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1.
Orv Hetil ; 152(7): 259-66, 2011 Feb 13.
Article in Hungarian | MEDLINE | ID: mdl-21296735

ABSTRACT

Sleep disorders are also considered as significant chronic disorders, as their physiological and psycho-social consequences are well documented. Restless legs syndrome has high prevalence, as it occurs in 5-10 % of the general population. Since clinical presentation is not well appreciated by many of the health care professionals, only a small proportion of the patients with restless legs syndrome is diagnosed and treated. The consequences of disease, however, are not negligible. The majority of the patients suffer from insomnia, impaired daytime functioning and quality of life. Although, restless legs syndrome is frequently characterized as a sleep disorder, it does not only influence sleep but also the daytime functioning of the patients. Additionally, restless legs syndrome causes not only subjective complaints and sleep disruption, but it is also associated with cardiovascular disorders.


Subject(s)
Restless Legs Syndrome , Analgesics, Opioid/metabolism , Cardiovascular Diseases/etiology , Chronic Disease , Dopamine/metabolism , Humans , Hungary/epidemiology , Iron/metabolism , Prevalence , Quality of Life , Restless Legs Syndrome/complications , Restless Legs Syndrome/diagnosis , Restless Legs Syndrome/epidemiology , Restless Legs Syndrome/metabolism , Restless Legs Syndrome/psychology , Restless Legs Syndrome/therapy , Sleep Initiation and Maintenance Disorders/diagnosis , Sleep Wake Disorders/diagnosis
2.
Int Urol Nephrol ; 43(1): 215-24, 2011 Mar.
Article in English | MEDLINE | ID: mdl-20058186

ABSTRACT

INTRODUCTION: Dialysis treatment prior to transplantation may contribute to premature mortality and graft loss in kidney-transplanted patients. In this prevalent cohort study (TransQol-HU Study), we analyzed the association between pre-transplant dialysis duration versus mortality and death-censored graft loss in kidney-transplanted patients. METHODS: Data from 926 kidney-transplanted patients followed at a single outpatient transplant center were analyzed. Socio-demographic parameters, laboratory data, medical history, donor characteristics and information on co-morbidities were collected at baseline. Data on 5-year outcome (graft loss, mortality) were collected. RESULTS: In multivariate analyses, pre-transplant dialysis duration was an independent risk factor for mortality (HR(for each month increase) = 1.011; 95% CI: 1.005-1.016) and also for death-censored graft loss (HR(for each month increase) = 1.008; 95% CI: 1.001-1.015) after adjustment for several co-variables. In the multivariate model, patients with less than 1 year (HR = 0.498; 95% CI: 0.302-0.820; P = 0.006) and 1-3 years (HR = 0.577; 95% CI: 0.371-0.899; P = 0.015) of pre-transplant dialysis had significantly better survival after transplantation compared to those with more than 3 years on dialysis. CONCLUSIONS: These findings add further strength to existing evidence about the significant association between longer pre-transplant dialysis duration and poor outcome in kidney-transplanted patients.


Subject(s)
Graft Rejection/epidemiology , Kidney Failure, Chronic/epidemiology , Kidney Transplantation , Preoperative Care/methods , Renal Dialysis/methods , Adolescent , Adult , Aged , Female , Follow-Up Studies , Graft Rejection/prevention & control , Humans , Hungary/epidemiology , Kidney Failure, Chronic/mortality , Male , Middle Aged , Prevalence , Retrospective Studies , Risk Factors , Survival Rate/trends , Time Factors , Treatment Outcome , Young Adult
3.
Nephron Clin Pract ; 117(2): c127-34, 2011.
Article in English | MEDLINE | ID: mdl-20693814

ABSTRACT

BACKGROUND: Although it is a known predictor of mortality, there is a relative lack of recent information about anaemia in kidney transplant recipients. Thus, we now report data about the prevalence and management of post-transplant anaemia (PTA) in Europe 5 years after the TRansplant European Survey on Anemia Management (TRESAM) study. METHODS: In a cross-sectional study enrolling the largest number of patients to date, data were obtained from 5,834 patients followed at 10 outpatient transplant clinics in four European countries using the American Society of Transplantation anaemia guideline. RESULTS: More than one third (42%) of the patients were anaemic. The haemoglobin (Hb) concentration was significantly correlated with the estimated glomerular filtration rate (eGFR) (r = 0.4, p < 0.001). In multivariate analysis, eGFR, serum ferritin, age, gender, time since transplantation and centres were independently and significantly associated with Hb. Only 24% of the patients who had a Hb concentration <110 g/l were treated with an erythropoiesis-stimulating agent. The prevalence of anaemia and also the use of erythropoiesis-stimulating agents were significantly different across the different centres, suggesting substantial practice variations. CONCLUSIONS: PTA is still common and under-treated. The prevalence and management of PTA have not changed substantially since the TRESAM survey.


