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1.
Transplant Proc ; 39(4): 901-3, 2007 May.
Article in English | MEDLINE | ID: mdl-17524845

ABSTRACT

OBJECTIVES: Although "in-hospital mortality" for several post-renal transplantation complications has been reported in various studies, there is no single published single-center study that compares their hospital mortality rates. We sought to rank the primary diagnoses post-renal transplantation by means of in-hospital mortality. METHODS: We selected 404 consecutive rehospitalizations following kidney transplantation from 2003 to 2005. The causes of rehospitalization were categorized into infection, allograft rejection, surgical complication, cerebrovascular accidents (CVA), malignancy, medication complications, and miscellaneous. Fatality was defined as the relative frequency of death due to the same cause among all admissions. RESULTS: The mortality rate (MR) was 5.7%. From the 23 cases of death, 17 (74%) had a functioning kidney at the time of death. The MR was 40% for CVA, 14.3% for surgical complications, 11.1% for miscellaneous, 5.3% for drug complications, 7% for infections, and 4.8% for graft rejection (P=.002). No death was observed among cases with a diagnosis of malignancy or nephrolithiasis. Inpatient mortality was higher among those with more than one diagnosis at admission: 42.9% for more than two diagnosis, 7.1% for those with two diagnosis, and 4.2% for those with one diagnosis (P=.001). CONCLUSIONS: The in-patient mortality ranking is totally different from the ranking of causes of death in renal recipients. In other words, infection is the leading cause of death due to high incidence, and not high fatality. More rare complications, including CVA and surgical complications, are more often fatal.


Subject(s)
Hospital Mortality , Kidney Diseases/mortality , Kidney Diseases/surgery , Kidney Transplantation/mortality , Postoperative Complications/mortality , Adult , Demography , Female , Humans , Iran , Male , Middle Aged , Postoperative Complications/classification
2.
Transplant Proc ; 39(4): 1122-5, 2007 May.
Article in English | MEDLINE | ID: mdl-17524909

ABSTRACT

BACKGROUND: While the association between chronic pain and high health care utilization is a known issue in the general population, this relation has not been well studied among kidney transplantation patients. METHODS: The subjects were first-time kidney transplant recipients engrafted between 2003 and 2006 and 6 months to 5 years postoperatively. Using SF-36 Bodily Pain Scale, patients were categorized in three groups: group I, those with scores over 66.6; group II, between 66.6 and 33.3; and group III, over 33.3. The subjects' health care utilization was prospectively assessed by recording the number of hospital admission days and the frequency of home nurse visits, outpatient physician visits, and emergency department visits for any medical reason in a 6-month period. RESULTS: A stepwise increase in the frequency of patients admitted to the hospital (P=.017), and those referred to emergency departments (P=.007) was correlated with greater severity of pain in the three groups. However, the frequency of patients having outpatient physician visits (P=.30) or home nurse visits (P=.387) did not vary significantly. Similarly, with increased pain severity, an increase was observed in the number of emergency department visits (P=.005) and duration of hospital stays (P=.049), but not in the number of home nurse (P=.890) or physician visits (P=.112). CONCLUSION: The severity of pain seems to increase the amount of health care use among kidney transplant patients. To minimize associated costs, appropriate pain rehabilitation programs are suggested.


Subject(s)
Emergency Service, Hospital/statistics & numerical data , Hospitalization/statistics & numerical data , Kidney Transplantation/physiology , Pain, Postoperative/physiopathology , Adult , Aged , Chronic Disease , Cross-Sectional Studies , Female , Humans , Iran , Male , Marital Status , Middle Aged , Pain Measurement , Pain, Postoperative/epidemiology , Prevalence , Retrospective Studies
3.
Transplant Proc ; 39(4): 1126-9, 2007 May.
Article in English | MEDLINE | ID: mdl-17524910

ABSTRACT

BACKGROUND: Chronic pain is prevalent in end-stage renal disease patients undergoing chronic hemodialysis. We do not fully know the intensity of chronic pain experienced by kidney recipients in comparison to those on chronic hemodialysis and healthy controls. Moreover, the effect of chronic pain on kidney recipients' health-related quality of life (HRQoL) is yet to be comprehensively addressed. We designed this study to find an answer to these questions. METHODS: In this case control study, we studied 205 kidney recipients, 69 hemodialysis patients, and 100 healthy controls, who were matched for age, sex, monthly family income, and educational level. The patients were evaluated for the intensity of chronic pain by Visual Analogue Scale (VAS). HRQoL was measured with Short Form 36 (SF-36) in the kidney recipients. Chronic pain intensity was compared in the study groups, and in the kidney recipients the correlation between SF-36 subscores and severity of pain was assessed. RESULTS: Severity of pain in the kidney recipients was lower than the hemodialysis patients, but more than the healthy controls (P=.001). The VAS pain score negatively correlated with the scores of SF- 36 total (r=-.329, P=01), mental health (r=-.190, P=07), physical health (r=-.275, P=.001), physical function (r=-.339, P=.001), role limitation due to physical problems (r=-.478, P=.001), role limitation due to emotional problems (r=-.326, P=.001), and bodily pain (r=-.894, P=.001). DISCUSSION: The intensity of chronic pain experienced by the kidney recipients is less than that experienced by patients under chronic hemodialysis, but higher than healthy subjects. Focusing on chronic pain as a cause of post-renal transplantation morbidity is expected to improve post-renal transplantation quality of life.


Subject(s)
Health Status , Kidney Transplantation/physiology , Pain/physiopathology , Quality of Life , Adult , Aged , Case-Control Studies , Emotions , Female , Humans , Kidney Failure, Chronic/etiology , Kidney Failure, Chronic/physiopathology , Kidney Failure, Chronic/surgery , Kidney Failure, Chronic/therapy , Male , Marital Status , Mental Health , Middle Aged , Pain/psychology , Pain Measurement , Reference Values , Renal Dialysis , Social Behavior , Surveys and Questionnaires
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