ failure.Fil: Domínguez Gil, Beatriz. Ministerio de Sanidad; EspañaFil: Ascher, Nancy L.. University of California; Estados UnidosFil: Fadhil, Riadh A.S.. Weill Cornell Medicine-qatar; QatarFil: Muller, Elmi. University of Cape Town; SudáfricaFil: Cantarovich, Marcelo. Centre Universitaire de Santé Mcgill; CanadáFil: Ahn, Curie. Asian Society of Transplantation; Corea del SurFil: Berenguer, Marina. La Fe University Hospital; España. Universidad de Valencia; EspañaFil: Bušić, Mirela. Ministry of Health of the Republic of Croatia; CroaciaFil: Egawa, Hiroto. Tokyo Women's Medical University; JapónFil: Gondolesi, Gabriel Eduardo. Fundación Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; ArgentinaFil: Haberal, Mehmet. Başkent University; TurquíaFil: Harris, David. The University Of Sydney; AustraliaFil: Hirose, Ryutaro. Scientific Registry of Transplant Recipients; ArgentinaFil: Ilbawi, André. Organizacion Mundial de la Salud; ArgentinaFil: Jha, Vivekanand. Imperial College London; Reino UnidoFil: López Fraga, Marta. Council Of Europe; FranciaFil: Andrés Madera, Sergio. Secretaria de Gobierno de Salud. Instituto Nacional Central Único Coordinador de Ablación e Implante; ArgentinaFil: Najafizadeh, Katayoun. Shahid Beheshti University Of Medical Sciences; IránFil: O'Connell, Philip J.. The University of Sydney; AustraliaFil: Rahmel, Axel. German Organ Transplantation Foundation; AlemaniaFil: Shaheen, Faissal A.M.. King Fahad Hospital; Arabia SauditaFil: Twahir, Ahmed. Aga Khan University Hospital; KeniaFil: Van Assche, Kristof. Universiteit Antwerp; BélgicaFil: Wang, Haibo. China Organ Transplant Response System; ChinaFil: Haraldsson, Boerje. University Goteborg; SueciaFil: Chatzixiros, Efstratios. Organizacion Mundial de la Salud; ArgentinaFil: Delmonico, Francis L.. Harvard Medical School; Estados Unido