Thrombotic microangiopathy in United States long-term dialysis patients
|
|
- Iris Foster
- 5 years ago
- Views:
Transcription
1 Nephrol Dial Transplant (2006) 21: doi: /ndt/gfi153 Advance Access publication 4 October 2005 Original Article Thrombotic microangiopathy in United States long-term dialysis patients Robert M. Perkins 1, Joel C. Reynolds 2, Tejinder S. Ahuja 3, Thomas Reid 4, Lawrence Y. Agodoa 5, Erin M. Bohen 1, Christina M. Yuan 1 and Kevin C. Abbott 1 1 Nephrology Service and 4 Hematology/Oncology Service, Walter Reed Army Medical Center, Washington and Uniformed Services University of the Health Sciences, Bethesda, MD, 2 Nephrology Service, Brooke Army Medical Center, Fort Sam Houston, TX, 3 Nephrology Service, University of Texas, Galveston and 5 NIDDK, NIH, Bethesda, MD, USA Abstract Background. The incidence, risk factors, recurrence rates and prognosis of thrombotic microangiopathy (TMA) among long-term dialysis patients in the United States have not been previously described in a national population. Methods Medicare primary patients in the United States Renal Data System (USRDS) initiated on end-stage renal disease (ESRD) therapy between 1 April 1995 and 31 December 1999 with Medicare as primary payer were analysed in a retrospective cohort study of USRDS of TMA. Cox regression was used to calculate adjusted hazard ratios (AHR) for risk of TMA and risk of death after TMA. Results. The incidence of TMA in the first year of dialysis was 0.5% overall. Among patients with renal failure due to haemolytic uraemic syndrome (HUS), the incidence of TMA was highest in the first year of dialysis (HUS, 11.3% first year, 4.5% per year thereafter), while among patients without HUS the incidence of TMA was much lower and more constant over time (0.3% per year). In Cox regression analysis, independent risk factors for TMA were renal failure due to HUS (adjusted hazard ratio (AHR) 179, 95% CI ), paediatric age (18 years vs older, AHR 2.59, 95% CI ), female gender (AHR 1.99, 95% CI ), and systemic lupus erythematosus (SLE, AHR 3.66, 95% CI ). One-year survival after TMA was poor at 58% (AHR for mortality 2.04, 95% CI ). Conclusions. TMA is an uncommon cause of hospitalization after dialysis, but does recur in patients with Correspondence and offprint requests to: Robert M. Perkins, MD, Nephrology Service, Walter Reed Army Medical Center, Washington, DC , USA. robert.perkins@na.amedd.army.mil HUS at a substantial rate. Younger age and SLE were risk factors for new onset TMA, which was associated with poor survival. Vigilant monitoring of select patients with HUS-related ESRD and higherrisk patients with SLE is warranted in the dialysis population. Keywords: dialysis; haemolytic uraemic syndrome (HUS); systemic lupus erythematosus; thrombotic thrombocytopenic purpura (TTP); thrombotic microangiopathy; United States Renal Data System (USRDS) Introduction Thrombotic microangiopathy (TMA) is a microvascular occlusive disorder marked by predominantly platelet thrombi in the renal and/or systemic circulations. Haemolytic uraemic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) are the clinical entities comprising TMA, with predominantly renal manifestations in the former, while the latter more often presents with systemic and neurologic findings. For most adult patients, diagnostic distinction is less important than timely treatment. Histopathologically, TTP and HUS are similar, and clinical overlap is common [1]. For both disorders, the incidence, risk factors, and prognosis for the non-renal population have been previously described. The reported incidence rate of HUS is variable by age, and ranges from cases/ persons annually [2]. Due to its rarity in adults, it is not tracked by the National Hospital Discharge Survey, and is routinely tracked only in children. It is the most common form of acute renal failure in children, and incidence falls with age. TTP is less common, with an annual incidence of Published by Oxford University Press on behalf of ERA-EDTA [2005].
2 192 R. M. Perkins et al. Table 1. Reported risk factors for TMA (HUS and TTP) in the non-dialysis population Idiopathic Familial Infection (HIV, shiga-toxin-producing strains of E.coli, Rocky Mountain spotted fever) Organ and bone marrow transplantation Medications (calcineurin inhibitors, ticlodipine, clopidogrel, quinine, mitomycin, cisplatin, gemcitabine) Malignancy Pregnancy Collagen vascular disease (SLE, rheumatoid arthritis, scleroderma) Antiphospholipid antibody syndrome 0.4 cases/ persons [2]. The incidence of TMA in the renal transplant population has been reported to be 4.9 episodes per 1000 person-years at-risk [3]. With the exception of this last study, no analysis has reported incidence rates in person-years at-risk, making comparisons among analyses problematic. The primary risk factor for HUS is infection with shiga-toxin-producing strains of Escherichia coli, though a familial form has also been identified. Multiple risk factors for TTP in the non-dialysis population have been proposed (Table 1) [4 6]. Prognosis for TTP has improved dramatically since the routine use of plasma exchange and plasmapheresis therapies [7,8]. An Ovid Medline Õ literature search was conducted encompassing the period 1966 through the third week of July, Search terms included thrombotic microangiopathy, haemolytic uraemic syndrome, and thrombotic thrombocytopenic purpura combined sequentially with end-stage renal disease or dialysis. This search identified no studies enrolling primarily a dialysis cohort. While recurrent HUS has been described after kidney transplantation, there is currently no information available for counselling patients with end-stage renal disease attributed to HUS or TTP about risk of recurrence, risk factors associated with recurrence, or long-term prognosis. In the present study, we report the incidence and prognosis of TMA in the US chronic dialysis population, and identify potential risk factors in this cohort. Subjects and methods A national registry (the USRDS) was analysed in a historical cohort study of the rate, risk factors and mortality associated with TMA in end-stage renal disease (ESRD) patients. The variables included in the USRDS standard analysis files (SAFs), as well as data collection methods and validation studies, are listed at the USRDS website, under Researcher s Guide to the USRDS Database, Section E, Contents of all the SAFs (Standard Analysis Files), and published in the USRDS ( The demographics of the dialysis population have been previously described (2002 USRDS report). All hospitalizations with a primary or secondary discharge diagnosis of thrombotic microangiopathy were extracted from SAF.HOSP and merged with SAF.PATIENTS. The latter file was also used to extract the cause of renal disease (PDIS) and the cause and date of patient death. SAF.MEDEVID was used for additional information coded in the medical evidence form starting in 1995, and has been validated for use in research [9]. Therefore, patients who presented to ESRD on or after 1 April 1995 until 31 December 1999 were selected for the study and followed through 31 December 2000 for a diagnosis of TMA, and until 30 September 2001 for death. Outcomes included hospitalizations with a primary or secondary discharge diagnosis of thrombotic