Performance of the MDRD, CKD-EPI, and Cockcroft-Gault Formulas in Relation to Nutritional Status in Stable Renal Transplant Recipients.

BACKGROUND: Monitoring of the function of the implanted kidney in renal transplant recipients (RTRs) is one of the superior elements of adequate therapeutic actions. The aim of this study was to assess the conventional and unconventional factors affecting the estimated glomerular filtration rate (eGFR) with the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), and Cockcroft-Gault (C-G) formulas among the RTRs. METHODS: The study included 144 RTRs (mean age 52 years). Clinical and laboratory data were analyzed; eGFR was calculated with MDRD, CKD-EPI, and C-G formulas. We compared the results with MDRD as a reference calculating the percentage of reclassifications of chronic kidney disease (CKD) stages. Nutritional status was assessed with a body composition analyzer, Tanita BC 418. RESULTS: Multivariable linear regression analysis with MDRD and CKD-EPI formula as a dependent variable retained the following independent predictors: hemoglobin (Hb) (B = .365; P = .000), and red blood cell distribution width (RDW) (B = -.191; P = .024). Analysis of variance showed the existence of statistically significant differences (all P for trend <.05) between the CKD-EPI, MDRD, and C-G equations within the total scope of eGFR results (51.2 ± 21.2 vs 47.5 ± 18.7 vs 55.6 ± 20.6, respectively) as well as in quartiles of eGFR. CONCLUSIONS: Our data indicate that (1) with a value of eGFR >60 mL/min/1.73 m(2), the MDRD formula shows values that are on average 11% lower than in the CKD-EPI and C-G formulas; (2) with a value of eGFR <60 mL/min/1.73 m(2), the MDRD and CKD-EPI formulas do not show statistically significant differences.

Successful Treatment of Urinary Tract Infection in Kidney Transplant Recipients Caused by Multiresistant Klebsiella pneumoniae Producing New Delhi Metallo-Beta-Lactamase (NDM-1) With Strains Genotyping.

BACKGROUND: Klebsiella pneumoniae New Delhi metallo-beta-lactamase-1 (NDM-1) strains have recently become a new threat in kidney transplant recipients due to the strains' resistance to almost all antibiotics, including carbapenems. METHODS: We present a case series of 3 patients with urinary tract infections (UTIs) caused by multiresistant K pneumoniae NDM-1 strains who were treated with the same protocol. Genotyping sequencing with pulsed-field gel electrophoresis was performed in all cases. RESULTS: All patients were male and had undergone kidney transplantation 4, 7, and 8 months, respectively, before the admission. Combined antibiotic therapy consisting of imipenem/cilastatin in maximal doses, gentamicin and/or colistin for 21 to 27 days, followed by oral fosfomycin, was used in all cases. There were no further UTI episodes in 2 patients at the 12-month visit. Three months after initial treatment, the third patient presented with leukocyturia with no clinical symptoms and a urine culture positive for K pneumonia NDM-1 strain. Interestingly, the strain was susceptible to trimethoprim/sulfamethoxazole despite resistance in previous urine culture samples. The patient was successfully treated with trimethoprim/sulfamethoxazole 2 × 960 mg/d for 3 weeks followed by 480 mg/d and 3 doses of fosfomycin. Genotyping sequencing revealed identical DNA restriction fragments in bacterial strains from 2 patients. In the third case, although a difference in 2 restriction fragments was observed, the strain was considered related to the others. CONCLUSIONS: In cases of UTI caused by K pneumoniae NDM-1 strains, prolong combined treatment followed by oral fosfomycin prophylaxis can be successful. Strain genotyping should be performed to optimize further treatment protocols in such cases.