DISPARITIES IN ACCESS TO KIDNEY TRANSPLANTATION IN DEVELOPING COUNTRIES

Chronic kidney disease (CKD) is a global health prob lem with nearly 0.1% of the world’s population suffering from end-stage kidney disease (ESKD).1 The availability and accessibility to treatments for ESKD differ around the globe because of variations in healthcare budgets and availability of treatments. Although the prevalence of ESKD in low-income countries (LICs, 0.05%) and lower middle–income countries (L-MICs, 0.07%) is estimated to be lower than in high-income countries (HICs, 0.2%), or potentially underdiagnosed, the proportion of patients who are not receiving effective treatment is much higher in LICs (96%) and L-MICs (90%) compared with upper mid dle–income countries (U-MICs, 70%) and HICs (40%).2 In some L-MICs, it is impossible to support hemodialysis treatment for every ESKD patient, and most patients are unable to pay for dialysis out of pocke

Outcomes following kidney transplantation in patients with sickle cell disease:The impact of automated exchange blood transfusion

There are over 12,000 people with sickle cell disease (SCD) in the UK, and 4-12% of patients who develop Sickle Cell Nephropathy (SCN) progress to End Stage Renal Disease (ESRD). Renal transplantation offers the best outcomes for these patients with but their access to transplantation is often limited. Regular automated exchange blood transfusions (EBT) reduce the complications of SCD and may improve outcomes. However, concerns over alloimmunisation limit its widespread implementation. In this retrospective multicenter study, data were collected on 34 SCD patients who received a kidney transplant across 6 London Hospitals between 1997 and 2017. 20/34 patients were on an EBT program, pre or post renal transplantation. Overall patient and graft survival were inferior to contemporaneous UK data in the ESRD population as a whole, a finding which is well-recognised. However, patient survival (CI 95%, p = 0.0032), graft survival and graft function were superior at all time-points in those who received EBT versus those who did not. 4/20 patients (20%) on EBT developed de novo donor specific antibodies (DSAs). 3/14 patients (21%) not on EBT developed de novo DSAs. The incidence of rejection in those on EBT was 5/18 (28%), as compared with 7/13 (54%) not on EBT. In conclusion, our data, while limited by an inevitably small sample size and differences in the date of transplantation, do suggest that long-term automated EBT post renal transplant is effective and safe, with improvement in graft and patient outcomes and no increase in antibody formation or graft rejection

Treating inflammation by blocking interleukin-1 in a broad spectrum of diseases.

Item does not contain fulltextInterleukin-1 (IL-1) is a highly active pro-inflammatory cytokine that lowers pain thresholds and damages tissues. Monotherapy blocking IL-1 activity in autoinflammatory syndromes results in a rapid and sustained reduction in disease severity, including reversal of inflammation-mediated loss of sight, hearing and organ function. This approach can therefore be effective in treating common conditions such as post-infarction heart failure, and trials targeting a broad spectrum of new indications are underway. So far, three IL-1-targeted agents have been approved: the IL-1 receptor antagonist anakinra, the soluble decoy receptor rilonacept and the neutralizing monoclonal anti-IL-1beta antibody canakinumab. In addition, a monoclonal antibody directed against the IL-1 receptor and a neutralizing anti-IL-1alpha antibody are in clinical trials