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Author(s): Aya Nawata [sup.1] , Takahiro Morishita [sup.2] , Satoshi Hisano [sup.1] , Kaneyasu Nakagawa [sup.3] , Koichi Kusuhara [sup.2] , Toshiyuki Nakayama [sup.1] Author Affiliations: (1) grid.271052.3, 0000 0004 [...]

Background Cardiovascular disease (CVD) is a major cause of death in kidney transplant (KT) recipients. To improve their long-term survival, it is clinically important to estimate the risk of CVD after living donor KT via adequate pre-transplant CVD screening. Methods A derivation cohort containing 331 KT recipients underwent living donor KT at Kyushu University Hospital from January 2006 to December 2012. A prediction model was retrospectively developed and risk scores were investigated via a Cox proportional hazards regression model. The discrimination and calibration capacities of the prediction model were estimated via the c-statistic and the Hosmer–Lemeshow goodness of fit test. External validation was estimated via the same statistical methods by applying the model to a validation cohort of 300 KT recipients who underwent living donor KT at Tokyo Women's Medical University Hospital. Results In the derivation cohort, 28 patients (8.5%) had CVD events during the observation period. Recipient age, CVD history, diabetic nephropathy, dialysis vintage, serum albumin and proteinuria at 12 months after KT were significant predictors of CVD. A prediction model consisting of integer risk scores demonstrated good discrimination (c-statistic 0.88) and goodness of fit (Hosmer–Lemeshow test P   =   0.18). In a validation cohort, the model demonstrated moderate discrimination (c-statistic 0.77) and goodness of fit (Hosmer–Lemeshow test P   =   0.15), suggesting external validity. Conclusions The above-described simple model for predicting CVD after living donor KT was accurate and useful in clinical situations. [ABSTRACT FROM AUTHOR]

It remains unclear which vascular access provides better survival in hemodialysis patients with heart failure, superficialization of the brachial artery (SBA), or tunneled central venous catheter (TCVC). We retrospectively followed up 60 hemodialysis patients with heart failure who underwent SBA (n = 36) or TCVC placement (n = 24). During the median 2.2‐year follow‐up period, 36 patients died. The median survival time was significantly longer for the SBA group than for the TCVC group (5.7 vs 1.7 years; P <.05, log‐rank test). A multivariate‐adjusted Cox regression analysis showed that SBA was associated with a reduced risk of all‐cause death (hazard ratio [HR] 0.30; 95% confidence interval [CI] 0.14‐0.65). In the cohort of propensity score‐matched 15 pairs, patients with SBA experienced fewer all‐cause deaths (HR 0.29; 95% CI 0.10‐0.77). Our study suggests that SBA is an alternative option in hemodialysis patients with heart failure. [ABSTRACT FROM AUTHOR]

Background The utility of the Columbia classification (Col-class) for focal segmental glomerulosclerosis (FSGS) has not yet been fully proven. Methods We extracted 201 FSGS patients from 10 nephrology centers in Japan and investigated the difference of a composite renal endpoint, defined as doubling of serum creatinine and/or development of end-stage renal disease, in pathological variants. Sensitivity analysis was used to prove the utility of the Col-class to predict renal outcomes. Additionally, the renal protective effects of steroids and/or immunosuppression (steroid/IS) were investigated in patients stratified according to the Col-class. Results The patients were classified into the following variants: not otherwise specified [NOS; n  = 121 (60.1%)], perihilar [ n  = 31 (15.4%)], cellular [ n  = 19 (9.5%)], tip [ n  = 17 (8.5%)] and collapsing [ n  = 13 (6.5%)]. No tip variant patients reached the renal endpoint. The renal outcome in the collapsing variant was significantly poorer than that in the NOS [hazard ratio (HR) 3.71; P = 0.005]. In the sensitivity analysis, the area under the receiver operating characteristic curve for the renal endpoint was increased by adding Col-class to a model including common risk factors (P = 0.021). In a subgroup treated without steroid/IS, the outcome in the cellular variant was worse than that in the NOS (HR 5.10; P =   0.040) but the difference was not observed in the subgroup with steroid/IS (HR 0.54; P =   0.539). Conclusions The Col-class is useful to predict renal prognosis in Japanese patients with FSGS. In addition to good prognosis in the tip variant and poor in the collapsing variant, good clinical course in the cellular variant treated with steroid/IS was suggested. [ABSTRACT FROM AUTHOR]

Background: Renin–angiotensin system blockers (RASBs) reduce end-stage kidney disease and cardiovascular event (CVE) development in chronic kidney disease. However, whether RASBs improve long-term prognosis in kidney transplant (KT) recipients remain unknown. Method: We investigated 900 kidney transplant patients in a multicenter retrospective cohort study in Japan and compared death-censored graft survival and CVE (total, cardiac events, stroke) based on RASB use within 12 months after KT. The associations were examined using a Cox hazard model and propensity score-matching analysis. Results: The cohort comprised 375 patients treated with RASBs (RASB group) and 525 patients without RASBs (control group). The median observational period was 82 months, with 68 patients reaching graft loss: 79 total CVE, 36 cardiac events, 26 stroke. In a matching cohort comprising 582 patients, death-censored graft survival, total CVE, and cardiac events were not different between the two groups. Only stroke incidence rate was significantly lower in the RASB group compared with the control group (1.4 vs. 6.4 per 1000 patients/year, log-ranked P = 0.005). In a multivariable analysis, stroke events were also significantly lower in the RASB group compared with the control group (Hazard ratio and 95% confidence interval, 0.20 [0.04–0.62]). Conclusion: Thus, RASBs potentially reduce stroke events in KT recipients. [ABSTRACT FROM AUTHOR]