ABSTRACT
Kidney transplantation (KT) is the treatment of choice for patients with end-stage renal disease. KT recipients are considered a vulnerable patient population because of their dependence on expensive immunosuppression drugs from the time of transplantation until graft failure. Management of KT recipients is complex, and therefore requires a sustainable infrastructure that is equipped to provide reliable medical care and continued access to immunosuppressive drugs. This structure, especially in third-world countries, relies on elements that may be easily disrupted during times of armed conflict. This results in a decrease in KT rate and interruption in access to immunosuppressive drugs, which may lead to poor KT outcomes. This review summarizes our experiences and reviews other literature published regarding the status and management of KT recipients in Syrians as an example of an armed conflict zone.
Subject(s)
Kidney Failure, Chronic , Kidney Transplantation , Armed Conflicts , Humans , Immunosuppression Therapy , Kidney Failure, Chronic/surgery , Transplant RecipientsABSTRACT
Cardiovascular disease is the leading cause of the death in dialysis patients. Arteriovenous fistulas (AVFs) are associated with lower mortality and are viewed as the desired access option in most patients with advanced kidney disease needing dialysis. However, AVFs have significant and potentially deleterious effects on cardiac functions particularly in the setting of preexisting heart disease. This article provides a comprehensive and contemporary review to what is known about the impact of AVFs on: congestive heart failure, left ventricular hypertrophy, pulmonary hypertension, right ventricular dysfunction, coronary artery disease and valvular heart disease.
Subject(s)
Arteriovenous Shunt, Surgical/adverse effects , Heart Diseases/etiology , Kidney Failure, Chronic/therapy , Renal Dialysis , Blood Volume , Causality , Comorbidity , Coronary Artery Bypass , Disease Progression , Endothelium, Vascular/physiopathology , Heart Diseases/epidemiology , Heart Diseases/physiopathology , Hemodynamics , Humans , Hypertension, Pulmonary/epidemiology , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/physiopathology , Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/surgery , Kidney Transplantation , Risk Factors , Treatment OutcomeABSTRACT
BACKGROUND: Older patients with metastatic pancreatic cancer (mPC) are poorly represented in clinical trials. We compared patterns of care and outcomes of patients with mPC < and >65 yrs (Group 1 and Group 2, respectively) treated at Fox Chase Cancer Center (FCCC) to identify predictors of survival and better understand the treatment approaches. METHODS: Charts of 579 patients with mPC treated at FCCC from 2000 to 2010 were reviewed. Group 1 and Group 2 were compared with respect to baseline, treatment characteristics, and overall survival (OS) after diagnosis of metastatic disease. RESULTS: 299 patients in Group 1 (median age 57) and 280 patients in Group 2 (median age 73) were evaluated. Patients in Group 2 were less likely to receive any chemotherapy for mPC compared to Group 1 (65% vs 75%, p=0.001) and if treated were less likely to receive more than one agent (37% vs 53%, p<0.001). Survival was comparable between the two groups (p=0.16) and Charlson Co-morbidity Index did not emerge as a prognostic factor. Longer OS was associated with higher number of agents used in both groups (p<0.001). Liver metastases conferred worse survival (p=0.02) while lung metastases conferred better survival in both groups (p=0.002). CONCLUSIONS: Older mPC patients are less likely to receive chemotherapy and receive fewer agents yet have similar OS compared to younger patients. OS improves with increasing number of agents, supporting the use of combination chemotherapy in healthy older patients. Our findings encourage enrollment of older patients with mPC with good performance status onto clinical trials with stratification by site of metastases.
Subject(s)
Liver Neoplasms/secondary , Lung Neoplasms/secondary , Pancreatic Neoplasms/drug therapy , Pancreatic Neoplasms/mortality , Adult , Age Factors , Aged , Aged, 80 and over , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Pancreatic Neoplasms/pathology , Retrospective Studies , Treatment Outcome , United States/epidemiologyABSTRACT
Cardiovascular disease is the leading cause of the death in dialysis patients. Arteriovenous fistulas (AVFs) are associated with lower mortality and are viewed as the desired access option in most patients with advanced kidney disease needing dialysis. However, AVFs have significant and potentially deleterious effects on cardiac functions particularly in the setting of preexisting heart disease. This article provides a comprehensive and contemporary review to what is known about the impact of AVFs on: congestive heart failure, left ventricular hypertrophy, pulmonary hypertension, right ventricular dysfunction, coronary artery disease and valvular heart disease (AU)
La enfermedad cardiovascular es la principal causa de muerte en los pacientes dializados. Las fístulas arteriovenosas (FAV) se asocian a una menor mortalidad y se consideran la opción preferible de vía de acceso en la mayor parte de los pacientes con enfermedad renal avanzada que requieren diálisis. Sin embargo, las FAV tienen efectos importantes y potencialmente nocivos sobre las funciones cardíacas, en especial en presencia de una cardiopatía preexistente. En este artículo se presenta una revisión completa y actualizada de los conocimientos existentes sobre las repercusiones que tienen las FAV en los trastornos de: insuficiencia cardiaca congestiva, hipertrofia ventricular izquierda, hipertensión pulmonar, disfunción ventricular derecha, enfermedad coronaria y valvulopatías cardíacas (AU)
