The choice between deceased and living donor kidney transplantation in children and adolescents: a multicentric cross-sectional study.

INTRODUCTION: The aim of our study was to evaluate the factors influencing the choice between a deceased donor (DD) and living donor kidney transplantation (LD KT) for children and adolescents with chronic kidney disease (CKD) from the perspective of parents and physicians. METHODS: Patients with CKD stages 4 and 5 at the University Hospitals of Ghent, Leuven and Antwerp were included. Between February 2019 and March 2020, the corresponding questionnaires were distributed among parents and physicians in order to evaluate the potential differences between the medical recommendation and parental choice. RESULTS: Twenty-eight patients (median age 11 yr, range 2-19 yr), 10 girls and 18 boys were included. Three patients had undergone kidney transplantation in the past. Parents of 13 children opted for DD and 13 LD, and in two cases, there was no preference. Physicians recommended DD in 14 cases and LD in 14 cases. Parental choice corresponded with physician's recommendation in 22 cases. Parental reasons for choosing DD were medical (n = 7), socio-economic (n = 1), combination of both (n = 1) or no reason (n = 4). Pediatric nephrologists advised against LD for medical (n = 6) or socio-economic (n = 6) reasons or a combination of both (n = 2). CONCLUSION: In our cohort, the treating physicians regarded the family's socio-economic factors more important for not actively promoting LD than the parents. A better understanding and communication regarding perceived socio-economic hurdles between caretakers and families might contribute to a higher incidence of living kidney donation in Belgium.

Nocturnal Urine Production in Women With Global Polyuria / 대한배뇨장애요실금학회지

Purpose@#Low nocturnal urine production (NUP) may be sufficient to rule out global polyuria (GP) in men. This study determines the sensitivity of indices for nocturnal polyuria (NP), defined as nocturnal polyuria index (NPi; nocturnal urine volume/24-hour urine volume) ≥0.33 or NUP ≥90 mL/hr, for detecting GP in women. @*Methods@#Data were analyzed from 2 prospective protocols involving subjects recruited from a urology ambulatory care unit and a continence clinic. Women ≥18 years with nocturia were included if they met either of 2 common criteria for GP: (1) ≥40 mL/kg/24 hr or (2) ≥3,000 mL/24 hr. @*Results@#Thirty-one women were included (NPi, 28.6 [21.3–40.7]; NUP, 100.8 [68.3–135.8] mL/hr). At the ≥40 mL/kg/24-hr cutoff, 40% and 63% of women reporting ≥1 nocturnal void(s) (n=30) had NPi ≥0.33 and NUP ≥90 mL/hr, respectively. Additionally, 53% and 71% of subjects reporting ≥2 nocturnal voids (n=17) had NPi ≥0.33 and NUP ≥90 mL/hr, respectively. At the ≥3,000 mL/24-hr cutoff, 38% and 69% of women reporting ≥1 nocturnal void(s) (n=13) had NPi ≥0.33 and NUP ≥90 mL/hr, respectively, and 63% and 88% of subjects reporting ≥2 nocturnal voids (n=8) had NPi ≥0.33 and NUP ≥90 mL/hr, respectively. By extension, 37%–62% of women with nocturia and GP did not have NP by NPi ≥0.33 criteria, and 12%–37% did not have NP by NUP ≥90 mL/hr criteria. @*Conclusions@#Indices of excess nighttime urination do not reliably predict GP in women. A full-length voiding diary may be particularly important in the evaluation of women with nocturia. Nocturia in women merits further consideration as a distinct entity.