KDOQI US Commentary on the 2020 KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation

Abstract

Evaluation of patients for kidney transplant candidacy is a comprehensive process that involves a detailed assessment of medical and surgical issues, psychosocial factors, and patients' physical and cognitive abilities with an aim of balancing the benefits of transplantation and potential risks of surgery and long-term immunosuppression. There is considerable variability among transplant centers in their approach to evaluation and decision-making regarding transplant candidacy. The 2020 KDIGO (Kidney Disease: Improving Guidelines Outcome) clinical practice guideline on the evaluation and management of candidates for kidney transplantation provides practice recommendations that can serve as a useful reference guide to transplant professionals. The guideline, covering a broad range of topics, was developed by an international group of experts from transplant and nephrology through a review of literature published until May 2019. A work group of US transplant nephrologists convened by NKF-KDOQI (National Kidney Foundation-Kidney Disease Quality Initiative) chose key topics for this commentary with a goal of presenting a broad discussion to the US transplant community. Each section of this article has a summary of the key KDIGO guideline recommendations, followed by a brief commentary on the recommendations, their clinical utility, and potential implementation challenges. The KDOQI work group agrees broadly with the KDIGO recommendations but also recognizes and highlights the decision-making challenges that arise from lack of high-quality evidence and the need to balance equity with utility of organ transplantation.Because they are designed to reflect the views and recommendations of the responsible KDOQI Commentary work group and they are reviewed and approved by KDOQI and NKF leadership, KDOQI Commentaries are not peer reviewed by AJKD. This article was prepared by a KDOQI Commentary work group comprising the authors and chaired by Dr Sundaram Hariharan. It was reviewed and approved by the NKF Scientific Advisory Board and the KDOQI Chair and Vice Chairs.Complete author and article information provided before references.

Racial and Ethnic Disparities in Kidney Replacement Therapies Among Adults With Kidney Failure: An Observational Study of Variation by Patient Age

“…8 Younger patients are relatively more likely to undergo transplants, PD, and HHD than older patients 2 ; this is because older age is associated with several clinical contraindications for these preferred modalities and also because age informs patients' relative preferences among kidney failure treatment alternatives. [9][10][11] If racial and ethnic disparities in access to transplant, PD, and HHD persist across all ages, the apparent average disparities in treatment may be understated in analyses that do not effectively account for differences in age at kidney failure incidence.…”

A roadmap to parathyroidectomy for kidney transplant candidates

“…These new guidelines suggest measuring serum PTH at the time of transplant evaluation and not transplanting patients with severe SHPT until they are adequately treated (medically or surgically) as per the 2017 KDIGO CKD-MBD guidelines (2D) [ 38 ]. Nevertheless, in the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) US Commentary on the 2020 KDIGO guidelines on evaluation of candidates for KT, there is no comment on management of pre-KT parathyroidectomy [ 105 ].…”

National Estimates of Mental Health Needs Among Adults With Self-Reported CKD in the United States

“…Among adults with CKD or kidney failure, comorbid mental illness is associated with reduced treatment adherence and increased risk of hospitalization, readmission, and death. 6,10,11,35 Moreover, severe mental illness that impairs functioning is often found as a contraindication to transplantation and home dialysis, [12][13][14][15] which the Centers for Medicare and Medicaid Services (U.S. Department of Health and Human Services) aims to help adults with CKD use more often under ongoing payment and delivery reforms. 36,37 US leaders in nephrology and public health can look to national surveillance of MH need and use of MH treatment among US adults with self-reported CKD to help guide reforms in integrated kidney and MH care delivery.…”

“…Transplantation and home dialysis (peritoneal dialysis and home hemodialysis) are contraindicated for individuals with severe mental illness that impairs functioning. [12][13][14][15] Yet, these treatments are more cost-effective and associated with a better quality-of-life relative to conventional in-center hemodialysis. [16][17][18][19][20] Thus, patients with advanced CKD who receive inadequate support in managing MH conditions will often be considered unsuitable candidates for transplant or home dialysis treatment, leading to substantially increased cost of treatment and diminished flexibility and convenience for patients and their caregivers.…”

“…25,26 Calls for implementing such approaches in CKD care are increasingly common. 15,27 Despite the associations between comorbid MH conditions and outcomes for individuals with CKD and the consequences these conditions have for patients' courses of treatment, surveillance efforts are hindered by the absence of nationally representative data on the prevalence of MH conditions or MH treatment use among adults with CKD in the United States. Data including depression plus other MH conditions are particularly rare.…”