1,720,968 research outputs found
Cardiovascular event prediction in kidney transplant recipients: a new risk score derivation and internal validation
No full textBackground: Kidney transplant recipients (KTRs) have a cardiovascular (CV) risk 3 to 5-fold higher than that of the general population. CV disease represents the main cause of death in KTRs, both due to the presence of traditional risk factors and factors strictly related to transplant. The main CV risk calculators proved to be poorly predictive in the KTR population. We, therefore, aimed to compare the performance of CV risk scores already in use and to develop and validate a CV risk score in our KTRs population.
Methods Our analysis included 371 adult KTRs in follow-up at the outpatient clinic from 1 January 2015 to 31 December 2016. The composite outcome was the occurrence of MACE. We compared the performance of two main CV risk calculators (Framingham Risk Score -FRS- and Patient Outcomes in Renal Transplantation-PORT-risk score). Thereafter, we built a predictive model selecting study variables by backward stepwise Cox regression. The risk score for each variable was weighted according to the hazard ratio (HR) of the final multivariable model. Internal and external validation of the prediction score and its discriminative capacity was assessed via area under the curve (AUC), and the calibration via the Hosmer–Lemeshow test.
Results After a mean follow-up of 68 months, CV events occurred in 71 (19%) KTRs. FRS and PORT were demonstrated to have low predictive power in our population. The accuracy did not improve after adjustment for immunological and adjuntive transplant-related variables. Therefore, we derived a model including significative variables at multivariate analysis: age, dialysis vintage, systolic blood pressure, eGFR and 24-hour proteinuria. The model discrimination was good (Harrel’s c: 0.73, AIC 713). According to the HR, 3 points were attributed to age higher than 60 years and 24 h proteinuria higher than 1 g/d, 2 points to dialysis vintage longer than 5 years, systolic blood pressure higher than 140 mmHg and eGFR less than 30 ml/min/1.73m2. The new score demonstrated good discrimination (AUC 0.70) and acceptable calibration (Hosmer-Lemeshow test χ211.34, P=0.12). The new score was internally validated by 10-fold cross-validation (mean AUC 0.70, 95% CI 0.60-0.77). For each point of the new score, the risk of the event increased by 40% and a score higher than three was associated with a 4-fold increased risk of composite endpoint
Kidney Transplantation in a Patient Affected by Sickle Cell Trait: A Case Report and State-of-the-Art Review
No full textChronic kidney disease (CKD) is a common feature of sickle cell disease (SCD). The awareness of the clinical presentation and renal involvement in patients affected by hemoglobinopathies is greatly needed. Patient management is particularly complex, especially with kidney transplantation. We, therefore, report the case of a 56-year-old patient affected by sickle cell trait who underwent kidney transplantation. This case will underline all the various challenges the nephrologist must face in this clinical setting and their management
Kidney transplantation from deceased donors with vaccine‐induced thrombosis and thrombocytopenia (VITT): Definitely feasible and safe?
No full textVisit-to-Visit Systolic Blood Pressure Variability Independently Predicts Cardiovascular Events in a Kidney Transplant Recipients' Cohort
No full textBACKGROUND: The predictive role of blood pressure variability for all-cause mortality and fatal and nonfatal cardiovascular events has been described in the general population and in patients with diabetes, independently of mean BP. Although systolic blood pressure variability has been proposed as an informative measure for predicting clinical outcomes in patients with chronic kidney disease, its role in kidney transplant recipients is still debatable. METHODS AND RESULTS: We performed a retrospective, observational, monocentric analysis of all kidney transplant recipients in follow-up at the outpatient Nephrology Clinic of San Martino Hospital from January 1, 2016 to December 31, 2016, who underwent kidney transplantation >12 months. The primary outcome was a fatal or nonfatal cardiovascular event (myocardial infarction, unstable angina, stroke, and hospitalization for heart failure). Visit-to-visit systolic blood pressure variability was expressed as the SD of systolic blood pressure values recorded at baseline and 3 months up to 18 months. Among the 272 patients (mean age, 64±13; 63% men) included in the present analyses, for each increase of 2.7 mm Hg in systolic blood pressure SD, the risk for events increased 3-fold (hazard ratio [HR], 3.1 [95% CI, 1.19–7.88]; P=0.02), and patients in the highest tertile of systolic blood pressure SD showed a 4-fold increased risk (HR, 4.1 [95% CI, 1.34–12.43]; P=0.01). This relationship was maintained even after incremental adjustment for time-averaged pulse pressure, age, diabetes, and prior cardiovascular event (HR, 3.2 [95% CI, 1.1–10.0]; P=0.04). CONCLUSIONS: Long-term blood pressure variability represents a risk factor for cardiovascular events in kidney transplant recipients, even independently by several confounding factors including blood pressure load
Changes over time in ambulatory blood pressure and cardiac parameters predict cardiovascular outcome of patients with CKD and low cardiovascular morbidity
No full textA new CHA2DS2VASC score integrated with estimated glomerular filtration rate, left ventricular hypertrophy, and pulse pressure is highly effective in predicting adverse cardiovascular outcome in chronic kidney disease
No full textEverolimus in kidney transplant recipients at high cardiovascular risk: a narrative review
No full textKidney transplant recipients (KTRs) are at increased risk of cardiovascular (CV) morbidity and mortality, and side effects induced by immunosuppressive therapy may be a major contributor to this risk, together with traditional CV risk factors. Many strategies have been considered in order to reduce CV risk in KTRs, such as steroid and/or calcineurin inhibitor (CNI) minimization, but current data are inconclusive. The introduction of mammalian target of rapamycin (mTOR) inhibitors, the cornerstone of CNI minimization, in the immunosuppressive protocol may reduce both the incidence and severity of CNI-associated side effects; however, whether this strategy has an impact on CV risk after kidney transplantation needs to be evaluated. To this end, a panel of Italian experts in the field of transplantation was convened in a series of meetings to assess the current literature on the potential of the mTOR inhibitor everolimus as a cardioprotective agent. This narrative review summarizes the panel’s round-table discussions and provides recommendations for CV risk management in KTRs
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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