Chronic respiratory disease: an unrecognized risk factor in dialysis

Couchoud, Cécile; Béchade, Clémence; Bemrah, Abdelkader; Delarozière, Jean-Christophe; Gadrey, Jean

doi:10.1093/ndt/gfx087

Cited by 5 publications

(5 citation statements)

References 31 publications

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“…Comorbidities and outcomes were identified using ICD codes, but they have not been validated in this EHR. 48 Our analysis did not adjust for all factors that can influence both acid-base status and outcomes, including dietary intake (protein and fruits/vegetables 49 , 50 ), respiratory disorders (other than COPD which is included in the CCI), 51 diuretics, and other covariates that may influence both serum bicarbonate and cardiovascular risk (eg, smoking, blood pressure, 52 and statins 53 ). Metabolic acidosis was only assessed at baseline and was not modeled as a time-varying covariate, which does not reflect longitudinal CKD care (ie, GFR decline, treatment with diuretics, and oral alkali).…”

Section: Discussionmentioning

confidence: 99%

Metabolic Acidosis and Cardiovascular Disease in CKD

Collister

Ferguson

Funk³

et al. 2021

Kidney Medicine

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Section: Discussionmentioning

confidence: 99%

Metabolic Acidosis and Cardiovascular Disease in CKD

Collister

Ferguson

Funk³

et al. 2021

Kidney Medicine

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“…This is similar to existing evidence that suggests patients with ESRD with a diagnosis of COPD or after a renal transplant carry a greater risk of infection, death, and repeated hospitalization, which increase the risk for graft failure. 12 Additionally, if nocardial infection presented as a brain abscess, there was an association with an increased risk for graft failure. The association with graft failure could be due to the severity of the infection, the nature of the therapy required, or the emphasis on decreasing immunosuppression due to severe infection.…”

Section: Discussionmentioning

confidence: 99%

Nocardiosis in Renal Transplant Patients

Gibson

Yang

Waller

et al. 2022

Journal of Investigative Medicine

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Renal transplant patients are immunosuppressed and are at increased risk of opportunistic infections, including Nocardia infection. In renal transplant patients, information on the incidence and risk factors associated with nocardiosis is limited. To address the incidence and risk factors associated with nocardiosis in a large renal transplant population, we used the US Renal Data System (USRDS). Sequelae of allograft failure or rejection after infection were also examined. Demographics, clinical risk factors, Nocardia diagnosis, and allograft failure following Nocardia infection were queried in USRDS renal transplant patients using International Classification of Diseases, Ninth Revision (ICD-9) codes in billing claims and Centers for Medicare and Medicaid Services Form 2728. Generalized linear models were used to determine the risk factors associated with nocardiosis, and Cox proportional hazards models were used to examine the association of risk factors with graft failure among patients with Nocardia infection. Of 203,233 renal transplant recipients identified from 2001 to 2011, 657 (0.32%) were diagnosed with Nocardia infection. Pneumonia was the most frequent presentation (15.2%), followed by brain abscess (8.4%). Numerous factors associated with increased Nocardia infection included age >65 years (OR=2.10, 95% CI 1.71 to 2.59), history of transplant failure (OR=1.28, CI 1.02 to 1.60) or history of rejection (OR=4.83, CI 4.08 to 5.72), receipt of a deceased donor transplant (OR=1.23, CI 1.03 to 1.46), and treatment with basiliximab (OR=1.25, CI 1.00 to 1.55), cyclosporine (OR=1.30, CI 1.03 to 1.65), tacrolimus (OR=2.45, CI 2.00 to 3.00), or thymoglobulin (OR=1.89, CI 1.59 to 2.25). In patients with nocardiosis administration of antithymocyte globulin (HR=2.76), chronic obstructive pulmonary disease (HR=2.47), and presentation of Nocardia infection with brain abscess (HR=1.85) were associated with an increased risk of graft failure. This study provides new information to enhance early recognition and targeted treatment of nocardiosis in renal transplant patients.

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“…CRF is also associated with premature death in dialysis. 15,16 However, whereas cardiac evaluation has been the subject of many studies and has given rise to several recommendations, few have focused on respiratory assessment before transplantation. Accordingly, chronic respiratory failure is wrongly identified and probably underreported.…”

Section: Discussionmentioning

confidence: 99%

“…Chronic respiratory failure is a major, although underreported, risk factor for early death after transplantation. CRF is also associated with premature death in dialysis 15,16 . However, whereas cardiac evaluation has been the subject of many studies and has given rise to several recommendations, few have focused on respiratory assessment before transplantation.…”

Section: Discussionmentioning

confidence: 99%

A simple score to predict early death after kidney transplantation

Bamoulid

Frimat

Courivaud

et al. 2020

Eur J Clin Investigation

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Background: Few studies have focused on risk stratification for premature death after transplantation. However, stratification of individual risk is an essential step in personalized care. Material and methods: We have developed a risk score of early post-transplant death (ORLY score) in a prospective multicentre cohort including 942 patients and validated our model in a retrospective independent replication cohort including 874 patients. Results: 60 patients (6.4%) from the prospective cohort died during the first threeyear post-transplant. Age, male gender, diabetes, dialysis duration and chronic respiratory failure were associated with early post-transplant death. The multivariable model exhibited good discrimination ability (C-index = 0.78, 95%CI [0.75-0.81]). ORLY score highly predicted early death after transplantation (1.34; 95%CI, 1.22 to 1.48 for each increase of 1 point in score; P < .001). The predictive value of the score in the validation cohort was close to that observed in the experimental cohort (1.41; 95%CI, 1.27 to 1.56 for each increase of 1 point in score; P < .001). Merging the two cohorts, four categories of risk could be individualized: low, 0-5 (n = 522, mean risk, 1%); intermediate, 6-7 (n = 739, mean risk 4.7%); moderate, 8-10 (n = 429, mean risk 10%); and high risk 11-15 (n = 132, mean risk 19%). Conclusions: The ORLY score discriminates patients with high risk of early death.

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Chronic respiratory disease: an unrecognized risk factor in dialysis

Cited by 5 publications

References 31 publications

Metabolic Acidosis and Cardiovascular Disease in CKD

Metabolic Acidosis and Cardiovascular Disease in CKD

Nocardiosis in Renal Transplant Patients

A simple score to predict early death after kidney transplantation

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