Quality of Life in Adult Transplant Recipients More than 15 Years after Kidney Transplantation

Neipp, Michael; Karavul, Behya; Jackobs, Steffan; Vilsendorf, Andreas Meyer zu; Richter, Nicolas; Becker, Thomas; Schwarz, Anke; Klempnauer, J.

doi:10.1097/01.tp.0000226070.74443.fb

Cited by 126 publications

(128 citation statements)

References 13 publications

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“…This is supported by cross-sectional studies which found that patients are less fatigued after kidney transplantation compared to patients before transplantation [5,6]. Even though fatigue seems to decrease after kidney transplantation, sparse studies indicate that kidney transplant recipients (KTRs) experience more fatigue than healthy controls [7,8]. Rodrigue et al [6] even classified 59% of recipients with high fatigue severity, based on an earlier defined cutoff score for clinically relevant fatigue determined in a sample of healthy women [9].…”

Section: Introductionmentioning

confidence: 61%

Severe fatigue after kidney transplantation: a highly prevalent, disabling and multifactorial symptom

et al. 2013

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SummaryFatigue is a common symptom of patients with chronic kidney disease, but seldom investigated after transplantation. We determined the prevalence, impact and related factors of severe fatigue in kidney transplant recipients (KTRs). Medical records and questionnaires were used to assess kidney function, donor characteristics, fatigue (Checklist Individual Strength), functional impairments (Sickness Impact Profile), work status, body mass index (BMI), pain, depressive symptoms, social support and sleeping problems in 180 participating KTRs. KTRs were compared with sex-and age-matched population-based controls. KTRs were significantly more often severely fatigued (39%) compared to matched controls (22%; P = 0.001). Severely fatigued KTRs had significantly more functional impairments than nonseverely fatigued recipients (effect size ≥ 0.7) P < 0.001, and less often a paid job (27% vs. 48%, P = 0.005). Univariate analysis showed that severely fatigued KTRs received more often a kidney from a deceased donor, had a higher BMI, more pain, discrepancy in social support, depressive symptoms and sleeping problems. In a multivariate analysis (n = 151) the latter two associations remained significant. Severe fatigue is a highly prevalent and disabling symptom in KTRs. Moreover, severe fatigue after kidney transplantation is more strongly related to behavioural and psychosocial factors than specific transplantation-related factors. Findings have implications for fatigue management.

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Section: Introductionmentioning

confidence: 61%

Severe fatigue after kidney transplantation: a highly prevalent, disabling and multifactorial symptom

et al. 2013

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“…19 Thus, exploration of better ways of informing patients about KT, particularly older adults, is needed, especially as indications for transplantation expand [20][21][22] and survival and quality of life improve after transplantation. [23][24][25][26][27] Finally, interventions to improve information disclosure and patient-provider communication may be useful in discussion of transplantation with patients initiating hemodialysis, because these have shown benefit in patient comprehension of treatment options, risks, and benefits in other clinical settings. 8 …”

Section: Discussionmentioning

confidence: 99%

Patient- and Provider-Reported Information about Transplantation and Subsequent Waitlisting

Salter

Orandi²,

McAdams‐DeMarco³

et al. 2014

Journal of the American Society of Nephrology

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Because informed consent requires discussion of alternative treatments, proper consent for dialysis should incorporate discussion about other renal replacement options including kidney transplantation (KT). Accordingly, dialysis providers are required to indicate KT provision of information (KTPI) on CMS Form-2728; however, provider-reported KTPI does not necessarily imply adequate provision of information. Furthermore, the effect of KTPI on pursuit of KT remains unclear. We compared providerreported KTPI (Form-2728) with patient-reported KTPI (in-person survey of whether a nephrologist or dialysis staff had discussed KT) in a prospective ancillary study of 388 hemodialysis initiates. KTPI was reported by both patient and provider for 56.2% of participants, by provider only for 27.8%, by patient only for 8.3%, and by neither for 7.7%. Among participants with provider-reported KTPI, older age was associated with lack of patient-reported KTPI. Linkage with the Scientific Registry for Transplant Recipients showed that 20.9% of participants were subsequently listed for KT. Patient-reported KTPI was independently associated with a 2.95-fold (95% confidence interval [95% CI], 1.54 to 5.66; P=0.001) higher likelihood of KT listing, whereas provider-reported KTPI was not associated with listing (hazard ratio, 1.18; 95% CI, 0.60 to 2.32; P=0.62). Our findings suggest that patient perception of KTPI is more important for KT listing than provider-reported KTPI. Patient-reported and provider-reported KTPI should be collected for quality assessment in dialysis centers because factors associated with discordance between these metrics might inform interventions to improve this process.

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“…For many patients with ESRD, kidney transplantation (KT) improves both survival and quality of life [1][2][3][4] ; however, the organ supply is limited, and careful patient selection is required to ensure equitable access to transplantation (ATT) for patients who stand to derive a survival benefit from transplantation (SBT). Studies of factors influencing ATT have identified a number of subgroup disparities that may not be explained by poor SBT, including patients of lower socioeconomic status, 5,6 black patients, 5,7-10 and obese patients.…”

mentioning

confidence: 99%

Age and Comorbidities Are Effect Modifiers of Gender Disparities in Renal Transplantation

Segev

Kucirka

Oberai

et al. 2009

Journal of the American Society of Nephrology

126

118

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Women have less access to kidney transplantation than men, but the contributions of age and comorbidity to this disparity are largely unknown. We conducted a national cohort study of 563,197 patients with first-onset ESRD between 2000 and 2005. We used multivariate generalized linear models to evaluate both access to transplantation (ATT), defined as either registration for the deceased-donor waiting list or receiving a live-donor transplant, and survival benefit from transplantation, defined as the relative rate of survival after transplantation compared with the rate of survival on dialysis. We compared relative risks (RRs) between women and men, stratified by age categories and the presence of common comorbidities. Overall, women had 11% less ATT than men. When the model was stratified by age, 18-to 45-yr-old women had equivalent ATT to men (RR 1.01), but with increasing age, ATT for women declined dramatically, reaching a RR of 0.41 for those who were older than 75 yr, despite equivalent survival benefits from transplantation between men and women in all age subgroups. Furthermore, ATT for women with comorbidities was lower than that for men with the same comorbidities, again despite similar survival benefits from transplantation. This study suggests that there is no disparity in ATT for women in general but rather a marked disparity in ATT for older women and women with comorbidities. These disparities exist despite similar survival benefits from transplantation for men and women regardless of age or comorbidities.

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Quality of Life in Adult Transplant Recipients More than 15 Years after Kidney Transplantation

Cited by 126 publications

References 13 publications

Severe fatigue after kidney transplantation: a highly prevalent, disabling and multifactorial symptom

Severe fatigue after kidney transplantation: a highly prevalent, disabling and multifactorial symptom

Patient- and Provider-Reported Information about Transplantation and Subsequent Waitlisting

Age and Comorbidities Are Effect Modifiers of Gender Disparities in Renal Transplantation

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