Risk of kidney stones with surgical intervention in living kidney donors.

A kidney stone in a person with a solitary kidney requires urgent attention, which may result in surgical and/or hospital attention. We conducted a matched retrospective cohort study to determine if living kidney donors compared to healthy nondonors have a higher risk of: (i) kidney stones with surgical intervention, and (ii) hospital encounters for kidney stones. We reviewed all predonation charts for living kidney donations from 1992 to 2009 at five major transplant centers in Ontario, Canada, and linked this information to healthcare databases. We selected nondonors from the healthiest segment of the general population and matched 10 nondonors to every donor. Of the 2019 donors and 20 190 nondonors, none had evidence of kidney stones prior to cohort entry. Median follow-up time was 8.4 years (maximum 19.7 years; loss to follow-up <7%). There was no difference in the rate of kidney stones with surgical intervention in donors compared to nondonors (8.3 vs. 9.7 events/10 000 person-years; rate ratio 0.85; 95% confidence interval [CI] 0.47-1.53). Similarly there was no difference in the rate of hospital encounters for kidney stones (12.1 vs. 16.1 events/10 000 person-years; rate ratio 0.75; 95% CI 0.45-1.24). These interim results are reassuring for the safety of living kidney donation.

Association between intrapartum epidural use and maternal postpartum depression presenting for medical care: a population-based, matched cohort study.

PURPOSE: To evaluate whether intrapartum epidural use is associated with maternal postpartum depression presenting for medical care. METHODS: Population-based, matched cohort study including all adult nulliparous women in Ontario, Canada from 2006 to 2012 without a history of depression, who had a term vaginal delivery. Seventy covariates including maternal demographics, medical and psychiatric conditions, prenatal and perinatal complications, and healthcare utilization were measured. Primary exposure was intrapartum epidural use. Primary outcome was the onset of depression requiring medical care within 12 months postpartum; and the secondary outcome was self-harm. RESULTS: A total of 40303 women who received an intrapartum epidural were matched 1:1 on age, year of cohort entry, and propensity score to an equal number of women who did not receive an intrapartum epidural. Overall rate of new onset depression presenting to the healthcare system was 0.88% within 12 months postpartum. Intrapartum epidural use was not associated with maternal postpartum physician or hospital visits (adjusted HR 1.05 [95% CI 0.87 to 1.28]) or self-harm (unadjusted HR 0.91 [95% CI 0.57 to 1.48]). CONCLUSIONS: Intrapartum epidural use was not associated with maternal postpartum depression presenting to the healthcare system in term nulliparous women who had a vaginal delivery. Further research is needed to determine if intrapartum epidural use is associated with postpartum depression among women who don't seek care from a physician.