microangiopathy (TMA, International Classification of Diseases, 9th Revision (ICD9) codes x or 446.6x, coded 1 if present, 0 if absent). We chose to limit the extraction to the primary or secondary discharge diagnosis because of potential inaccuracies in regional reporting of TMA in the Physicians supplier and Institutional Claims files (personal communication to Dr Paul Eggers). Only ICD9 procedure codes, and not Current Procedural Terminology (CPT) codes, were available from the database and were not considered reliable for reporting performance of therapeutic plasma exchange. Cases of TMA occurring after renal transplantation were not considered an outcome for purposes of this study (i.e. coded as 0). Other outcomes included death from any cause. Time to diagnosis of TMA was defined as the time from the first dialysis session until the date of discharge diagnosis for TMA, with patients censored for death, transplantation, or the end of the study period (31 December 2000), whichever came first. Time to death was defined as time after the date of diagnosis of TMA until death, censored for the end of the study period, in this case considered 30 September All analyses were performed using SPSS 12.0 TM (SPSS, Inc., Chicago, IL). Files were merged and converted to SPSS files using DBMS/Copy (Conceptual Software, Houston, TX). Statistical significance was defined as P<0.05. Univariate analysis was performed with chi-square testing for categorical variables (Fisher exact test for violations of Cochran s assumptions) and Student s t-test (Mann Whitney for non-normal distributions) for continuous variables. Variables with P<0.10 in univariate analysis for a relationship with TMA (including age, gender, year of first dialysis session, and history of transplant, diabetes, or HUS as cause of ESRD) were entered into multivariate analysis as covariates. An exception was made for factors with a potential biological relationship with TMA [10]. These additional variables include race, BMI, smoking status, use of Epo at the time of dialysis initiation, haematocrit at the time of dialysis initiation, and history of alcoholism or SLE. Cox regression models were performed after testing associations with TMA, using covariates as specified above. Patient survival curves were calculated using life table analysis with patients censored at the time of loss to follow-up. Time to TMA was calculated as the time from the date of dialysis initiation until the diagnosis date of TMA, censored for death, end of the study period, loss to follow-up, or renal transplantation. Survival was calculated from the date of TMA diagnosis until death, censored for last follow-up visit, or loss to follow-up occurring after diagnosis. Covariates were as for univariate analysis. The association of TMA with survival was calculated as a time-dependent variable in Cox regression, with all values prior to TMA coded as 0 (including patients who were never diagnosed with TMA, all values after diagnosis as 1).
3 Thrombotic microangiopathy in ESRD 193 Table 2. Factors assessed in US long-term dialysis patients, 1 April 1995 to 31 December 1999 Factor Dialysis patients hospitalized for TMA All other dialysis patients Fig. 1. Life table plot of time to thrombotic microangiopathy (TMA), stratified by end-stage renal disease (ESRD) due to haemolytic uraemic syndrome (HUS) vs all other causes of renal failure. Patients with HUS as a cause of renal failure had a high rate of recurrence in the first year, at 11.3%, and 4.5% per year afterward. In contrast, patients without HUS had a much lower rate of TMA (de novo TMA, 0.3% per year) and the rate was relatively constant over time. Results From 1 April 1995 to 31 December 1999, patients started long-term dialysis. Of these, were documented as having Medicare as primary payer at the time of the first dialysis session. This cohort therefore comprised the study population. There were 215 cases of TMA during the study period; among those coded as a primary diagnosis, 20 were coded as HUS and 35 coded as TMA unspecified; among those coded as secondary diagnoses, 107 were coded as HUS and 54 coded as TMA unspecified (one patient was coded as TMA primary and HUS secondary). The overall incidence in the cohort was 0.5% annually. The incidence of TMA was the highest in the first year of dialysis among patients with renal failure due to HUS, occurring in 49 patients (11.3%) at one year and in approximately 20 patients (4.5%) annually thereafter, while the incidence of TMA was more constant over time among patients without HUS (815 patients per year, or 0.3% annually), as shown in Figure 1. Factors assessed in the study population and results of univariate analysis are shown in Table 2. Variables with statistically significant associations with TMA incidence include female gender, paediatric age, HUS, SLE, glomerulonephritis as cause of ESRD and a history of illicit drug use. Diabetes as cause of ESRD was associated with a reduced incidence of TMA in univariate analysis. In addition to the factors listed in Table 2, there were no statistically significant differences in incidence of TMA by state, region of country, or quartiles of albumin (data not shown). 215 (0.1%) (99.9%) N with valid causes of ESRD Female 141 (65.6%) a (47.2%) African American 72 (33.5%) (29.9%) (vs other races) Mean age (years) 46.1± ±15.9 Age 18 years 18 (8.4%) 1958 (0.7%) Body mass index (kg/m 2 ) 24.9± ±5.9 b Cause of ESRD c HUS (ICD ) d 73 (30.7%) a 361 (0.001%) Glomerulonephritis 101 (47.6%) a (10.7%) Diabetes 33 (15.6%) a (44.3%) Systemic lupus 10 (4.7) a 2837 (1.1) erythematosus Categorical variables from the medical evidence form (2728), history of Smoking 14 (6.6%) (5.6%) Alcohol use 5 (2.4%) 4064 (1.5%) Illicit drug use 7 (3.3%) a 2300 (0.9%) HIVþ e 1 (1.9%) 1718 (2.6%) Cancer 7 (3.3%) (5.0%) Dialysis modality c Haemodialysis 191 (90.1%) (90.1%) Peritoneal dialysis 21 (9.9%) (9.9%) Haematocrit (%) 25.2± ±8.5 b Serum creatinine (mg/dl) 8.8± ±3.8 b Serum albumin (g/l) 3.2± ±0.7 Data given as the number (% of total) or mean ± one SD. SLE, systemic lupus erythematosus; HUS, haemolytic uraemic syndrome; ESRD, end-stage renal disease; TMA, thrombotic microangiopathy. To convert creatinine from mg/dl to mmol/l multiply by 88. a P<0.05 by chi-square testing. b P<0.05 by students T-test. c Information missing for 3% of study population. d Only HUS, not TMA, is listed as a cause of ESRD. e Information missing for 75.4% of patients. In Cox regression analysis, only four factors were independently associated with TMA: HUS and systemic lupus as causes of ESRD, younger (and especially paediatric age), and female gender. Table 3 shows the results of Cox regression analysis. Figure 2 shows survival after TMA for patients with ESRD due to HUS and for those with ESRD due to all other causes. Regardless of the cause of ESRD, the survival was 58% at one year after the diagnosis of TMA. In time-dependent Cox regression, TMA was independently associated with an increased risk of death (adjusted hazard ratio, 2.04; 95% CI, ). The leading causes of death after TMA were cardiovascular disease (29%), followed by infectious death (14.3%) and cancer-related death (3.2%). These percentages were not substantially different from causes of death among patients who were not diagnosed with TMA.
