Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
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Nephrol. Dial. Transplant. · Nov 2013
Review Meta AnalysisAnticoagulant therapies for the prevention of intravascular catheters malfunction in patients undergoing haemodialysis: systematic review and meta-analysis of randomized, controlled trials.
Catheter malfunction (CM), including thrombosis, is associated with reduced dialysis adequacy, as well as an increased risk of catheter-related bacteraemia (CRB) and mortality. The role of alternative anticoagulant regimens for CM prevention remains uncertain. ⋯ There is uncertainty on the benefits and harms of anticoagulant therapies over conventional care for prevention of CM. Further high-quality randomized trials, including safety outcomes, are needed.
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Nephrol. Dial. Transplant. · Nov 2013
Comparative StudyKidney Disease Improving Global Outcomes or creatinine kinetics criteria in acute kidney injury: a proof of concept study.
It has been recently mathematically demonstrated that the percentage increase in serum creatinine (SCr) can delay acute kidney injury (AKI) diagnosis in patients with previous chronic kidney disease (CKD). Based on creatinine (Cr) kinetics, it was suggested a new AKI classification using absolute increase in SCr elevation over specified time periods. However, this classification has not been evaluated in clinical studies. ⋯ AKI classification proposed by a Cr kinetics model can be superior when diagnosing patients with previous CKD. However, KDIGO had a better performance in patients with no previous CKD.
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Nephrol. Dial. Transplant. · Nov 2013
When do we need competing risks methods for survival analysis in nephrology?
Survival analyses are commonly applied to study death or other events of interest. In such analyses, so-called competing risks may form an important problem. ⋯ Conventional methods for survival analysis ignoring the competing event(s), such as the Kaplan-Meier method and standard Cox proportional hazards regression, may be inappropriate in the presence of competing risks, and alternative methods specifically designed for analysing competing risks data should then be applied. This problem deserves more attention in nephrology research and in the current article, we therefore explain the problem of competing risks in survival analysis and how using different techniques may affect study results.
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Nephrol. Dial. Transplant. · Nov 2013
Sensitization from transfusion in patients awaiting primary kidney transplant.
Sensitization to human leukocyte antigen (HLA) from red blood cell (RBC) transfusion is poorly quantified and is based on outdated, insensitive methods. The objective was to evaluate the effect of transfusion on the breadth, magnitude and specificity of HLA antibody formation using sensitive and specific methods. ⋯ Among prospective primary kidney transplant recipients, RBC transfusion results in clinically significant increases in HLA antibody strength and breadth, which adversely affect the opportunity for future transplant.
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Nephrol. Dial. Transplant. · Nov 2013
Case ReportsOrlistat, an under-recognised cause of progressive renal impairment.
Obesity is an emerging risk factor for chronic kidney disease (CKD) in the developed world. Orlistat, an intestinal lipase inhibitor, used in the treatment of obesity is available as an over-the-counter medication across the European union and in many countries worldwide. ⋯ We present three adults, followed up from 1 to 6 years, who developed de novo or worsening renal impairment while on orlistat. Stopping the drug halted progression, but did not reverse the degree of renal impairment at presentation.