Management and Outcomes of Kidney Transplant Candidates With Severe Pulmonary Hypertension: A Single-center Strategy and Experience.

Background: Severe pulmonary hypertension (PH) is associated with high mortality posttransplant and thus is considered a contraindication to kidney transplantation. In this study, we describe the pretransplant management and posttransplant outcomes in patients with severe PH using a multidisciplinary approach. Methods: Between 11 of 2013 and 8 of 2022, we identified all patients with severe PH on initial pretransplant workup who underwent ultrafiltration (UF) or medical therapy for PH before transplant. Posttransplant we evaluated the perioperative course, renal function, graft, and patient survival. We compared survival to those who remained waitlisted or were delisted. Results: Three-two patients (mean age = 55.03 ± 10.22 y) diagnosed with severe PH on pretransplant screening echocardiogram. Thirty patients (94%) were subjected to a median of 4 (range, 3-8) UF sessions with an average weight loss of 4.33 ± 2.6 kg. Repeat assessment of PH revealed a decline in mean pulmonary artery systolic pressure from 67 ± 12 mm Hg to 43 ± 13 mm Hg (P < 0.0001). Seventeen patients (53%) received a kidney transplant. The mean estimated Glomerular Filtration Rate at 3, 6, 9, and 12 mo was 72 ± 27, 72 ± 28, 75 ± 29, and 75 ± 29 mL/min/1.73 m2. Among, those who underwent transplantation both graft and patient survival was 100% at 1-y posttransplant. Overall, since the UF intervention, at a median follow-up of 88 ± 12 mo those transplanted had a patient survival of 88% while those who remained on dialysis had a survival of 53% (P = 0.0003). Conclusion: In this single-center study, we report postcapillary PH can be a significant contributor to elevations in pulmonary artery systolic pressure. Using a multidisciplinary approach, PH can improve with volume removal and phosphodiesterase 5 inhibitors therapy leading to a successful posttransplant outcome.

Correlation of microalbumin and sialic acid with anthropometric variables in type 2 diabetic patients with and without nephropathy.

AIM: The objective of this study is to correlate microalbumin and sialic acid levels with anthropometric variables in type 2 diabetic patients with and without nephropathy. METHODS: This study was a case control study and included 108 Trinidadian subjects (aged 15-60 years) of which 30 were healthy individuals, 38 had type 2 diabetes, and 40 were of type 2 diabetic patients with nephropathy. Blood pressure and waist to hip ratio were recorded. Fasting venous blood samples and urine samples were collected from all the subjects. Blood samples were analysed for the glucose, C-reactive protein, and sialic acid. Urine sample was analysed for microalbumin and sialic acid. RESULTS: Urinary microalbumin was higher among diabetic subjects (28.9 +/- 30.3 mg/L) compared with controls (8.4 +/- 10.2 mg/L) and was significantly higher in diabetic patients with nephropathy (792.3 +/- 803.9 mg/L). Serum sialic acid was higher in subjects with diabetic nephropathy (71.5 +/- 23.3 mg/dL) compared to diabetics (66.0 +/- 11.7 mg/dL) and controls (55.2 +/- 8.3 mg/dL). Increased microalbumin and sialic acid were correlated with other cardiovascular risk factors such as hypertension and waist to hip ratios (p < 0.05). CONCLUSIONS: From these results it can be concluded that the increased microalbumin and sialic acid were strongly correlated with hypertension and waist to hip ratios in Trinidadian type-2 diabetic patients. Measurement of sialic acid, microalbumin, and waist to hip ratio along with the blood pressure is recommended for all type 2 diabetic patients to reduce the cardiovascular risk.

Correlation of microalbumin and sialic acid with anthropometric variables in type 2 diabetic patients with and without nephropathy.

AIM: The objective of this study is to correlate microalbumin and sialic acid levels with anthropometric variables in type 2 diabetic patients with and without nephropathy. METHODS: This study was a case control study and included 108 Trinidadian subjects (aged 15-60 years) of which 30 were healthy individuals, 38 had type 2 diabetes, and 40 were of type 2 diabetic patients with nephropathy. Blood pressure and waist to hip ratio were recorded. Fasting venous blood samples and urine samples were collected from all the subjects. Blood samples were analysed for the glucose, C-reactive protein, and sialic acid. Urine sample was analysed for microalbumin and sialic acid. RESULTS: Urinary microalbumin was higher among diabetic subjects (28.9 +/- 30.3 mg/L) compared with controls (8.4 +/- 10.2 mg/L) and was significantly higher in diabetic patients with nephropathy (792.3 +/- 803.9 mg/L). Serum sialic acid was higher in subjects with diabetic nephropathy (71.5 +/- 23.3 mg/dL) compared to diabetics (66.0 +/- 11.7 mg/dL) and controls (55.2 +/- 8.3 mg/dL). Increased microalbumin and sialic acid were correlated with other cardiovascular risk factors such as hypertension and waist to hip ratios (p < 0.05). CONCLUSIONS: From these results it can be concluded that the increased microalbumin and sialic acid were strongly correlated with hypertension and waist to hip ratios in Trinidadian type-2 diabetic patients. Measurement of sialic acid, microalbumin, and waist to hip ratio along with the blood pressure is recommended for all type 2 diabetic patients to reduce the cardiovascular risk.