4 194 R. M. Perkins et al. Table 3. Cox regression analysis of factors associated with hospitalizations for TMA after initiation of dialysis, censored for renal transplantation a Factor Adjusted hazard ratio for TMA (95% confidence interval) HUS as cause of ESRD 179 (95 338) b Female gender (vs male) 1.99 ( ) b Age Age 18 (vs older) 2.59 ( ) b Quartile 1 (52.6 years) 3.27 ( ) b Quartile 2 (> years) 2.37 ( ) b Quartile 3 (> years) 1.67 ( ) Quartile 4 (>74.7 years) 1.00 (reference) Data from CMS form 2728 (at time of dialysis initiation) SLE (history of) 3.66 ( ) b SLE, systemic lupus erythematosus; HUS, haemolytic uraemic syndrome; ESRD, end-stage renal disease; TMA, thrombotic microangiopathy. a Variables with P<0.10 in univariate analysis for a relationship with TMA (age, gender, year of first dialysis session and history of transplant, diabetes or HUS as cause of ESRD) were entered into multivariate analysis as covariates. An exception was made for factors (race, BMI, smoking status, use of Epo at time of dialysis initiation, haematocrit at time of dialysis initiation and history of alcoholism or SLE) with a potential biological relationship with TMA. b P<0.05. Discussion We describe the incidence, risk factors, recurrence rates and survival of patients with TMA in the United States long-term dialysis population. The incidence of TMA after the onset of dialysis has not been previously described. The rate of recurrence of TMA in dialysis patients with HUS as the cause of ESRD was quite high, particularly in the first year after initiation of dialysis. This was not the case with de novo TMA, in which the rate was much lower and stable over time. Identified risk factors for TMA in this population were similar to those reported for the non-dialysis population, though some previously identified factors, such as malignancy, were not observed in our study. Not surprisingly, given the burden of co-morbid illness in the dialysis population, mortality after TMA was higher than that reported in the non-dialysis population. Incidence of TMA Shumak et al. and Hayward et al. have reported relapse rates up to 30% of patients with TMA, some of which occurred years after successful treatment of the initial episode [11,12]. It is possible that differential rates of plasmapheresis and exchange therapies between this cohort and historical comparison groups are responsible for the improved long-term survival of dialysis patients with TMA. Unfortunately, the USRDS database does not reliably track the performance of therapeutic plasma exchange, and it could not be determined whether plasma exchange was associated with improved survival in such patients. In any case, Fig. 2. Survival after TMA did not differ between those with HUS and other causes of renal failure. the indications and contraindications for plasma exchange were not available (for example, plasma exchange might not be performed in patients with mild disease), and therefore interpretation of outcomes of patients in whom plasma exchange was used would be problematic. Only one study of TMA in ESRD (dialysis or transplant) has reported rates of TMA in person-years at-risk, allowing for comparison [4]. While this analysis was limited to TMA in the post-renal transplant population, the comparison may provide intriguing insights into the pathophysiology of TMA. While we report a TMA recurrence rate of 11.3% in the first year in the dialysis population, vs 0.3% of de novo TMA in those with ESRD due to causes other than HUS, Reynolds reported a recurrence rate (post-transplant) of 15% at 1 year in patients with ESRD due to HUS, vs a de novo rate of 0.4% in patients with ESRD due to non-hus causes [4]. While it is tempting to attribute the higher rates in the transplant population to prevalent use of immunosuppressive medications, some of which have been implicated as potential causes of TMA, several points argue against this. First, Reynolds et al. used all discharge diagnoses rather than primary or secondary diagnoses, as in our study. It is, therefore, possible that our data underreports the true incidence of TMA in the dialysis population. Second, the rate of de novo TMA was similar in the transplant population to the rate in our cohort; if immunosuppressive regimens (primarily those including calcineurin inhibitors) were causative, we might expect de novo TMA rates to be higher in the transplant group. In fact, given the widely held belief that calcineurin inhibitors are associated with TMA, the similarity of the de novo rates of TMA between the dialysis and transplant populations is rather striking.
5 Thrombotic microangiopathy in ESRD 195 Risk factors for TMA We identified similar potential risk factors for TMA as in the non-dialysis population. Younger age, female gender and a history of systemic lupus erythematosus were all independent predictors of TMA in our study. The increased risk of developing TMA in patients with SLE has been recognized for some time, though the pathophysiologic mechanism underlying the relationship has not been well defined. The higher prevalence of anti-phospholipid antibodies (which in turn have been shown to cause a microangiopathic syndrome) in patients with SLE may be in part responsible for this association [13]. In a case report and literature review Musio et al. have hypothesized that SLE and TMA patients share several additional features, such as common auto-immune mechanisms, platelet abnormalities, and fibrinolytic disorders, all of which (alone or in combination) may account for the association [14]. Malignancy was not identified as a potential risk factor in our analysis, though other studies have identified multiple cancers and chemotherapeutic agents (which we did not examine) as risk factors for TMA [5,15]. The reasons for this finding are unclear and impossible to deduce from our retrospective analysis, though may be related to differences in rates of higher-tma risk cancer types, in rates of chemotherapy use between the two populations, or other population differences we did not examine. We did not find a significant association between HIV seropositivity and TMA, as has been reported in the pre- HAART era [16]. However, in the HAART era, TMA in association with HIV has become rare [17]. Finally, an important negative finding in our study was the lack of difference in rates of TMA between those on haemodialysis compared with those on peritoneal dialysis. This may be useful information for counselling patients with ESRD due to TMA about their options for renal replacement therapy. Survival of ESRD patients with TMA Survival after TMA was poor in our analysis, particularly in comparison to reported studies in the non-dialysis population, where mortality has improved dramatically (reported as less than 10%) since plasmapheresis and exchange therapies have become standards of care [9]. This difference may be due to several factors. One possibility may be under-recognition of TMA in the dialysis population, where anaemia is prevalent and co-morbid conditions may cloud identification of subclinical illness. Another possibility is that the burden of co-morbid disease in the dialysis population negatively impacts survival when compared with a non-dialysis population that is typically healthier. There are a number of important limitations of our study. As with all retrospective analyses, our findings are associative; it would be misleading to assign causality to our identified potential risk factors. In addition, the diagnosis of TMA in our analysis is limited to hospital discharge diagnoses, either primary or secondary; those patients with sub-clinical disease or those patients dying prior to hospitalization from complications of TMA are not included in our analysis and may lead to under-reporting in our study. With respect to the diagnosis of TMA, our study design does not allow us to verify clinic details of the diagnosis, which may introduce unpredictable errors into our findings. Likewise, limitations of the registry preclude making prognostic or other distinctions between subtypes of TMA. For example, shiga-toxin-associated HUS and non-shiga-toxin HUS have different prognoses as well as different associated risk factors; coding limitations preclude clarification of these distinctions. It is also important to note that our study cannot distinguish between relapse and recurrence, both of which occur frequently in the non-dialysis