Lung transplantation following coronary artery bypass surgery-improved outcomes following single-lung transplant.

Background: Prior coronary artery bypass grafting (CABG) has been a contraindication to lung transplantation (LTx) because of disease severity and technical considerations. Although patients increasingly are being referred for and receiving LTx, whether it should remain a contraindication is unknown. We sought to define the prevalence of LTx after CABG and determine the effect on outcomes.

Ventricular assist devices or inotropic agents in status 1A patients? Survival analysis of the United Network of Organ Sharing database.

Background: Improved outcomes as well as lack of donor hearts have increased the use of ventricular assist devices (VADs), rather than inotropic support, for bridging to transplantation. Recognizing that organ allocation in the highest status patients remains controversial, we sought to compare outcomes of patients with VADs and those receiving advanced medical therapy.

Methods: The United Network of Organ Sharing (UNOS) database was used to compare survival on the waiting list and posttransplantation survival in status 1A heart transplantation patients receiving VADs or high-dose/dual inotropic therapy or an intraaortic balloon pump( IABP), or both.

Impact of ventricular assist device complications on posttransplant survival: an analysis of the United network of organ sharing database.

Background: Although current left ventricular assist device (LVAD) technology has proven more durable than first-generation devices, all mechanical devices are prone to complications that can elevate patient acuity before transplantation. LVAD patients with complications intuitively carry a higher risk profile than other status 1A LVAD patients who are generally stable and use their 30 days of clinically stable status 1A time. We sought to determine if the presence or absence of complications in status 1A LVAD patients at the time of transplant influenced survival after transplant.

Associations of serum skeletal alkaline phosphatase with elevated C-reactive protein and mortality.

Background And Objectives: Higher serum total alkaline phosphatase (AP) levels are associated with increased serum C-reactive protein (CRP) levels and mortality in the general and CKD populations. It is unclear to what extent these associations are related to bone disease.

Design, Setting, Participants, & Measurements: In a nationally representative sample of 10,707 adult participants from the 1999-2004 National Health and Nutrition Examination Survey, serum nonskeletal AP levels were estimated from the measured serum skeletal and total AP levels.

Effect of donor kidney volume on recipient outcome: does the "dose" matter?

Background: The effect of donor kidney volume on recipient kidney function has not been fully evaluated.

Methods: We performed a prospective analysis of 125 consecutive living kidney donor/recipient pairs. Donor kidney volume was calculated from pretransplantation computed tomography angiograms using a three-dimensional computerized volume method.

Education is associated with reduction in racial disparities in kidney transplant outcome.

In this study, we hypothesized that higher level of education might be associated with reduced racial disparities in renal transplantation outcomes. We used data from the United States Renal Data System (September 1, 1990-September 1, 2007) (n=79,223) and analyzed two outcomes, graft loss and recipient mortality, using Cox models. Compared with whites, African Americans had increased risk of graft failure (HR, 1.

Cognitive function and the risk of death in chronic kidney disease.

Background And Aims: Cognitive impairment is a risk factor for death in dialysis patients and the general population. We sought to determine if cognitive impairment is associated with death in people with non-dialysis-dependent chronic kidney disease (CKD), and if so, whether this relationship is greater in the CKD population compared to the general population.

Methods: National Health and Nutrition Examination Survey-III participants older than 60 years were asked to subtract 3 from 20 five times and to perform immediate and delayed recall of three items.

Improved survival in heart transplant patients living at high altitude.

Objective: Higher altitudes are associated with chronic hypoxia and elevated pulmonary vascular resistance, both potentially detrimental to patients requiring heart transplantation. The purpose of the present study was to determine whether altitude negatively affects survival among patients undergoing heart transplantation.

Methods: The United Network of Organ Sharing database for adult patients undergoing heart transplantation from 1990 to 2008 (n = 36,529) was analyzed, and each patient was assigned an altitude according to their home ZIP code.

Social adaptability index predicts kidney transplant outcome: a single-center retrospective analysis.

Background: Social adaptability index (SAI) is the composite index of socioeconomic status based upon employment status, education level, marital status, substance abuse and income. It has been used in the past to define populations at higher risk for inferior clinical outcomes. The objective of this retrospective study was to evaluate the association of the SAI with renal transplant outcome.

High dietary fiber intake is associated with decreased inflammation and all-cause mortality in patients with chronic kidney disease.

Chronic kidney disease is considered an inflammatory state and a high fiber intake is associated with decreased inflammation in the general population. Here, we determined whether fiber intake is associated with decreased inflammation and mortality in chronic kidney disease, and whether kidney disease modifies the associations of fiber intake with inflammation and mortality. To do this, we analyzed data from 14,543 participants in the National Health and Nutrition Examination Survey III.

Dietary phosphorus intake and mortality in moderate chronic kidney disease: NHANES III.

Background: Dietary phosphorus intake is usually restricted in dialysis patients but the associations of dietary phosphorus intake with mortality in moderate chronic kidney disease (CKD) are unknown. Therefore, we examined these associations in National Health and Nutrition Examination Survey III.

Methods: Dietary phosphorus intake was estimated from 24-h dietary recalls administered by trained personnel.

Predicting three-year kidney graft survival in recipients with systemic lupus erythematosus.

Predicting the outcome of kidney transplantation is important in optimizing transplantation parameters and modifying factors related to the recipient, donor, and transplant procedure. As patients with end-stage renal disease (ESRD) secondary to lupus nephropathy are generally younger than the typical ESRD patients and also seem to have inferior transplant outcome, developing an outcome prediction model in this patient category has high clinical relevance. The goal of this study was to compare methods of building prediction models of kidney transplant outcome that potentially can be useful for clinical decision support.

Associations of serum alkaline phosphatase with metabolic syndrome and mortality.