Subject(s)
Anemia/mortality , Anemia/prevention & control , Kidney Failure, Chronic/mortality , Kidney Failure, Chronic/rehabilitation , Kidney Transplantation/mortality , Comorbidity , Europe/epidemiology , Female , Humans , Male , Middle Aged , Prevalence , Risk Assessment , Risk Factors , Survival Analysis , Survival Rate , Treatment Outcome
4.
Nephrol Dial Transplant ; 26(3): 1058-65, 2011 Mar.
Article in English | MEDLINE | ID: mdl-20685829

ABSTRACT

BACKGROUND: Kidney transplantation is believed to improve health-related quality of life (HRQoL) of patients requiring renal replacement therapy (RRT). Recent studies suggested that the observed difference in HRQoL between kidney transplant recipients (Tx) vs patients treated with dialysis may reflect differences in patient characteristics. We tested if Tx patients have better HRQoL compared to waitlisted (WL) patients treated with dialysis after extensive adjustment for covariables. METHODS: Eight hundred and eighty-eight prevalent Tx patients followed at a single outpatient transplant clinic and 187 WL patients treated with maintenance dialysis in nine dialysis centres were enrolled in this observational cross-sectional study. Data about socio-demographic and clinical parameters, self-reported depressive symptoms and the most frequent sleep disorders assessed by self-reported questionnaires were collected at enrollment. HRQoL was assessed by the Kidney Disease Quality of Life Questionnaire. RESULTS: Patient characteristics were similar in the Tx vs WL groups: the proportion of males (58 vs 60%), mean ± SD age (49 ± 13 vs 49 ± 12) and proportion of diabetics (17 vs 18%), respectively, were all similar. Tx patients had significantly better HRQoL scores compared to the WL group both in generic (Physical function, General health perceptions, Energy/fatigue, Emotional well-being) and in kidney disease-specific domains (Symptoms/problems, Effect- and Burden of kidney disease and Sleep). In multivariate regression models adjusting for clinical and socio-demographic characteristics, sleep disorders and depressive symptoms, the modality of RRT (WL vs Tx) remained independently associated with three (General health perceptions, Effect- and Burden of kidney disease) out of the eight HRQoL dimensions analysed. CONCLUSIONS: Kidney Tx recipients have significantly better HRQoL compared to WL dialysis patients in some, but not all, dimensions of quality of life after accounting for differences in patient characteristics. Utilizing multidimensional disease-specific questionnaires will allow better understanding of treatment, disease and patient-related factors potentially affecting quality of life in patients with chronic medical conditions.


Subject(s)
Depression/diagnosis , Kidney Failure, Chronic/therapy , Kidney Transplantation , Quality of Life , Renal Dialysis , Sleep Wake Disorders/diagnosis , Waiting Lists , Cross-Sectional Studies , Female , Glomerular Filtration Rate , Health Status , Humans , Male , Middle Aged , Prognosis , Renal Replacement Therapy , Risk Factors
5.
Am J Kidney Dis ; 56(1): 102-11, 2010 Jul.
Article in English | MEDLINE | ID: mdl-20471737

ABSTRACT

BACKGROUND: Chronic protein-energy wasting, termed malnutrition-inflammation complex syndrome, is frequent in patients with chronic kidney disease and is associated with anemia, morbidity, and mortality in patients on maintenance dialysis therapy. The Malnutrition-Inflammation Score (MIS) recently has been developed and validated in dialysis patients. STUDY DESIGN: Observational cross-sectional study. SETTING & PARTICIPANTS: 993 prevalent kidney transplant recipients. PREDICTOR: MIS computed from change in body weight, dietary intake, gastrointestinal symptoms, functional capacity, comorbid conditions, decreased fat store/Systemic Global Assessment, signs of muscle wasting/Systemic Global Assessment, body mass index, serum albumin level, and serum transferrin level. OUTCOMES: Markers of inflammation and malnutrition, including serum C-reactive protein, interleukin 6, tumor necrosis factor alpha, serum leptin, prealbumin, body mass index, and abdominal circumference. The relationship was modeled by using structural equation models. RESULTS: Mean age was 51 +/- 13 years, 57% were men, and 21% had diabetes. Median time from transplant was 72 months. MIS significantly correlated with abdominal circumference (r = -0.144), serum C-reactive protein level (r = 0.094), serum interleukin 6 level (r = 0.231), and serum tumor necrosis factor alpha level (r = 0.102; P < 0.01 for all). A structural equation model with 2 latent variables (malnutrition and inflammation factor) showed good fit to the observed data. LIMITATIONS: Single-center study, lack of information about vascular access, presence of nonfunctioning kidney transplant, relatively high refusal rate. CONCLUSIONS: Our results confirm that MIS reflects both energy-protein wasting and inflammation in kidney transplant recipients. This simple instrument appears to be a useful tool to assess the presence of protein-energy wasting in this patient population.