population. Our findings emphasize the need for ongoing close surveillance of patients with ESRD due to HUS. Serial monitoring of the haematocrit, platelet count and lactate dehydrogenase levels, in addition to surveillance for recurrence of symptoms, has been recommended in the non-dialysis population. While there is no consensus regarding a standard surveillance schedule in the dialysis population, our findings suggest that more frequent clinical monitoring of patients with HUS as the cause of ESRD should be undertaken, particularly in the first year after initiation of dialysis. Certain populations are known to be at higher risk of recurrence than others, and careful surveillance of these patients would be prudent [18]. In conclusion, we report a substantial rate of recurrent TMA in the dialysis population, in which survival is noted to be poor and risk factors similar to the non-dialysis population. However, de novo TMA is uncommon. Similar to the non-esrd population, TMA occurred primarily in younger patients, with females and patients with systemic lupus erythematosus at particular risk. Whether better recognition of TMA in the dialysis population would yield improvements in survival is unknown. Given the paucity of information in this patient population, and the relatively limited disease incidence, creation of a dedicated clinical registry for research purposes is indicated. Conflict of interest statement. The authors report no conflict of interest related to any aspect of study concept, design, analysis or reporting. The opinions are solely those of the authors and do not represent an endorsement by the Department of Defense or the National Institutes of Health. This is a US Government work. There are no restrictions on its use. References 1. Ruggenenti P, Remuzzi G. Pathophysiology and management of thrombotic microangiopathies. J Nephrol 1998; 11: Su C, Brandt L. Escherichia coli O157:H7 infection in humans. Ann Intern Med 1995; 123: Reynolds J, Agodoa L, Yuan C, Abbott K. Thrombotic microangiopathy after renal transplantation in the United States. Am J Kidney Dis 2003; 42:
6 196 R. M. Perkins et al. 4. Lesesne JB, Rothschild N, Erickson B. Cancer-associated hemolytic uremic syndrome: Analysis of 85 cases from a national registry. J Clin Oncol 1989; 7: Nesher G, Vaughn E, Terry L et al. Thrombotic microangiopathic hemolytic anemia in systemic lupus erythematosus. Semin Arthritis Rheum 1994; 24: Weiner C. Thrombotic microangiopathy in pregnancy and the postpartum period. Semin Hematol 1987; 24: Rock G, Shumak K, Buskard N et al. Comparison of plasma exchange with plasma infusion in the treatment of thrombotic thrombocytopenic purpura. N Engl J Med 1991; 325: Von Baeyer. Plasmapheresis in thrombotic microangiopathyassociated syndromes: review of outcome data derived from clinical trials and open studies. Ther Apher 2002; 6: Longenecker JC, Coresh J, Klag MJ et al. Validation of co-morbid conditions on the end-stage renal disease medical evidence report: the CHOICE study. Choices for Healthy Outcomes in Caring for ESRD. J Am Soc Nephrol 2000; 11: Szklo M, Nieto FJ. Epidemiology: Beyond the Basics. Stratification and Adjustment: Multivariate Analysis in Epidemiology. Aspen Publishers, Gaithersburg, MD: 2000; Shumak K, Rock G, Nair R. Late relapses in patients successfully treated for thromobotic thrombocytopenic purpura. Ann Intern Med 1995; 122: Hayward C, Sutton D, Carter WH et al. Treatment outcomes in patients with adult thrombotic thrombocytopenic purpura hemolytic uremic syndrome. Arch Intern Med 1994; 154: Nzerue CM, Hewan-Lowe K, Pierangeli S, Harris EN. Black swan in the Kidney : Renal involvement in the antiphospholipid antibody syndrome. Kidney Int 2002; 62: Musio F, Bohen EM, Yuan CM, Welch PG. Review of thrombotic thrombocytopenic purpura in the setting of systemic lupus erythematosus. Semin Arthritis Rheum 1998; 28: Jackson AM, Rose BD, Graff LG et al. Thrombotic microangiopathy and renal failure associated with antineoplastic chemotherapy. Ann Intern Med 1984; 101: Ahmed S, Siddiqui RK, Siddiqui AK, Zaidi SA, Cervia J. HIV associated thrombotic microangiopathy. Postgrad Med J 2002; 78: Becker S, Fusco G, Fusco J et al. Collaborations in HIV Outcomes Research/US Cohort. HIV-associated thrombotic microangiopathy in the era of highly active antiretroviral therapy: an observational study. Clin Infect Dis 2004; 39 [Suppl 5]: S267 S George JN. How I treat patients with thrombotic thrombocytopenic purpura hemolytic uremic syndrome. Blood 2000; 96: Received for publication: Accepted in revised form:
THROMBOTIC MICROANGIOPATHY. Jun-Ki Park 7/19/11
THROMBOTIC MICROANGIOPATHY Jun-Ki Park 7/19/11 TMAs are microvascular occlusive disorders characterized by systemic or intrarenal aggregation of platelets, thrombocytopenia, and mechanical injury to erythrocytes.
More informationBeyond Plasma Exchange: Targeted Therapy for Thrombotic Thrombocytopenic Purpura
Beyond Plasma Exchange: Targeted Therapy for Thrombotic Thrombocytopenic Purpura Kristen Knoph, PharmD, BCPS PGY2 Pharmacotherapy Resident Pharmacy Grand Rounds April 25, 2017 2016 MFMER slide-1 Objectives
More informationWhat is meant by Thrombotic Microangiopathy (TMA)?
What is meant by Thrombotic Microangiopathy (TMA)? Thrombotic Microangiopathy (TMA) is a group of disorders characterized by injured endothelial cells, microangiopathic hemolytic anemia (MAHA), with its
More informationDRUG NAME: Eculizumab Brand(s): Soliris DOSAGE FORM/ STRENGTH: 10 mg/ml (300 mg per vial)
Preamble: A confirmed diagnosis of atypical hemolytic uremic syndrome (ahus) is required for eculizumab funding. The information below is to provide clinicians with context for how a diagnosis of ahus
More informationAtypical Hemolytic Uremic Syndrome: When the Environment and Mutations Affect Organ Systems. A Case Report with Review of Literature
Atypical Hemolytic Uremic Syndrome: When the Environment and Mutations Affect Organ Systems. A Case Report with Review of Literature Mouhanna Abu Ghanimeh 1, Omar Abughanimeh 1, Ayman Qasrawi 1, Abdulraheem
More informationTMA in HUS and TTP: new insights
TMA in HUS and TTP: new insights Daan Dierickx University Hospitals Leuven, Department of Hematology, Belgium 20th Annual Meeting Belgian Society on Thrombosis and Haemostatis Antwerpen, 22 th November
More informationR. Coward has documented that he has received cooperative grants from Takeda and Novo Nordisk
R. Coward has documented that he has received cooperative grants from Takeda and Novo Nordisk Advances in our understanding of the pathogenesis of glomerular thrombotic microangiopathy Lindsay Keir Richard
More informationNew insights in thrombotic microangiopathies : TTP and ahus
New insights in thrombotic microangiopathies : TTP and ahus Dr Catherine LAMBERT Hematology Cliniques universitaires Saint-Luc Catherine.lambert@uclouvain.be New insights in thrombotic microangiopathies
More informationSara K. Vesely, James N. George, Bernhard Lämmle, Jan-Dirk Studt, Lorenzo Alberio, Mayez A. El-Harake, and Gary E. Raskob
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS ADAMTS13 activity in thrombotic thrombocytopenic purpura hemolytic uremic syndrome: relation to presenting features and clinical outcomes in
More informationChapter 5: Acute Kidney Injury
Chapter 5: Acute Kidney Injury Introduction In recent years, acute kidney injury (AKI) has gained increasing recognition as a major risk factor for the development of chronic kidney disease (CKD). The
More informationHemolytic uremic syndrome: Investigations and management
Hemolytic uremic syndrome: Investigations and management SAWAI Toshihiro M.D., Ph.D. Department of Pediatrics, Shiga University of Medical Science Otsu, JAPAN AGENDA TMA; Thrombotic micro angiopathy STEC-HUS;
More informationDR V PHILIP CLINICAL HAEMATOLOGY UNIT CHRIS HANI BARAGWANATH ACADEMIC HOSPITAL
DR V PHILIP CLINICAL HAEMATOLOGY UNIT CHRIS HANI BARAGWANATH ACADEMIC HOSPITAL Rare but fatal disease if unrecognized and untreated Incidence about 1: 1 million in the USA Female preponderance of 2:1 Part
More informationPresentation Outline. Disease Background Previous research on platelet recovery rate Goal of our study Methods Results Limitations Conclusions
Platelet Recovery Rate at Day 5 of Therapeutic Plasma Exchange for Acquired Thrombotic Thrombocytopenic Purpura Can Aid in Identifying Risk of Disease Exacerbation Suzanne Zhou, Yara A. Park, Marian A.