Background: Recent data suggest that elevated serum alkaline phosphatase levels are associated with increased mortality, but the mechanisms for this association are unknown. As metabolic syndrome is associated with higher serum alkaline phosphatase levels, we examined the joint association of mortality with metabolic syndrome and serum alkaline phosphatase levels in the US general population.

Methods: Retrospective observational study of 15,234 adult participants in the National Health and Nutrition Examination Survey III.

Validating prediction models of kidney transplant outcome using single center data.

Prediction of kidney transplant outcome represents an important and clinically relevant problem. Although several prediction models have been proposed based on large, national collections of data, their utility at the local level (where local data distributions may differ from national data) remains unclear. We conducted a comparative analysis that modeled the outcome data of transplant recipients in the national US Renal Data System (USRDS) against a representative local transplant dataset at the University of Utah Health Sciences Center, a regional transplant center.

Social Adaptability Index predicts access to kidney transplantation.

Identifying the group of subjects prone to disparities in access to kidney transplantation is important for developing potential interventions. Data from the United States Renal Data System (January 1, 1990-September 1, 2007; n = 3407) were used to study association between the Social Adaptability Index (SAI; based upon employment, marital status, education, income, and substance abuse) and outcomes (time to being placed on the waiting list and time to being transplanted once listed). Patients were 56.

Social Adaptability Index: application and outcomes in a dialysis population.

Background: Patient groups associated with disparities in health care are usually defined on the basis of race, gender or geographic location. Social Adaptability Index (SAI), calculated based on education, marital status, income, employment and substance abuse, has been strongly associated with clinical outcome in other patient populations and may be used to identify individuals at risk. We used data from the United States Renal Data System to evaluate the role of SAI in survival of patients on dialysis.

Effect of education on racial disparities in access to kidney transplantation.

Higher education level might result in reduced disparities in access to renal transplantation. We analyzed two outcomes: (i) being placed on the waiting list or transplanted without listing and (ii) transplantation in patients who were placed on the waiting list. We identified 3224 adult patients with end-stage renal disease (ESRD) in United States Renal Data System with education information available (mean age of ESRD onset of 57.

Higher serum bicarbonate levels within the normal range are associated with better survival and renal outcomes in African Americans.

Recent studies suggest that correcting low serum bicarbonate levels may reduce the progression of kidney disease; however, few patients with chronic kidney disease have low serum bicarbonate. Therefore, we examined whether higher levels of serum bicarbonate within the normal range (20-30 mmol/l) were associated with better kidney outcomes in the African American Study of Kidney Disease and Hypertension (AASK) trial. At baseline and during follow-up of 1094 patients, the glomerular filtration rates (GFR) were measured by iothalamate clearances and events were adjudicated by the outcomes committee.

Serum alkaline phosphatase levels associate with elevated serum C-reactive protein in chronic kidney disease.

High serum alkaline phosphatase concentrations are associated with elevated serum C-reactive protein (CRP) levels in the general population. To examine whether this association is independent of serum vitamin D levels or modified in chronic kidney disease (CKD), we determined if such associations exist using data from the National Health and Nutrition Examination Survey III of 14,420 adult participants in which 5.7% had CKD (defined as estimated glomerular filtration rate < 60 ml/min per 1.

Timing of dialysis initiation and survival in ESRD.

Background And Objectives: The optimal time of dialysis initiation is unclear. The goal of this analysis was to compare survival outcomes in patients with early and late start dialysis as measured by kidney function at dialysis initiation.

Design, Setting, Participants, & Measurements: We performed a retrospective analysis of patients entering the U.

Physical activity and mortality in chronic kidney disease (NHANES III).

Background And Objectives: Chronic kidney disease (CKD) is associated with impaired physical activity. However, it is unclear whether the associations of physical activity with mortality are modified by the presence of CKD. Therefore, we examined the effects of CKD on the associations of physical activity with mortality.

The changing phenotype of academic nephrology -- a future at risk?

Background And Objectives: Academic nephrology faces increasing challenges in faculty hiring and development. However, it is unknown how these pressures have affected the number and demographics of academic nephrologists.

Design, Setting, Participants, & Measurements: Using the Association of American Medical Colleges Faculty Roster database, changes were analyzed in MD nephrology, as well as other internal medicine subspecialty, faculty from 1998 to 2008.

Serum alkaline phosphatase and mortality in African Americans with chronic kidney disease.

Background And Objectives: Serum alkaline phosphatase has been associated with increased mortality in hemodialysis patients but its associations with mortality in chronic kidney disease (CKD) stages III and IV are unknown. Design, settings, participants & measurements: In 1094 participants in the African-American Study of Kidney Disease and Hypertension (AASK) database, the associations of serum alkaline phosphatase with mortality and cardiovascular events were examined in Cox models.

Results: The mean (+/-SD) age was 54 +/- 11 yr, and 61% were men.

Volume indicators and left ventricular mass during aggressive volume management in patients on thrice-weekly hemodialysis.

Objective: We examined the relationship between various volume indicators, i.e. multifrequency bioelectric impedance analysis (BIA), predialysis serum N-terminus-pro-brain natriuretic peptide (NT[-]pro[-]BNP) levels, and inferior vena cava diameter, and left ventricular mass index (LVMI) at baseline and with rigorous volume management on thrice-weekly hemodialysis.

The role of the economic environment in kidney transplant outcomes.

The relationship between global economic indicators and kidney allograft and patient survival is unknown. To investigate possible relationships between the two, we analyzed kidney transplant recipients receiving transplants between January of 1995 and December of 2002 (n = 105,181) in the USA using Cox regression models. We found that: The Dow Jones Industrial Average had a negative association with outcome at one year post-transplant (HR 1.