Subject(s)
Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/surgery , Kidney Transplantation , Malnutrition/diagnosis , Severity of Illness Index , Transplantation , Adult , Aged , Cross-Sectional Studies , Female , Humans , Inflammation/complications , Inflammation/diagnosis , Inflammation/pathology , Kidney Failure, Chronic/pathology , Kidney Transplantation/pathology , Male , Malnutrition/complications , Malnutrition/pathology , Middle Aged , Transplantation/pathology
6.
Psychosom Med ; 72(6): 527-34, 2010 Jul.
Article in English | MEDLINE | ID: mdl-20410250

ABSTRACT

OBJECTIVE: To analyze in a prospective cohort study if depressive symptoms are an independent predictor of mortality in kidney transplant recipients. METHODS: Data from 840 transplanted patients followed at a single outpatient transplant center were analyzed. Sociodemographic parameters and clinical data were collected at enrollment (between August 2002 and February 2003). Participants completed the Center for Epidemiologic Studies-Depression (CES-D) scale. Depression was defined as CES-D score of > or = 18. Data on 5-year outcomes (death censored graft loss or mortality) were collected. RESULTS: The prevalence of depression was 22%. Mortality was higher (21% versus 13%; p = .004) in patients with versus without depression. In a multivariate Cox proportional hazard model, both the baseline CES-D score (hazard ratio(for each 1-point increase) = 1.02; 95% confidence interval, 1.00-1.04) and the presence of depression at baseline (hazard ratio(presence) = 1.66; 95% confidence interval, 1.12-2.47) were significantly associated with mortality. The baseline CES-D score also significantly predicted death censored graft loss (hazard ratio(for each 1-point increase) = 1.03; 95% confidence interval, 1.01-1.05). CONCLUSION: Depressive symptoms are an independent predictor of mortality in kidney transplanted patients.


Subject(s)
Depression/mortality , Kidney Transplantation/mortality , Aged , Cause of Death , Cohort Studies , Depression/diagnosis , Depression/epidemiology , Depressive Disorder/diagnosis , Depressive Disorder/epidemiology , Depressive Disorder/mortality , Female , Graft Rejection/epidemiology , Humans , Hungary/epidemiology , Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/surgery , Longitudinal Studies , Male , Middle Aged , Prevalence , Prospective Studies , Psychiatric Status Rating Scales , Severity of Illness Index
7.
Clin J Am Soc Nephrol ; 5(1): 125-32, 2010 Jan.
Article in English | MEDLINE | ID: mdl-19965541

ABSTRACT

BACKGROUND AND OBJECTIVES: We assessed the prevalence of obstructive sleep apnea (OSA) and its clinical correlates in a large sample of patients who received a kidney transplant (Tx). We also compared the prevalence of the disorder between dialysis patients who were on the waiting list for a Tx (WL) and Tx patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a cross-sectional study of 100 Tx and 50 WL patients who underwent one-night polysomnography (SLeep disorders Evaluation in Patients after kidney Transplantation [SLEPT] Study). Sociodemographic information and data about medication, comorbidity, and laboratory parameters were collected. RESULTS: The prevalence of mild (apnea-hypopnea index [AHI] > or =5/h and <15/h), moderate (AHI > or =15/h and <30/h), and severe OSA (AHI > or =30/h) was 18, 11, and 14% in the Tx group and 28, 16, and 10% in the WL group, respectively. The AHI was significantly correlated with age (rho = 0.34), body mass index (rho = 0.45), neck circumference (rho = 0.4), abdominal circumference (rho = 0.51), and hemoglobin (rho = 0.24) in the Tx group. The proportion of Tx patients who were treated with three or more antihypertensive drugs was significantly higher in the OSA group (56 versus 31%; P = 0.022). Despite taking significantly more antihypertensive drugs, the average systolic BP was still higher in patients with versus without OSA (147 +/- 21 versus 139 +/- 18 mmHg; P = 0.059). CONCLUSIONS: The prevalence of OSA is similar in Tx and WL patients and it may contribute to presence of hypertension in patients who receive a Tx.


Subject(s)
Cardiovascular Diseases/epidemiology , Kidney Transplantation , Postoperative Complications/epidemiology , Sleep Apnea, Obstructive/epidemiology , Cardiovascular Diseases/etiology , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Prevalence , Risk Factors , Sleep Apnea, Obstructive/complications , Waiting Lists
8.
Int Urol Nephrol ; 42(3): 799-809, 2010 Sep.
Article in English | MEDLINE | ID: mdl-19779844

ABSTRACT

INTRODUCTION: To date, only a few, at times conflicting, reports suggested that renal function and mortality are associated in kidney-transplanted patients. In our prevalence cohort study, we tested the hypothesis that renal function is associated with mortality in transplanted patients. METHODS: Data from 985 transplanted patients were analyzed. Socio-demographic parameters, laboratory data, medical and transplant history, type of immunosuppression and estimated glomerular filtration rate were tabulated at baseline. Data on 5-year outcome were collected prospectively. RESULTS: In multivariate Cox proportional hazard models, the estimated glomerular filtration rate measured at baseline significantly predicted mortality [hazard ratio (HR)(for each 10 ml/min decrease) = 1.271; 95% confidence interval (CI): 1.121-1.440] after adjustment for several covariables. Additionally, in multivariate Cox proportional hazard models, chronic kidney disease stage 4-5 (HR = 2.678; 95% CI: 1.494-4.802) significantly increased the mortality hazard compared to chronic kidney disease stage 1-2. CONCLUSIONS: Renal function is significantly and independently associated with mortality over 5 years in kidney-transplanted patients among whom mycophenolate mofetil use was very prevalent.