More informationESRD affects approximately 300,000 people in the United
Dementia as a Predictor of Mortality in Dialysis Patients Daniel A. Rakowski,* Sophie Caillard, Lawrence Y. Agodoa, and Kevin C. Abbott* *Nephrology Service, Walter Reed Army Medical Center, Washington,
More informationRisk factors of chronic renal failure after atypical Hemolytic Uremic Syndrome under plasmatherapy
Risk factors of chronic renal failure after atypical Hemolytic Uremic Syndrome under plasmatherapy Professeur Eric Rondeau Urgences néphrologiques et Transplantation rénale Hôpital Tenon, Paris WWA SFH
More informationThrombotic Thrombocytopenic
The Treatment of TTP and the Prevention of Relapses GERALD APPEL, MD Professor of Clinical Medicine Columbia University College of Physicians and Surgeons NY-Presbyterian Hospital New York, New York Thrombotic
More informationThrombotic Thrombocytopenic Purpura and the Role of ADAMTS-13
Thrombotic Thrombocytopenic Purpura and the Role of ADAMTS-13 Mark Cunningham,MD Director, Hematology Laboratory Department of Pathology University of Kansas Medical Center College of American Pathologists
More informationStatus of the CKD and ESRD treatment: Growth, Care, Disparities
Status of the CKD and ESRD treatment: Growth, Care, Disparities United States Renal Data System Coordinating Center An J. Collins, MD FACP Director USRDS Coordinating Center Robert Foley, MB Co-investigator
More informationThrombotic thrombocytopenic purpura: 2008 Update
MEDICAL GRAND ROUNDS CME CREDIT MARK A. CROWTHER, MD Director, Division of Hematology, McMaster University, Hamilton, Ontario, Canada JAMES N. GEORGE, MD Hematology-Oncology Section, Department of Medicine,
More informationSpectrum of complement-mediated thrombotic microangiopathies after kidney transplantation
Spectrum of complement-mediated thrombotic microangiopathies after kidney transplantation Marius Miglinas Vilnius university hospital: Nephrology center, Center of Rare Kidney Diseases Vilnius university
More informationDr. E.SUDHA (Fellow in Pediatric Nephrology) DEPT OF PEDIATRIC NEPHROLOGY & DIALYSIS Dr.MEHTA CHILDRENS HOSPITAL
Dr. E.SUDHA (Fellow in Pediatric Nephrology) DEPT OF PEDIATRIC NEPHROLOGY & DIALYSIS Dr.MEHTA CHILDRENS HOSPITAL CASE HISTORY 4 yrs old previously well boy Born to 2 nd degree consanguinity Fever x 5 days
More informationSoliris (eculizumab) DRUG.00050
Market DC Soliris (eculizumab) DRUG.00050 Override(s) Prior Authorization Approval Duration 1 year Medications Soliris (eculizumab) APPROVAL CRITERIA Paroxysmal Nocturnal Hemoglobinuria I. Initiation of
More information* Renal insufficiencies
Thrombotic Thrombocytopenic Purpura Behzad Poopak, DCLS PhD. Tehran medical Branch Islamic Azad university bpoopak@yahoo.com Case Summary Ms. X, a 35-year year-old woman Complained of weakness, low grade
More informationIncreased risk of death in African American patients with end-stage renal disease secondary to lupus
Clin Kidney J (2014) 7: 40 44 doi: 10.1093/ckj/sft157 Advance Access publication 2 January 2014 Original Article Increased risk of death in patients with end-stage renal disease secondary to lupus Sangeeta
More informationChapter 2: Identification and Care of Patients With Chronic Kidney Disease
Chapter 2: Identification and Care of Patients With Chronic Kidney Disease Introduction The examination of care in patients with chronic kidney disease (CKD) is a significant challenge, as most large datasets
More informationA 60 year old woman with altered mental status and thrombotic microangiopathy. Josh Veatch
A 60 year old woman with altered mental status and thrombotic microangiopathy Josh Veatch Previously healthy 60 year old woman 2 3 months of fatigue following a URI, transient episodes being out of it
More informationRenal failure and thrombocytopaenia? Don t forget TTP/HUS. Jonathan Wala Nephrologist
Renal failure and thrombocytopaenia? Don t forget TTP/HUS Jonathan Wala Nephrologist Thrombotic microangiopathies Disorders characterized by: thrombocytopaenia microangiopathic haemolytic anaemia (MAHA)
More informationAABB 2003 ANNUAL MEETING AWARD LECTURES
Blackwell Science, LtdOxford, UKTRFTransfusion0041-11322004 American Association of Blood BanksSeptember 200444913841392Original ArticleTHE OKLAHOMA TTP-HUS REGISTRYGEORGE AABB 2003 ANNUAL MEETING AWARD
More informationChapter 3: Morbidity and Mortality in Patients with CKD
Chapter 3: Morbidity and Mortality in Patients with CKD In this 2017 Annual Data Report (ADR) we introduce analysis of a new dataset. To provide a more comprehensive examination of morbidity patterns,
More informationChapter 5: Acute Kidney Injury
Chapter 5: Acute Kidney Injury In 2015, 4.3% of Medicare fee-for-service beneficiaries experienced a hospitalization complicated by Acute Kidney Injury (AKI); this appears to have plateaued since 2011
More informationCHAPTER 3 SECONDARY GLOMERULONEPHRITIS
CHAPTER 3 SECONDARY GLOMERULONEPHRITIS Leong Chong Men Kok Lai Sun Rosnawati Yahya 53 5th Report of the 3.1: Introduction This chapter covers the main secondary glomerulonephritis that were reported to
More informationRECURRENT AND DE NOVO RENAL DISEASES IN THE ALLOGRAFT. J. H. Helderman,MD,FACP,FAST
RECURRENT AND DE NOVO RENAL DISEASES IN THE ALLOGRAFT J. H. Helderman,MD,FACP,FAST Vanderbilt University Medical Center Professor of Medicine, Pathology and Immunology Medical Director, Vanderbilt Transplant
More informationPREGNANCY ASSOCIATED THROMBOTIC THROMBOCYTOPENIC PURPURA AND ACUTE KIDNEY INJURY
VII, 2013, 2 33 A, PREGNANCY ASSOCIATED THROMBOTIC THROMBOCYTOPENIC PURPURA AND ACUTE KIDNEY INJURY M. Lubomirova Clinic of Nephrology, University Hospital Aleksandrovska So a : ( ), /HELLP, (AFLP) (TTP)
