Changing landscape of dialysis withdrawal in patients with kidney failure: Implications for clinical practice.

Dialysis withdrawal has become an accepted treatment option for patients with kidney failure and is one of the leading causes of death in patients receiving dialysis in high-income countries. Despite its increasing acceptance, dialysis withdrawal currently lacks a clear, consistent definition. The processes and outcomes of dialysis withdrawal have wide temporal and geographical variability, attributed to dialysis patient selection, influence from cultural, religious and spiritual beliefs, and availability of kidney replacement therapy and conservative kidney management.

Allograft and Patient Outcomes Between Indigenous and Nonindigenous Kidney Transplant Recipients.

Background: Kidney transplant outcomes of indigenous Australians are poorer compared with nonindigenous Australians, but it is unknown whether the type of acute rejection differs between these patient groups or whether rejection mediates the effect between ethnicity, death-censored graft failure (DCGF), and death with a functioning graft (DWFG).

Methods: Biopsy-proven acute rejection (BPAR) rates and types were compared between indigenous and nonindigenous recipients. The associations between ethnicity, BPAR, DCGF, and DWFG were examined using adjusted competing risk analyses, and mediation analysis was conducted to determine whether BPAR mediated the adverse effects between ethnicity and outcomes.

Cytomegalovirus burden improves a predictive model identifying measures of vascular risk in renal transplant recipients and healthy adults.

Cytomegalovirus (CMV) has been implicated in vascular pathologies and may warrant inclusion in cardiovascular predictive algorithms. We addressed this in healthy older adults and renal transplant recipients (RTR) as they retain a high burden of CMV. RTR (n  =  45) stable more than 2 years after transplantation and 58 age-matched healthy adults were assessed.

Deciphering Effects of Uncontrolled Cytomegalovirus Replication on Immune Responses in Cytomegalovirus DNA-Positive Renal Transplant Recipients.

Cytomegalovirus (CMV) is a highly prevalent virus and a common cause of morbidity in solid organ transplant patients. It is also known for its long-lasting imprint on the immune system, expanding populations of highly differentiated T cells and natural killer (NK) cells with novel phenotypes. However, it is unclear whether these cells mark success or failure in the management of an active infection.

A high burden of cytomegalovirus marks poor vascular health in transplant recipients more clearly than in the general population.

Objectives: Meta-analyses have now confirmed that persistent infections with cytomegalovirus (CMV) can accelerate the onset of diseases of ageing, notably cardiovascular pathologies. We address the circumstances in which the association may be strong enough to warrant intervention to reduce the viral burden.

Results: We compare markers of the burden of CMV with established indices of vascular pathology in healthy adults ( = 82) and in renal transplant recipients (RTR;  = 81).

The Relationship Between esentation and the Time of Initial Administration of Antibiotics With utcoes of erionitis in Peritoneal Dialysis Patients: The PROMPT Study.

Introduction: The impact of time to treatment on clinical outcome is an established precept in infectious disease but is not established in peritoneal dialysis-related peritonitis (PDRP).

Methods: In a prospective multicenter study of PDRP, symptom-to-contact time (SC), contact-to-treatment time (CT), defined as the time from health care presentation to initial antibiotic, and symptom-to-treatment time (ST) were determined.

Results: One hundred sixteen patients had 159 episodes of PDRP.