Subject(s)
Kidney Transplantation/mortality , Kidney/physiopathology , Creatinine/blood , Female , Glomerular Filtration Rate , Graft Rejection , Humans , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Proportional Hazards Models , Survival Analysis , Survival Rate
9.
Am J Kidney Dis ; 55(1): 132-40, 2010 Jan.
Article in English | MEDLINE | ID: mdl-19932540

ABSTRACT

BACKGROUND: Depression is associated with impaired quality of life and increased morbidity and mortality in patients with end-stage renal disease. Little is known about the prevalence and correlates of depression in kidney transplant recipients. In this study, we aimed to compare depressive symptoms between kidney transplant recipients and wait-listed dialysis patients and identify the correlates of depressive symptoms in the transplant recipient population. STUDY DESIGN: Observational cross-sectional study using the Center for Epidemiologic Studies Depression Scale (CES-D) to assess the severity of depressive symptoms. A cutoff score of 18 was used to identify the presence of depression. SETTING & PARTICIPANTS: 1,067 kidney transplant recipients and 214 wait-listed dialysis patients were asked to participate; the final analysis included 854 kidney transplant and 176 wait-listed dialysis patients, respectively. PREDICTORS: Sociodemographic and clinical variables. OUTCOME: Severity of depressive symptoms and presence of depression (CES-D score > or = 18). RESULTS: The prevalence of depression was 33% versus 22% in wait-listed versus transplant patients, respectively (P = 0.002). In multivariate regression, number of comorbid conditions, estimated glomerular filtration rate, perceived financial situation, and marital status were significant and independent predictors of depression in the transplant recipient group. Treatment modality was associated significantly with the presence of depression, even after adjustment for clinical and sociodemographic variables (OR, 2.01; 95% CI, 1.25-3.23; P = 0.004). LIMITATIONS: Self-reported measurement of depressive symptoms. CONCLUSIONS: The prevalence of depression is lower in transplant recipients than in wait-listed patients. However, one-fifth of transplant patients are still at high risk of clinically significant depression. Comorbid conditions, socioeconomic status, and treatment modality predicted depressive symptoms in patients with end-stage renal disease.


Subject(s)
Depression/epidemiology , Kidney Failure, Chronic/surgery , Kidney Transplantation/psychology , Cross-Sectional Studies , Depression/diagnosis , Depression/etiology , Female , Humans , Hungary/epidemiology , Male , Middle Aged , Prevalence , Prognosis , Retrospective Studies , Risk Factors , Severity of Illness Index , Surveys and Questionnaires
10.
Int Urol Nephrol ; 41(4): 1029-38, 2009 Dec.
Article in English | MEDLINE | ID: mdl-19701690

ABSTRACT

INTRODUCTION: Impaired kidney function is common in kidney-transplanted patients and complications of chronic kidney disease (CKD), such as mineral and bone disorders (MBD) are also prevalent in this population. Similarly to other stages of CKD, increasing evidence supports the association between MBD and cardiovascular risk after kidney transplantation as well. Still, little is known about the prevalence, clinical correlates of MBD and its management in transplanted patients. In this study, we aimed to examine the characteristics of MBD and its associations with clinical parameters in a large prevalent cohort of patients after kidney transplantation. METHODS: Nine hundred and ninety stable patients followed at a single kidney transplant outpatient clinic were included in the study. Detailed medical history, demographic data and routine laboratory results, including Ca, P and intact PTH were collected. Estimated GFR was calculated using the abbreviated MDRD formula, patients were stratified into three groups based on eGFR. Target levels for Ca, P and iPTH were based on CKD stages according to the NKF-K/DOQI guidelines. Standard statistical procedures, binomial and multinomial regressions were used in the analysis. RESULTS: The mean age was 51 years, 57% were males and 21% were diabetic, with 72 months (median) post-transplantation. Most of the patients were in CKD stage 3. Serum phosphorus showed strong negative correlation with graft function in CKD stages 4-5 (r = -0.633, P < 0.001). Hyperphosphatemia was independently associated with the time spent on dialysis before transplantation, serum iPTH and CKD stages 4-5. iPTH showed negative correlation with eGFR in CKD stages 3-5 (rho = -0.289, P < 0.001) and weak positive correlation with time spent on dialysis prior to transplant (rho = 0.114, P < 0.001). Both hyperparathyroidism (42%) and relative hypoparathyroidism (15%) were frequent. The prescription of P-binders (6%) and vitamin D analogs (33%) was sporadic. CONCLUSION: Disturbances of bone and mineral metabolism after transplantation are prevalent and are strongly correlated with the kidney function, similarly to non-transplanted CKD patients. MBD in this population is not adequately managed.