More informationApproccio morfologico alle microangiopatie trombotiche
Approccio morfologico alle microangiopatie trombotiche Gina Zini Polo Oncologia e Ematologia Policlinico A. Gemelli Università Cattolica S. Cuore - Roma 1 Thrombotic microangiopathies Occlusive microangiopathic
More informationUSRDS UNITED STATES RENAL DATA SYSTEM
USRDS UNITED STATES RENAL DATA SYSTEM Chapter 2: Identification and Care of Patients With CKD Over half of patients from the Medicare 5 percent sample have either a diagnosis of chronic kidney disease
More informationARIC Manuscript Proposal # 1518
ARIC Manuscript Proposal # 1518 PC Reviewed: 5/12/09 Status: A Priority: 2 SC Reviewed: Status: Priority: 1. a. Full Title: Prevalence of kidney stones and incidence of kidney stone hospitalization in
More informationISTITUTO DI RICERCHE FARMACOLOGICHE MARIO NEGRI CLINICAL RESEARCH CENTER ALDO E FOR CELE RARE DACCO DISEASES ALDO E CELE DACCO
ISTITUTO DI RICERCHE FARMACOLOGICHE MARIO NEGRI CENTRO MARIO DI NEGRI RICERCHE INSTITUTE CLINICHE FOR PHARMACOLOGICAL PER LE MALATTIE RESEARCH RARE CLINICAL RESEARCH CENTER ALDO E FOR CELE RARE DACCO DISEASES
More informationChronic kidney disease (CKD) has received
Participant Follow-up in the Kidney Early Evaluation Program (KEEP) After Initial Detection Allan J. Collins, MD, FACP, 1,2 Suying Li, PhD, 1 Shu-Cheng Chen, MS, 1 and Joseph A. Vassalotti, MD 3,4 Background:
More informationMeeting the Guidelines for End-of-Life Care
Advances in Peritoneal Dialysis, Vol. 22, 2006 Gillian Brunier, David M.J. Naimark, Michelle A. Hladunewich Meeting the Guidelines for End-of-Life Care The number of patients initiating dialysis in most
More informationThrombotic thrombocytopenic purpura: a look at the future
Thrombotic thrombocytopenic purpura: a look at the future Andrea Artoni, MD Ph.D. Angelo Bianchi Bonomi Hemophilia and Thrombosis Center IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Italy andrea.artoni@policlinico.mi.it
More informationReduced graft function (with or without dialysis) vs immediate graft function a comparison of long-term renal allograft survival
Nephrol Dial Transplant (2006) 21: 2270 2274 doi:10.1093/ndt/gfl103 Advance Access publication 22 May 2006 Original Article Reduced graft function (with or without dialysis) vs immediate graft function
More informationChapter 3: Morbidity and Mortality
Chapter 3: Morbidity and Mortality Introduction In this chapter we evaluate the morbidity and mortality of chronic kidney disease (CKD) patients continuously enrolled in Medicare. Each year s analysis
More informationASBMT and Marrow Transplantation
Biol Blood Marrow Transplant 19 (2013) 661e675 Brief Articles Improved Survival over the Last Decade in Pediatric Patients Requiring Dialysis after Hematopoietic Cell Transplantation American Society for
More informationTemporal Trends in Demographics and Overall Survival of Non Small-Cell Lung Cancer Patients at Moffitt Cancer Center From 1986 to 2008
Special Report Temporal Trends in Demographics and Overall Survival of Non Small-Cell Lung Cancer Patients at Moffitt Cancer Center From 1986 to 2008 Matthew B. Schabath, PhD, Zachary J. Thompson, PhD,
More informationFOUR. Clinical Indicators of Care
Clinical Indicators of Care T FOUR The great questions of the time are not decided by speeches and majority decisions but by iron and blood. Otto von Bismarck, Speech to the Prussian Diet 78 ž 2000 ATLAS
More informationPrimary causes: Complement dysregulation (50% of non-shiga toxin-producing E. coli ) Secondary causes:
General department INTRODUCTION The hemolytic uremic syndrome (HUS): microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury One of the main causes of acute kidney injury in children
More informationChapter 2: Identification and Care of Patients With CKD
Chapter 2: Identification and Care of Patients With CKD Over half of patients in the Medicare 5% sample (aged 65 and older) had at least one of three diagnosed chronic conditions chronic kidney disease
More informationA 23 year old Caucasian male presented with shortness of breath, hypertension, bloody sputum, and a history of drug abuse (confirmed by urinalysis).
A 23 year old Caucasian male presented with shortness of breath, hypertension, bloody sputum, and a history of drug abuse (confirmed by urinalysis). He was found to have severe kidney injury requiring
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Bucholz EM, Butala NM, Ma S, Normand S-LT, Krumholz HM. Life
More informationSafety and Efficacy of Eculizumab in Pediatric Patients With ahus, With or Without Baseline Dialysis
SA-PO546 Safety and Efficacy of Eculizumab in Pediatric Patients With ahus, With or Without Baseline Johan Vande Walle, 1 Larry A. Greenbaum, 2 Camille L. Bedrosian, 3 Masayo Ogawa, 3 John F. Kincaid,
More informationSecular Trends in Cardiovascular Disease in Kidney Transplant Recipients: 1994 to 2009
Western University Scholarship@Western Electronic Thesis and Dissertation Repository June 2015 Secular Trends in Cardiovascular Disease in Kidney Transplant Recipients: 1994 to 2009 Ngan Lam The University
More informationYear 2004 Paper one: Questions supplied by Megan
QUESTION 53 Endothelial cell pathology on renal biopsy is most characteristic of which one of the following diagnoses? A. Pre-eclampsia B. Haemolytic uraemic syndrome C. Lupus nephritis D. Immunoglobulin
More informationahus A PATIENT S GUIDE To learn more about ahus, visit Copyright 2011, Alexion Pharmaceuticals, Inc. All rights reserved.
