Factors Responsible for Nonselection of Donors in Living Related Kidney Transplantation.

OBJECTIVES: Living donor kidney transplant is the preferred method of renal transplant in Pakistan as deceased donor transplant has not yet been estab-lished. However, many patients who are dialysis-dependent, particularly younger patients, lack suitable living related donors. We aimed to determine factors contributing to nonselection of donors for living related renal transplant in Pakistan. MATERIALS AND METHODS: For this cross-sectional study, we included patients seen at the Sindh Institute of Urology & Transplantation Karachi, Pakistan) from March to November 2019. Potential donors were adult family members who accompanied patients with end-stage kidney disease to the clinic. Demographic and clinical information were recorded on predesigned proforma. After workup and baseline investigations had been completed, potential living related donors were selected. Factors leading to nonselection of donors were noted for those who did not qualify for donation. We used SPSS version 20 for analysis. RESULTS: During the study period, 253 potential donors (151 males, 102 females) with mean age of 35.68 ± 6.14 years were found to be ineligible for kidney donation. ABO incompatibility was the most common factor leading to nonselection (n = 101; 39.92%), followed by diabetes mellitus (n = 71; 28.06%), hypertension (n= 50; 19.76%), renal disease (n = 15; 5.92%), liver disease (n = 8; 3.16%), crossmatch positive (n = 5; 1.97%), and ischemic heart disease (n = 3; 1.18%). No differences were shown between potential male and female donors regarding factors leading to nonselection; diabetes was significantly more prevalent among those <40 years of age (P = .025). CONCLUSIONS: ABO incompatibility, diabetes mellitus, and hypertension were the most common factors leading to nonselection of potential donors in living related kidney transplant. More efforts are needed to expand the donor pool by considering second- or third-degree relatives to tackle the scarcity of organs for transplantation.

Outcomes of Dialysis Among Patients With End-Stage Renal Disease (ESRD).

Background Dialysis-associated morbidity and mortality among end-stage renal disease (ESRD) patients has been increasing, despite the advancement in pharmacological treatment and dialysis technology. The aim of this study was to determine the outcomes of dialysis among ESRD patients presenting at the nephrology department of Jinnah Postgraduate Medical Centre (JPMC).  Methodology This cross-sectional study was conducted during the year 2015-2016, including 105 ESRD patients. Data were collected through a structured questionnaire inquiring about patient's demographics and hemodialysis details. The outcomes in terms of survival and death within one month of dialysis were also recorded. The statistical analysis was carried out using SPSS version 21.0 (IBM Corp, Armonk, NY). Results Gender distribution showed that most of the study patients were males (58.1%). The mean duration of ESRD was 7.65 ± 3.69 months while the mean duration of hemodialysis was 36.5 ± 5.65 hours. Among the comorbid conditions, hypertension (69.5%) and diabetes (64.8%) were the most prevalent, followed by renal stones, chronic pyelonephritis, and chronic nephritis. The outcomes indicated mortality among 16.2% of patients; all deceased ESRD patients had diabetes (p < 0.05). Moreover, the duration of hemodialysis was significantly associated with the outcomes of dialysis (p < 0.05). Conclusion In conclusion, a considerable mortality rate was observed among ESRD patients undergoing hemodialysis. Moreover, patient survival was better with the increased duration of dialysis.

Accuracy of GFR estimation formula in determination of glomerular filtration rate in kidney donors: Comparison with 24 h urine creatinine clearance.

To determine the accuracy of estimated glomerular filtration rate (eGFR) using the modification of diet in renal disease (MDRD), Cockcroft-Gault (CG), and chronic kidney disease epidemiology (CKD-EPI) formulas in potential kidney donors compared with 24-h urine creatinine clearance, we studied 207 potential live kidney donors in our center. There were 126 (60.9%) males and 81 (39.1%) females. Male:female ratio was 1.6:1. The age of the donors ranged from 18-58 years, with mean age of 35.30 ± 9.23 years and most of the individuals were below 40 years of age. The body mass index (BMI) was calculated and venous blood samples were obtained for the measurement of serum creatinine and every study participant was instructed to collect 24-h urine. GFR was calculated based on 24-h urine creatinine clearance and the formulas. The accuracy of GFR estimation formula was taken as positive if the GFR calculated by the formulas and urine creatinine clearance fell between 90-120 mL/min/1.73 m(2). The accuracy of the MDRD formula was 48.8% and the CG formula was 41.5% whereas the accuracy of the CKD-EPI formula was 78.2%. The accuracy of the eGFR using the MDRD formula was significantly higher in males than females (57.9% vs. 33.3% P = 0.001), while there was no statistically significant difference in the eGFR between them in case of the use of the CG and the CKD-EPI formulas. BMI and obesity had no effect on the accuracy of eGFR by the use of the different formulas. The performance of GFR estimation formulas was sub optimal and these either underestimated and/or over-estimated the GFR in healthy subjects. CKD-EPI is closer to 24 -h urinary creatinine clearance in the calculation of eGFR. However, none of the eGFR formulas can be used in renal transplant donors because of their low accuracy, and 24-h urine creatinine clearance should be used for evaluation of the GFR in this population.