Subject(s)
Calcium/metabolism , Kidney Transplantation/adverse effects , Parathyroid Hormone/metabolism , Phosphates/metabolism , Renal Insufficiency, Chronic/diagnosis , Adult , Aged , Analysis of Variance , Biomarkers/analysis , Biomarkers/metabolism , Blood Chemical Analysis , Calcium/analysis , Chi-Square Distribution , Cohort Studies , Disease Progression , Female , Follow-Up Studies , Glomerular Filtration Rate , Graft Rejection , Graft Survival , Humans , Kidney Function Tests , Kidney Transplantation/methods , Logistic Models , Male , Middle Aged , Multivariate Analysis , Parathyroid Hormone/analysis , Phosphates/analysis , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Predictive Value of Tests , Probability , Renal Insufficiency, Chronic/epidemiology , Renal Insufficiency, Chronic/etiology , Risk Assessment , Survival Rate , Time Factors
11.
J Psychosom Res ; 67(2): 173-80, 2009 Aug.
Article in English | MEDLINE | ID: mdl-19616146

ABSTRACT

Restless legs syndrome (RLS) is reportedly associated with depression. This association may be mediated by both sleep-dependent and sleep-independent mechanisms. Here we analyze the association between RLS and depressive symptoms in patients with chronic kidney disease (CKD). We also assessed whether the relationship is independent of insomnia. In a cross-sectional study, socio-demographic parameters, laboratory data, and medical history were collected from 788 kidney transplant patients and 161 dialyzed patients. Insomnia, depression, and the presence of RLS symptoms were assessed with standard questionnaires. Patients with probable RLS had a higher prevalence of depressive symptoms than those without RLS (56% vs. 22% with vs. without RLS, respectively; P<.001). Patients presenting RLS symptoms had higher Athens Insomnia Scale (AIS) scores than patients without RLS [median AIS score (interquartile range): 7 (6) vs. 3 (4) with vs. without RLS, respectively; P<.001]. The AIS score correlated with the CES-D score (Spearman's rho=0.54, P<.001). In multivariate analysis, the presence of RLS symptoms was independently associated with depressive symptoms (OR=3.96, 95% CI 2.21-7.1, P<.001). This relationship remained significant even after including insomnia in the model (OR=2.9, CI 1.55-5.43, P<.001). The presence of RLS symptoms is associated with depression in patients with CKD. This relationship remained significant even after accounting for insomnia. Sleep-independent mechanisms may also contribute to the association between RLS and depression in patients with CKD.


Subject(s)
Depressive Disorder, Major/epidemiology , Kidney Failure, Chronic/epidemiology , Restless Legs Syndrome/epidemiology , Adolescent , Adult , Aged , Cross-Sectional Studies , Depressive Disorder, Major/diagnosis , Female , Humans , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/therapy , Kidney Function Tests , Kidney Transplantation/psychology , Kidney Transplantation/statistics & numerical data , Male , Middle Aged , Prevalence , Renal Dialysis , Restless Legs Syndrome/diagnosis , Severity of Illness Index , Surveys and Questionnaires , Young Adult
12.
Pathol Oncol Res ; 15(4): 597-603, 2009 Dec.
Article in English | MEDLINE | ID: mdl-19343544

ABSTRACT

Splenic marginal zone lymphoma is a rare disease, accounting for 1% of all lymphomas. We reviewed our single center experience of 13 patients with splenic marginal zone lymphoma (SMZL). Based on the prognostic model developed by Intergruppo Italiano Linfomi, 31% (4/13) of our patients had good, 38% (5/13) had intermediate and 31% (4/13) had a poor prognosis. The presence of two out of three prognostic factors (anemia, elevated LDH, low serum albumin) assignes the patient into the high risk category. In patients with anemia and an elevated LDH due to hemolysis, the outcome seems to be especially poor. Three out of 13 (23%) cases were complicated by autoimmune hemolytic anemia. All patients with autoimmune hemolytic anaemia (AIHA) died 7-28 months after the diagnosis. The mean follow-up time of those nine patients who are still alive is longer than 5 years (36-100 months). Patients with AIHA had significantly (p < 0.001) worse survival than those without AIHA. The main finding of our study is that the presence of AIHA is an adverse prognostic factor in SMZL.


Subject(s)
Anemia, Hemolytic, Autoimmune/diagnosis , Anemia, Hemolytic, Autoimmune/etiology , Lymphoma, B-Cell, Marginal Zone/complications , Lymphoma, B-Cell, Marginal Zone/diagnosis , Splenic Neoplasms/complications , Splenic Neoplasms/diagnosis , Aged , Aged, 80 and over , Antineoplastic Agents/therapeutic use , Female , Follow-Up Studies , Humans , Kaplan-Meier Estimate , L-Lactate Dehydrogenase/blood , Lymphoma, B-Cell, Marginal Zone/therapy , Male , Middle Aged , Prognosis , Retrospective Studies , Risk Factors , Serum Albumin/metabolism , Splenectomy , Splenic Neoplasms/therapy
13.
Int Urol Nephrol ; 41(2): 373-82, 2009.
Article in English | MEDLINE | ID: mdl-19184510

ABSTRACT

Kidney transplantation provides the best outcome for patients with end-stage renal failure both in terms of morbidity and mortality and health-related quality of life (QoL). Health-related QoL has become recognized as an important outcome measure in patients with different chronic medical conditions, including chronic kidney disease (CKD). There are several factors in kidney-transplanted patients which have a negative impact on QoL in these patients. Sleep disorders, such as insomnia, sleep apnea syndrome (SAS), and restless legs syndrome (RLS), are common in kidney-transplanted patients and clearly belong to this group of factors, although there is only limited published data available about the association between sleep problems and QoL in this patient population. The prevalence of both insomnia and RLS is reduced in kidney-transplanted patients compared to dialysis patients, and it is similar to the prevalence observed in the general population. The prevalence of sleep apnea, however, is very high, around 30%. The association between the presence of these sleep disorders and impaired QoL has been relatively well documented in dialysis patients, but there is only scarce published information about this association in the kidney transplant population. In this paper, we will summarize data from the literature describing the impact of sleep problems, which are potentially treatable, on QoL in kidney-transplanted patients. We suggest that the appropriate diagnosis and management of sleep disorders may improve QoL in kidney-transplanted patients.