To learn more about ahus, visit www.ahussource.com ahus A PATIENT S GUIDE Copyright 2011, Alexion Pharmaceuticals, Inc. All rights reserved. SOL 1169 BECOME EMPOWERED By learning more and taking control
More informationRecent advances in pathogenesis & treatment of ahus
Recent advances in pathogenesis & treatment of ahus Miquel Blasco Pelicano Nephrology and Kidney Transplant Unit Hospital Clínic, Barcelona Atypical Hemolytic Uremic Syndrome (ahus) Ultra-rare disease:
More informationThrombotic Microangiopathies (TMA) / TTP/HUS/αHUS Pathology & Molecular. Genetics
Thrombotic Microangiopathies (TMA) / TTP/HUS/αHUS Pathology & Molecular Genetics Helen Liapis, M.D. Senior Consultant Arkana Labs Professor of Pathology & Immunology. retired Washington University School
More informationChapter 2: Identification and Care of Patients with CKD
Chapter 2: Identification and Care of Patients with CKD Over half of patients in the Medicare 5% sample (aged 65 and older) had at least one of three diagnosed chronic conditions chronic kidney disease
More informationChapter six Outcomes: hospitalization & mortality. There is an element of death in life, and I am astonished
INTRODUCTION 1 OVERALL HOSPITALIZATION & MORTALITY 1 hospital admissions & days, by primary diagnosis & patient vintage five-year survival mortality rates, by patient vintage expected remaining lifetimes
More informationNarender Goel et al. Middletown Medical PC, Montefiore Medical Center & Albert Einstein College of Medicine, New York
Narender Goel et al. Middletown Medical PC, Montefiore Medical Center & Albert Einstein College of Medicine, New York 4th International Conference on Nephrology & Therapeutics September 14, 2015 Baltimore,
More informationAcceptance onto Dialysis Guidelines
Guidelines John Kelly (Kogarah, New South Wales) Melissa Stanley (Melbourne, Victoria) David Harris (Westmead, New South Wales) Date written: December 2004 Final submission: June 2005 Predialysis education
More informationAppendix to Notification Letter for rituximab and eltrombopag dated 20 February 2014
Appendix to Notification Letter for rituximab and eltrombopag dated 20 February 2014 The notification letter which contains details of the decision to widen the restriction criteria for rituximab and eltrombopag
More informationChapter 2: Identification and Care of Patients With CKD
Chapter 2: Identification and Care of Patients With Over half of patients from the Medicare 5% sample (restricted to age 65 and older) have a diagnosis of chronic kidney disease (), cardiovascular disease,
More informationRole of High-sensitivity C-reactive Protein as a Marker of Inflammation in Pre-dialysis Patients of Chronic Renal Failure
ORIGINAL ARTICLE JIACM 2009; 10(1 & 2): 18-22 Abstract Role of High-sensitivity C-reactive Protein as a Marker of Inflammation in Pre-dialysis Patients of Chronic Renal Failure N Nand*, HK Aggarwal**,
More informationClinical correlates, outcomes and healthcare costs associated with early mechanical ventilation after kidney transplantation
The American Journal of Surgery (2013) 206, 686-692 Association of Women Surgeons: Clinical Science Clinical correlates, outcomes and healthcare costs associated with early mechanical ventilation after
More informationComparison of prognosis between patients with renal cell carcinoma on hemodialysis and those with renal cell carcinoma in the general population
DOI 10.1007/s10147-015-0812-9 ORIGINAL ARTICLE Comparison of prognosis between patients with renal cell carcinoma on hemodialysis and those with renal cell carcinoma in the general population Yasunobu
More informationName of Policy: Therapeutic Apheresis, with Extracorporeal Column Immunoadsorption and Plasma Reinfusion
Name of Policy: Therapeutic Apheresis, with Extracorporeal Column Immunoadsorption and Plasma Reinfusion Policy #: 010 Latest Review Date: December 2008 Category: Surgical Policy Grade: Effective March
More informationManifestation of Antiphospholipid Syndrome among Saudi patients :examining the applicability of sapporo Criteria
Manifestation of Antiphospholipid Syndrome among Saudi patients :examining the applicability of sapporo Criteria Farjah H AlGahtani Associate professor,md,mph Leukemia,Lymphoma in adolescent,thromboembolic
More informationMortality after kidney transplant failure: The impact of non-immunologic factors
Kidney International, Vol. 62 (2002), pp. 1875 1883 Mortality after kidney transplant failure: The impact of non-immunologic factors JOHN S. GILL, REKHA ABICHANDANI, ANNAMARIA T. KAUSZ, and BRIAN J.G.
More informationAssociation between causes of peritoneal dialysis technique failure and all-cause mortality
www.nature.com/scientificreports Received: 27 September 2017 Accepted: 21 February 2018 Published: xx xx xxxx OPEN Association between causes of peritoneal dialysis technique failure and all-cause mortality
More informationMETABOLISM AND NUTRITION WITH PD OBESITY. Rajnish Mehrotra Harborview Medical Center University of Washington, Seattle
METABOLISM AND NUTRITION WITH PD OBESITY Rajnish Mehrotra Harborview Medical Center University of Washington, Seattle 1 Body Size in Patients New to Dialysis United States Body Mass Index, kg/m2 33 31
More informationThrombotic Microangiopathy in the era of HIV
Thrombotic Microangiopathy in the era of HIV Malcolm Davies A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: eculizumab_soliris 8/2014 4/2018 4/2019 4/2018 Description of Procedure or Service Paroxysmal nocturnal hemoglobinuria
More informationChapter 1: CKD in the General Population
Chapter 1: CKD in the General Population Overall prevalence of CKD (Stages 1-5) in the U.S. adult general population was 14.8% in 2011-2014. CKD Stage 3 is the most prevalent (NHANES: Figure 1.2 and Table
More informationPredictors of cardiac allograft vasculopathy in pediatric heart transplant recipients
Pediatr Transplantation 2013: 17: 436 440 2013 John Wiley & Sons A/S. Pediatric Transplantation DOI: 10.1111/petr.12095 Predictors of cardiac allograft vasculopathy in pediatric heart transplant recipients
More informationSpecialised Services Policy: CP98 Eculizumab for Atypical Haemolytic Uraemic Syndrome (ahus)
Specialised Services Policy: CP98 Eculizumab for Atypical Haemolytic Uraemic Syndrome (ahus) Document Author: Assistant Director for Evidence, Evaluation and Effectiveness Executive Lead: Medical Director
More information. Time to transplant listing is dependent on. . In 2003, 9.1% of all prevalent transplant. . Patients with diabetes mellitus are less
Chapter 5: Joint Analyses with UK Transplant in England and Wales; Access to the Renal Transplant Waiting List, Time to Listing, Diabetic Access to Transplantation and the Influence of Social Deprivation
More informationSafety and Efficacy of Eculizumab in Pediatric Patients With ahus, With or Without Baseline Dialysis
