We discuss the use of urine electrolytes and urine osmolality in the clinical diagnosis of patients with fluid, electrolytes, and acid-base disorders, emphasizing their physiological basis, their utility, and the caveats and limitations in their use. While our focus is on information obtained from measurements in the urine, clinical diagnosis in these patients must integrate information obtained from the history, the physical examination, and other laboratory data.
Objectives Obesity is associated with worsening kidney allograft function. Since kidney allograft function may rapidly change throughout the course of kidney transplantation, particularly during early post-transplant period, we aim to examine association between pre-transplant obesity and development of chronic kidney disease (CKD) over several time points during post-transplant periods. Methods A single center retrospective cohort study included kidney transplant recipients who received kidney transplantation, between 2012 and 2015. The study population were divided into non-obese and obese groups based on pre-transplant body mass index (BMI) of < 30 and ≥30 kg/m2, respectively. Association between the obesity status and post-transplant CKD defined as estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 was examined by multivariable Cox proportional hazard regression analysis with a time-dependent effect at 12, 24, 36, and 48 weeks post-kidney transplantation. Results Of all 105 patients, mean age ± SD was 54 ± 12 and 61% was female. Non-obese and obese groups were account for 64% and 36%, respectively and their corresponding mean BMI were 24.34 ± 3.54 and 34.27 ± 3.53 kg/m2 (P < 0.001). The risk of developing CKD at 12, 36, and 48 weeks post-kidney transplantation, were not significantly difference. However, at 24-week post- kidney transplantation, obese group had 71% greater the risk for CKD compared to non-obese group (Hazard ratio (HR) 1.71, P 0.049, 95% confidence interval (95%CI) 1.002, 2.908). After adjusted for age, gender, type of kidney transplantation, systolic and diastolic blood pressure at 24 weeks post-kidney transplantation, the obese group remain at higher the risk for CKD (HR 1.74, P 0.044, 95% CI 1.014, 2.985). Conclusions Pre-kidney transplant obesity was associated with increased risk of CKD at the early, but not at the immediate or long-term post-transplant periods independent to the baseline characteristics and blood pressure. Pathophysiological changes during different post-transplant periods including immunological or non-immunological factors may contribute to this time-dependent effects of pre-transplant obesity and CKD. Additional studies are warranted to further examine possible mechanism. Funding Sources None.
Background and Aims Obesity is associated with poor clinical outcomes including cardiovascular (CV) diseases, but it becomes protective for mortality in end‐stage kidney disease population as the so‐called reverse epidemiology. After successful kidney transplant (KT), association between obesity and transplant outcomes is conflicting. Hypertension (HTN) is one of the leading causes of CV morbidities and mortality in kidney transplant recipients (KTR). We aim to examine this association between pre‐KT obesity and post‐KT HTN over several post‐KT periods. Method This is a single center retrospective cohort including KTR who received KT between 2012 and 2015. The study population were divided into 3 groups: normal weight, overweight, and obesity based on pre‐KT body mass index (BMI) of <25, 25 ‐ <30, and ≥30 kg/m2, respectively. Association of the BMI categories with post‐KT systolic and diastolic HTN defined as SBP ≥130 and DBP ≥80 mmHg, respectively was examined by multivariable Cox proportional hazard regression analysis with a time‐dependent effect at 4, 12, 24, 36, and 48 weeks post‐KT. Results Of 105 patients, mean age±SD was 54±12 and 61% was female. Patients with normal weight, overweight, and obesity were account for 32%, 31%, and 36%, respectively and their corresponding mean BMI were 21.44±2.37, 27.32±1.38, and 34.27±3.53 kg/m2. There was no statistically significant difference in the risk of developing SHTN and DHTN at 4, 12, 24, and 36 weeks post‐KT. However, at 48‐week post‐KT, only obese, but not overweight had significant higher the risk for SHTN (HRobese 2.29, p 0.017, 95% CI 1.160, 4.51; HRoverweight 1.24, p 0.571, 95% CI 0.60, 2.56) after adjusted for age, gender, type of KT, and immunosuppression. For obesity‐DHTN association, both obese and overweight groups had 308% and 154% significantly greater risk for DHTN in multivariable analysis, respectively (HRobese 4.08, p 0.002, 95% CI 1.66, 10.00 and HRoverweight 2.54, p 0.046, 95% CI 1.02, 6.35). Conclusion Obesity at the time of KT was associated with increased risk of SHTN at the long‐term, but not short‐term post‐KT; whereas overweight increased risk of both SHTN and DHTN at the long‐term‐post‐KT. Immunologic or non‐immunologic during short‐term post‐KT may contribute to these associations and further studies are required to elucidate the mechanism.
Background and Aims Coronavirus disease 19 (COVID-19) pandemic leads to poorer health outcomes and more utilizing of healthcare resources. Kidney transplant (KT) can lead to worsening transplant outcomes with COVID-19 and trend of KT in the United States decreases. Given a highly contagious disease, high population density may contribute to not only higher rate of the disease, but also lower rate of KT. We aim to examine the association of the number of COVID-19 cases and change in the number of KT with the interaction of population density in the United States. Method A cross-sectional study was conducted by using publicly available data of COVID-19 cases and KT in the United States were retrieved from the Centers of Disease Control and Prevention (CDC) and the Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients (OPTN/SRTR), respectively. The association of the cumulative COVID-19 cases of 47 states in the United States where KT occurred between January 1, 20202 and January 6, 2021 with difference in the number of KT between year 2019 and 2020 (ΔKT) was examined by using multiple linear regression. Results During the study period, a total of 20,136,895 COVID-19 cases were detected in the United States and 326,535 patients died. From all 47 states, 23,002 and 20,554 adult KT were performed in 2019 and 2020, respectively. Mean COVID-19 cases and deaths were 428,445±457,344 and 6,948± 6,911, respectively among the 47 states. Mean ΔKT2019 - 2020 were 52± 81. Every 10,000 COVID-19 cases was associated with a decrease in 1.06 KT in year 2020 compared to year 2019 (βcoeff 0.00011, p <0.0001, 95% CI 0.00006, 0.00015). However, after adjusted for the number of KT in 2019, COVID-19 cases (< or ≥ median cases of 317,545), population density (< or ≥ median density of 114 people/mile2), and the interaction term between COVID-19 cases and population density, the states with high rate of COVID-19 (≥317,545 cases/year) and high population density (≥114 people/mile2) had a decrease in 12.4 KT; whereas, there was 4.5 KT decrease in states with low COVID-19 rate and low population density (βcoeff 0.1024705, p 0.000, 95%CI 0.066272, 0.1386691, p interaction -0.686). Conclusion The number of KT in 2020 has decreased independent to the number of 2019 KT and population density. However, a decrease in the number of KT was lower in the states with low COVID-19 rate and low population density compared to those with high COVID-19 rate and high population density. Distribution of healthcare resources and utilization including KT in the states with low COVID-19 cases and low population density may be one of the strategies to continue KT, which is life-saving therapy and better survival benefit compared to being on dialysis in end-stage kidney disease population with a high mortality risk.
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