Subject(s)
Kidney Failure, Chronic/surgery , Kidney Transplantation/psychology , Quality of Life , Sleep Wake Disorders/etiology , Health Status , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/psychology , Sleep Wake Disorders/psychology
14.
Nephrol Dial Transplant ; 24(2): 653-60, 2009 Feb.
Article in English | MEDLINE | ID: mdl-19047018

ABSTRACT

BACKGROUND: Treatment decisions made by patients with chronic kidney disease are crucial in the renal transplantation process. These decisions are influenced, amongst other factors, by attitudes towards different treatment options, which are modulated by knowledge and perceptions about the disease and its treatment and many other subjective factors. Here we study the attitude of dialysis patients to renal transplantation and the association of sociodemographic characteristics, patient perceptions and experiences with this attitude. METHODS: In a cross-sectional study, all patients from eight dialysis units in Budapest, Hungary, who were on haemodialysis for at least 3 months were approached to complete a self-administered questionnaire. Data collected from 459 patients younger than 70 years were analysed in this manuscript. RESULTS: Mean age of the study population was 53 +/- 12 years, 54% were male and the prevalence of diabetes was 22%. Patients with positive attitude to renal transplantation were younger (51 +/- 11 versus 58 +/- 11 years), better educated, more likely to be employed (11% versus 4%) and had prior transplantation (15% versus 7%)(P < 0.05 for all). In a multivariate model, negative patient perceptions about transplantation, negative expectations about health outcomes after transplantation and the presence of fears about the transplant surgery were associated, in addition to increasing age, with unwillingness to consider transplantation. CONCLUSIONS: Negative attitudes to renal transplantation are associated with potentially modifiable factors. Based on this we suggest that it would be necessary to develop standardized, comprehensible patient information systems and personalized decision support to facilitate modality selection and to enable patients to make fully informed treatment decisions.


Subject(s)
Kidney Transplantation/psychology , Renal Dialysis/psychology , Adolescent , Adult , Aged , Attitude to Health , Cross-Sectional Studies , Female , Health Knowledge, Attitudes, Practice , Humans , Hungary , Kidney Failure, Chronic/psychology , Kidney Failure, Chronic/therapy , Male , Middle Aged , Socioeconomic Factors , Surveys and Questionnaires , Young Adult
15.
J Nephrol ; 21 Suppl 13: S84-91, 2008.
Article in English | MEDLINE | ID: mdl-18446738

ABSTRACT

Chronic kidney disease (CKD) is frequently associated with other chronic medical conditions. Adjusting for potential confounding factors that are associated with the outcome of interest is important both in clinical research and in everyday clinical practice. Comorbidity is such an important co-variable that it is reported to predict different outcomes in patients with ESRD. Health related quality of life (HRQoL) has increasingly been recognized as an important aspect of health care delivery, measure of effectiveness and patient experience, in chronic medical conditions. The progressively older ESRD patient population of industrialized countries is significantly debilitated by the burden of disease and also by the intrusiveness of renal replacement therapies. For these patients simply prolonging life is not enough. Little information has been published about the association of comorbidity and HRQoL. The aim of this review is to summarize the significance of comorbidity in patients with ESRD, with a special focus on the complex relationship between comorbidity and HRQoL. Several frequently used instruments will be described and the current literature, that compared the relative utility and accuracy of these tools, will be reviewed. Finally, the impact of selected medical conditions on HRQoL of patients with end-stage renal disease will be demonstrated.


Subject(s)
Comorbidity , Kidney Failure, Chronic/therapy , Quality of Life , Renal Dialysis , Treatment Outcome , Cost of Illness , Humans , Kidney Failure, Chronic/epidemiology , Research Design , Surveys and Questionnaires
16.
J Psychosom Res ; 63(6): 591-7, 2007 Dec.
Article in English | MEDLINE | ID: mdl-18061749

ABSTRACT

OBJECTIVE: Restless legs syndrome (RLS) is associated with insomnia and impaired quality of life (QoL) in patients on maintenance dialysis; however, no information has been published on the association of RLS and QoL in kidney-transplanted patients. In a cross-sectional study, we analyzed the complex relationship between RLS, insomnia, and health-related QoL in kidney-transplanted patients. METHODS: In a cross-sectional survey at a single transplant center, 1067 patients were invited to participate. Complete data set was available from 785 kidney-transplanted patients. The RLS Questionnaire and the Athens Insomnia Scale were used to assess the prevalence of RLS and insomnia, respectively. QoL was measured using the Kidney Disease QoL-SF Questionnaire. RESULTS: Patients with RLS were three times more likely to have insomnia than patients without RLS (29% vs. 9%, P=.001), and the presence of RLS was a significant and independent predictor of insomnia in multivariate analysis. The presence of RLS was independently associated with impaired health-related QoL along several QoL domains after statistical adjustment for clinical and sociodemographic covariables. Importantly, this association remained significant even after adjusting for insomnia for some QoL domains. CONCLUSION: RLS is associated with poor sleep, increased odds for insomnia, and impaired QoL in kidney-transplanted patients. Our results suggest that both sleep-related and sleep-independent factors may contribute to the association of RLS and QoL.