SP281 Safety and Efficacy of Eculizumab in Pediatric Patients With ahus, With or Without Baseline Johan Vande Walle, 1 Larry A. Greenbaum, 2 Camille L. Bedrosian, 3 Masayo Ogawa, 3 John F. Kincaid, 3 Chantal
More informationImprovement in Pittsburgh Symptom Score Index After Initiation of Peritoneal Dialysis
Advances in Peritoneal Dialysis, Vol. 24, 2008 Matthew J. Novak, 1 Heena Sheth, 2 Filitsa H. Bender, 1 Linda Fried, 1,3 Beth Piraino 1 Improvement in Pittsburgh Symptom Score Index After Initiation of
More informationAtypical IgA Nephropathy
Atypical IgA Nephropathy Richard J. Glassock, MD, MACP Geffen School of Medicine at UCLA XXXIII Chilean Congress of Nephrology, Hypertension and Transplantation Puerto Varas, Chile October 6, 2016 IgA
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acute lung injury (ALI) transfusion-related, 363 372. See also Transfusion-related acute lung injury (TRALI) ALI. See Acute lung injury
More informationDepartment of Clinical Haematology. Diagnosis and management of thrombotic thrombocytopenic purpura (TTP): Summary
Diagnosis and management of thrombotic thrombocytopenic purpura (TTP): Summary Suspected TTP Investigations Further Investigations Blood Products URGENT treatment Suspect TTP if MAHA and thrombocytopenia
More informationClinical Commissioning Policy Proposition: Rituximab for cytopaenia complicating primary immunodeficiency
Clinical Commissioning Policy Proposition: Rituximab for cytopaenia complicating primary immunodeficiency Reference: NHS England F06X02/01 Information Reader Box (IRB) to be inserted on inside front cover
More informationTrends and Comparative Effectiveness in Treatment of Stage IV Colorectal Adenocarcinoma
Trends and Comparative Effectiveness in Treatment of Stage IV Colorectal Adenocarcinoma Taylor S. Riall, MD, PhD CERCIT Workshop October 19, 2012 Department of Surgery Center for Comparative Effectiveness
More informationA Methodological Issue in the Analysis of Second-Primary Cancer Incidence in Long-Term Survivors of Childhood Cancers
American Journal of Epidemiology Copyright 2003 by the Johns Hopkins Bloomberg School of Public Health All rights reserved Vol. 158, No. 11 Printed in U.S.A. DOI: 10.1093/aje/kwg278 PRACTICE OF EPIDEMIOLOGY
More informationSoliris Medical Policy Prior Authorization Program Summary
Soliris Medical Policy Prior Authorization Program Summary Precertification/Prior Authorization may be required under certain plans. Please verify each member s benefits. OBJECTIVE The intent of the Soliris
More information2015 Children's Mercy Hospitals and Clinics. All Rights Reserved.
Growth van Stralen KJ, et al., Kidney Int, 2014 Blood Pressure Management van Stralen KJ, et al., Kidney Int, 2014 Sodium Losses on PD Infants might need higher UF rate per BSA as compared to adults to
More informationmorbidity & mortality
morbidity & mortality esrd introduction of ESRD treatment. We examine these concerns throughout the ADR, particularly in Chapter One. This year we focus on infectious complications, especially those related
More informationTHE MULTIPLE FACETS OF THROMBOTIC MICROANGIOPATHIES
THE MULTIPLE FACETS OF THROMBOTIC MICROANGIOPATHIES Summary of Presentations from the Alexion-Sponsored Symposium, held at the 19 th EHA Congress, Milan, Italy, on 12 th June 2014 Chairperson Pier Mannuccio
More informationEchocardiography analysis in renal transplant recipients
Original Research Article Echocardiography analysis in renal transplant recipients S.A.K. Noor Mohamed 1*, Edwin Fernando 2, 1 Assistant Professor, 2 Professor Department of Nephrology, Govt. Stanley Medical
More informationEffect of previously failed kidney transplantation on peritoneal dialysis outcomes in the Australian and New Zealand patient populations
NDT Advance Access published November 9, 2005 Nephrol Dial Transplant (2005) 1 of 8 doi:10.1093/ndt/gfi248 Original Article Effect of previously failed kidney transplantation on peritoneal dialysis outcomes
More informationSection K. Economic costs of ESRD. Vol 3 esrd. pg 731. K tables
Section K Economic costs of ESRD Vol 3 esrd pg 731 Table K.1 733 Total costs ($) of reported ESRD per calendar year all ESRD with at least one claim, & Table K.2 734 Total costs ($) of reported ESRD :
More informationPART ONE. Peritoneal Kinetics and Anatomy
PART ONE Peritoneal Kinetics and Anatomy Advances in Peritoneal Dialysis, Vol. 22, 2006 Paul A. Fein, Irfan Fazil, Muhammad A. Rafiq, Teresa Schloth, Betty Matza, Jyotiprakas Chattopadhyay, Morrell M.
More informationTwo: Chronic kidney disease identified in the claims data. Chapter
Two: Chronic kidney disease identified in the claims data Though leaves are many, the root is one; Through all the lying days of my youth swayed my leaves and flowers in the sun; Now may wither into the
More informationChapter 6: Transplantation
Chapter 6: Transplantation Introduction During calendar year 2012, 17,305 kidney transplants, including kidney-alone and kidney plus at least one additional organ, were performed in the United States.
More informationKidney Transplant. Description
Section: Surgery Effective Date: October 15, 2015 Subject: Kidney Transplant Page: 1 of 9 Last Review Status/Date: September 2015 Kidney Transplant Description A kidney transplant involves the surgical
More informationLecture Outline Biost 517 Applied Biostatistics I
Lecture Outline Biost 517 Applied Biostatistics I Scott S. Emerson, M.D., Ph.D. Professor of Biostatistics University of Washington Lecture 2: Statistical Classification of Scientific Questions Types of
More informationIn adults, urinary tract infection (UTI) after renal transplantation
CJASN epress. Published on December 6, 2006 as doi: 10.2215/CJN.01820506 Effects of Urinary Tract Infection on Outcomes after Renal Transplantation in Children Vikas R. Dharnidharka,* Lawrence Y. Agodoa,
More informationQuantification of the Early Risk of Death in Elderly Kidney Transplant Recipients
Wiley Periodicals Inc. C Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons Quantification of the Early Risk of Death in Elderly Kidney Transplant Recipients
More informationUpdates on Paediatric clinical research activities
Updates on Paediatric clinical research activities Shivaram Hegde Consultant paediatric nephrologist Children Kidney centre UHW, Cardiff Aim to Brief introduction Research updates Improve contribution
More informationpatient characteriuics Chapter Two introduction 58 increasing complexity of the patient population 60 epo use & anemia in the pre-esrd period 62
introduction 58 < increasing complexity of the patient population 6 < epo use & anemia in the pre-esrd period 62 < biochemical & physical characteristics at initiation 64 < estimated gfr at intiation &
More informationPalliative and End of Life Care in End Stage Renal Disease
Palliative and End of Life Care in End Stage Renal Disease Palliative and End of Life Care Priority for Action Regional Consensus Workshop 30.06.2010 Neal Morgan Consultant Nephrologist SHSCT Outline Introduction
More information