Willingness of Hemodialysis Patient's Family Members Toward Kidney Donation: A Cross-Sectional Study.

BACKGROUND AND OBJECTIVES: There is a significant shortage of kidneys available for donation. Family members of hemodialysis (HD) patients are experiencing the suffering of their close relatives, which can be a factor toward better acceptance to kidney donation. Knowledge is also an important factor that might affect willingness. In this study, we aimed to estimate the rate of willingness to donate kidneys as live donors (LD) and identify related potential barriers among family members of HD patients. METHODS: This was a cross-sectional observational study involving family members of adult HD patients from King Abdulaziz Medical City and the King Abdullah International Foundation dialysis project in Jeddah, Saudi Arabia. Participants were interviewed through phone calls using a pretested questionnaire. Calculated sample size was 385. RESULTS: A total of 370 family members of HD patients were included. Median age was 37 (interquartile range: 33-44) years and 64% were male. All participants were first-degree relatives to HD Patients. The majority reported willingness to donate kidneys as LD (n = 300, 81%), a proportion 0.81% with 95% confidence interval (CI; 0.77-0.85). Only 42 (11%) graded their knowledge about kidney transplantation as high or very high. On multivariable analysis, less willingness was shown with age >40 years (adjusted odds ratio [AOR] 0.459; 95% CI 0.266-0.792; P = .005), and female gender (AOR 0.496; 95% CI 0.287-0.856; P = .012). CONCLUSION: The majority of family members of HD patients were willing to donate kidneys. The willingness rate was lower among participants 40 years of age and older, as well as among women. The majority of patients graded their knowledge about kidney transplantation as average or lower. Therefore, education targeting of relatives of HD patients may help optimize knowledge and hence improve acceptance of kidney donation.

Remission and long-term outcomes of proliferative lupus nephritis: retrospective study of 96 patients from Saudi Arabia.

BACKGROUND: Few data are available about the rate of short-term remission and its impact on the long-term outcomes of proliferative lupus nephritis in the Middle East. METHODS: An observational study was carried out involving 96 adult patients with biopsy-proven focal or diffuse proliferative lupus nephritis (PLN) from four different hospitals. Data on induction, remission and long-term outcomes were collected and analyzed. RESULTS: Among the 96 patients with biopsy-proven PLN (median age 27 (IQR: 21,34) years, 85% women and median duration of systemic lupus erythematosus (SLE) prior to diagnosis 27 (IQR: 11, 55) months), 67% developed remission at 6 months (proportion 0.67; 95% CI 0.57, 0.76). Mycophenolate mofetil (MMF) was used in 45/96 (47%), CYC in 41/95 (43%) and other agents in 10/96 (10%). The choice of MMF as induction agent has increased in recent years. Among baseline characteristics, only histologic activity was found to have a significant association with remission, with active lesions more likely to remit than active/chronic and chronic lesions (AOR 6.5, 95% CI 1.44-29.39, p = 0.015). Based on Kaplan-Meier analysis, the 5-year renal survival rate without doubling serum creatinine was 73.8%. Compared to patients with complete remission, lower long-term renal survival rates were observed in patients with no remission (89.7 versus 43%, p = 0.001) and partial remission (89.7 versus 77.6%, p = 0.256). The cumulative rate of doubling serum creatinine, dialysis, relapse and death was 23%, 11%, 10% and 5%, respectively, at 48-month median follow up. CONCLUSION: Approximately two-thirds of patients with PLN develop remission in response to standard induction therapy. Remission was negatively associated with the presence of chronic changes in renal biopsy. Overall, MMF is the most commonly used agent to induce remission; however, with more severe disease CYC, is used more frequently. PLN is associated with significant long-term renal outcomes including a 26% cumulative rate of doubling of serum creatinine at 5 years. Initial remission predicts this long-term renal survival.