Subject(s)
Kidney Transplantation/statistics & numerical data , Quality of Life/psychology , Restless Legs Syndrome/epidemiology , Sleep Initiation and Maintenance Disorders/epidemiology , Comorbidity , Cross-Sectional Studies , Female , Graft Rejection/prevention & control , Humans , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Prednisone/therapeutic use , Restless Legs Syndrome/diagnosis , Severity of Illness Index , Sleep Initiation and Maintenance Disorders/diagnosis , Surveys and Questionnaires
17.
Am J Kidney Dis ; 50(5): 813-20, 2007 Nov.
Article in English | MEDLINE | ID: mdl-17954294

ABSTRACT

BACKGROUND: Previous studies showed an association between the presence of restless legs syndrome (RLS) and mortality in patients on dialysis therapy. An association between RLS and cardiovascular risk also was reported in the general population. However, no prospective study to date assessed the association between the presence of RLS and mortality in kidney transplant recipients. In a prospective cohort study (Transplantation and Quality of Life-Hungary Study), we tested the hypothesis that the presence of RLS predicts mortality in transplant recipients. STUDY DESIGN: Prospective cohort study was performed. SETTINGS & PARTICIPANTS: 804 kidney transplant recipients followed up at a single outpatient transplant center were enrolled in the study. Sociodemographic parameters, laboratory data, and medical history were collected at baseline. Data for 4-year outcomes were collected prospectively from patient charts. PREDICTOR: Presence of RLS assessed using the RLS Questionnaire. OUTCOME & MEASUREMENTS: We defined 3 primary outcomes: mortality with functioning graft, return to dialysis therapy, and the combined outcome of these 2. RESULTS: Mean age was 49 +/- 13 years, estimated glomerular filtration rate was 49 +/- 19 mL/min/1.73 m(2), and median time after transplantation was 54 months. During the 4 years, 97 patients died and 63 patients returned to dialysis therapy. Mortality at 4 years was significantly greater in patients who had RLS at baseline: univariate hazard ratio for the presence of RLS was 2.53 (95% confidence interval, 1.31 to 4.87). In multivariate Cox proportional hazard analysis, the presence of RLS significantly predicted mortality (hazard ratio, 2.02; 95% confidence interval, 1.03 to 3.95) after adjustment for several covariables. LIMITATIONS: The RLS Questionnaire was not validated in transplant recipients. We lacked information for key variables, including HLA mismatch, panel reactive antibodies, cold ischemic time, acute rejection episodes, viral infections, smoking status, and dyslipidemia. CONCLUSIONS: RLS, a potentially treatable disease, is a significant risk factor for mortality in kidney transplant recipients.


Subject(s)
Kidney Diseases/epidemiology , Kidney Transplantation/mortality , Restless Legs Syndrome/epidemiology , Adult , Female , Humans , Kidney Diseases/mortality , Kidney Diseases/surgery , Male , Middle Aged , Proportional Hazards Models , Prospective Studies , Restless Legs Syndrome/diagnosis , Risk Factors , Surveys and Questionnaires
18.
Nephrol Dial Transplant ; 22(9): 2686-92, 2007 Sep.
Article in English | MEDLINE | ID: mdl-17478489

ABSTRACT

BACKGROUND: Obstructive sleep apnoea syndrome (OSAS) is much more prevalent in patients on dialysis than in the general population. Our aim was to assess for the first time the prevalence of patients with a high risk for OSAS and its clinical correlates in a large sample of kidney transplanted patients. We also wanted to compare the prevalence of the disorder between waitlisted dialysis patients (WL) and kidney transplanted patients (Tx). METHODS: One thousand sixty-seven kidney transplanted patients were asked to participate in a cross-sectional survey ('TransQoL-HU Study'). Socio-demographic data, history of renal disease, medication, comorbidity and laboratory parameters were collected at enrolment. Patients completed a battery of self-administered questionnaires including the Berlin Sleep Apnoea Questionnaire to assess risk status of OSAS. RESULTS: The final analyses included 841 Tx and 175 WL patients. The prevalence of high risk for OSAS was similar in the transplanted group vs WL patients (27% vs 33%). In multivariate logistic regression analysis male gender, older age, lower educational status, worse kidney function, use of hypnotic drugs and comorbidity were independent predictors for high risk of OSAS in kidney transplanted patients. CONCLUSIONS: High risk for sleep apnoea is highly prevalent in the kidney transplanted population. In addition to the well-known risk factors of OSAS (male gender, obesity, use of hypnotic drugs, comorbidity), impaired kidney function was also independently associated with high risk for OSAS.


