Pregnancy within 1 year of kidney transplantation does not affect graft survival

Pregnancy within 1 year of kidney transplantation does not affect graft survival

Nature Clinical Practice Nephrology 4, 469 (2008). doi:10.1038/ncpneph0875

AJKD: Temporary iron depletion and relative thrombocytosis may underline increased mortality with high doses of EPO.

AJKD: Results: Higher platelet count was associated with lower iron stores and greater prescribed rHuEPO dose. Compared with a hemoglobin level of 12 to 13 g/dL, a hemoglobin level of 13 g/dL or greater was associated with increased mortality in the presence of relative thrombocytosis, ie, platelet count of 300,000/microL or greater (case-mix–adjusted death-rate ratio, 1.21; 95% confidence limits, 1.02 to 1.44; P = 0.03) as opposed to the absence of relative thrombocytosis (death-rate ratio, 1.04; 95% confidence limits, 0.98 to 1.08; P = 0.1). A prescribed rHuEPO dose greater than 20,000 U/wk was associated with a greater likelihood of iron depletion (iron saturation ratio < 20%) and relative thrombocytosis (case-mix–adjusted odds ratio, 2.53; 95% confidence limits, 2.37 to 2.69; and 1.36; 95% confidence limits, 1.30 to 1.42, respectively; P < 0.001) and increased mortality during 3 years (death-rate ratio, 1.59; 95% confidence limits, 1.54 to 1.65; P < 0.001). Limitations ................................... Our results may incorporate uncontrolled confounding. Achieved hemoglobin level may have different mortality predictability than targeted hemoglobin level.......... Conclusions: Iron depletion and associated relative thrombocytosis might contribute to increased mortality when administering high rHuEPO doses to achieve hemoglobin levels of 13 g/dL or greater in long-term hemodialysis patients. Randomized trials are needed to test these observational associations.

Clopidogrel decreases arteriovenous fistula thrombosis but does not improve fistula maturation

Clopidogrel decreases arteriovenous fistula thrombosis but does not improve fistula maturation

Nature Clinical Practice Nephrology 4, 476 (2008). doi:10.1038/ncpneph0908

Author: Michael S Gersch

Utility of the "Surprise" Question to Identify Dialysis Patients with High Mortality

Background and objectives: Dialysis patients are increasingly characterized by older age, multiple comorbidities, and shortened life expectancy. This study investigated whether the "surprise" question, "Would I be surprised if this patient died in the next year?" identifies patients who are at high risk for early mortality.

Design, setting, participants, & measurements: This prospective cohort study of 147 patients in three hemodialysis dialysis units classified patients into "yes" and "no" groups on the basis of the "surprise" question response and tracked patient status (alive or dead) at 12 mo. Demographics, Charlson Comorbidity Index score, and Karnofsky Performance Status score were measured.

Results: Initially, 34 (23%) patients were classified in the "no" group. Compared with the 113 patients in the "yes" group, the patients in the "no" group were older (72.5 ± 12.8 versus 64.5 ± 14.9), had a higher comorbidity score (7.1 ± 2.3 versus 5.8 ± 2.1), and had a lower performance status score (69.7 ± 17.1 versus 81.6 ± 15.8). At 12 mo, 22 (15%) patients had died; the mortality rate for the "no" group was 29.4% and for the "yes" group was 10.6%. The odds of dying within 1 yr for the patients in the "no" group were 3.5 times higher than for patients in the "yes" group, (odds ratio 3.507, 95% CI 1.356 to 9.067, P = 0.01).

Conclusions: The "surprise" question is effective in identifying sicker dialysis patients who have a high risk for early mortality and should receive priority for palliative care interventions.

Fanconi or not Fanconi? Lowe Syndrome Revisited