Subject(s)
Kidney Transplantation/adverse effects , Kidney/physiopathology , Sleep Apnea, Obstructive/epidemiology , Sleep Apnea, Obstructive/etiology , Comorbidity , Demography , Female , Glomerular Filtration Rate/drug effects , Humans , Hypnotics and Sedatives/pharmacology , Immunosuppressive Agents/pharmacology , Kidney Function Tests , Male , Middle Aged , Multivariate Analysis , Prevalence , Renal Dialysis , Risk Factors , Socioeconomic Factors
19.
Drugs Today (Barc) ; 42(9): 587-98, 2006 Sep.
Article in English | MEDLINE | ID: mdl-17028668

ABSTRACT

In this paper we discuss therapy with ropinirole (known as adartrel in the United Kingdom) in patients with restless legs syndrome. Restless legs syndrome is characterized by an urge to move the legs, uncomfortable sensations in the legs and worsening of these symptoms during rest with at least temporary relief brought on by activity. Current recommendations suggest dopaminergic therapy (levodopa or dopamine receptor agonists like ropinirole) as the first-line treatment for restless legs syndrome. Based on the results of randomized, placebo-controlled, double-blind trials, we conclude that ropinirole is effective in reducing symptoms of restless legs syndrome in the general population. Ropinirole has no serious or common side effects that would limit its use significantly. Rebound and augmentation problems are relatively rarely seen with ropinirole, although properly designed comparative trials are still needed to address this question. It must be noted, however, that most published studies with ropinirole compare this drug with placebo. Very few studies have compared ropinirole with other drugs (L-dopa, gabapentin, opioids, benzodiazepines, other dopaminergic agents and selegiline hydrochloride). No cost-effectiveness trial has been published yet. Treatment of restless legs syndrome with ropinirole shows it to be effective, well-tolerated and safe and it can be used in restless legs syndrome in general.


Subject(s)
Dopamine Agonists/therapeutic use , Indoles/therapeutic use , Restless Legs Syndrome , Adult , Aged , Dopamine Agonists/adverse effects , Dopamine Agonists/pharmacology , Female , Humans , Indoles/adverse effects , Indoles/pharmacology , Male , Middle Aged , Randomized Controlled Trials as Topic , Restless Legs Syndrome/diagnosis , Restless Legs Syndrome/drug therapy , Restless Legs Syndrome/physiopathology
20.
Am J Kidney Dis ; 45(2): 388-96, 2005 Feb.
Article in English | MEDLINE | ID: mdl-15685518

ABSTRACT

BACKGROUND: There is an almost complete lack of information on the epidemiology of sleep disorders in kidney-transplanted patients. In this report the authors assess the prevalence and clinical correlates of restless legs syndrome (RLS) in kidney-transplanted (Tx) patients. They also analyze the impact of declining renal function on this condition in the Tx population. Finally, the prevalence of RLS was compared between waitlisted dialysis patients (WL), and the Tx group. METHODS: In a cross-sectional study enrolling 992 patients (816 Tx and 176 WL), the presence of RLS was assessed using the Restless Legs Syndrome Questionnaire. Clinical and sociodemographic data were collected from the patients' medical records. RESULTS: In transplanted patients, the prevalence of RLS was 4.8%. RLS was associated strongly with declining renal function. In groups formed on the basis of estimated glomerular filtration rate (eGFR), the prevalence of RLS was 1.8%, 5.1%, 6.5%, and 23.5% in patients with eGFR greater than 60 mL/min/1.73 m 2 ; eGFR 30 to 59 mL/min/1.73 m 2 ; eGFR 15 to 29 mL/min/1.73 m 2 ; and eGFR less than 15 mL/min/1.73 m 2 , respectively (P < 0.001). There was also a significant association between RLS and lower serum hemoglobin, higher number of self-reported comorbid conditions, and higher prevalence of iron deficiency. RLS was significantly less frequent in patients taking steroids than in patients not taking this medication (4% versus 9%, P < 0.05). In multivariate analysis, not taking steroids, eGFR, self-reported comorbidity, and iron deficiency were significant and independent predictors of RLS. Dialysis treatment was associated with increased odds for RLS (odds ratio 2.2; 95% confidence interval 1.11 to 4.35; P < 0.05) even after adjusting for serum hemoglobin and comorbidity. CONCLUSION: The prevalence of RLS is significantly lower in Tx patients than in patients on maintenance dialysis. Declining renal function is associated with increasing prevalence of the condition.


Subject(s)
Kidney Transplantation/adverse effects , Restless Legs Syndrome/epidemiology , Anemia , Anemia, Iron-Deficiency , Body Mass Index , Comorbidity , Cross-Sectional Studies , Female , Glomerular Filtration Rate/physiology , Humans , Immunosuppressive Agents/therapeutic use , Kidney/blood supply , Kidney/physiopathology , Male , Middle Aged , Multivariate Analysis , Population Surveillance/methods , Prevalence , Renal Dialysis/adverse effects , Renal Insufficiency/blood , Renal Insufficiency/physiopathology , Restless Legs Syndrome/physiopathology , Restless Legs Syndrome/prevention & control , Self-Examination
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