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Prediction of Nonadherence and Renal Prognosis by Pre-Transplantation Serum Phosphate Levels

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Title: Prediction of Nonadherence and Renal Prognosis by Pre-Transplantation Serum Phosphate Levels
Authors: Kitamura, Mineaki / Mochizuki, Yasushi / Kitamura, Satoko / Mukae, Yuta / Nakanishi, Hiromi / Ota, Yuki / Muta, Kumiko / Yamashita, Hiroshi / Obata, Yoko / Iwata, Takahisa / Nishikido, Masaharu / Kawanami, Sachiko / Takashima, Miwa / Sasaki, Hitoshi / Sakai, Hideki / Mukae, Hiroshi / Nishino, Tomoya
Issue Date: 10-May-2019
Publisher: International Scientific Information, Inc.
Citation: Annals of transplantation, 24, pp.260-267; 2019
Description: BACKGROUND Identifying characteristics of patients at high risk of poor adherence before transplantation would be advantageous. However, the optimal approach for characterizing such patients remains unknown.We aimed to evaluate the association between factors for hemodialysis nonadherence and post-transplant renal prognosis. We hypothesized that these factors would influence post-transplantation adherence and worsen renal prognosis. MATERIAL AND METHODS We reviewed patients on hemodialysis who underwent kidney transplantation at our hospital between 2000 and 2017 to identify risk factors associated with poor prognosis. The patients' background and pre-transplantation data, known hemodialysis nonadherence factors, serum phosphate and potassium levels, and interdialytic weight gains were evaluated. The primary endpoint was renal death. We also evaluated the fluctuation of calcineurin inhibitor concentration and weight gain after transplantation. RESULTS Seventy-seven patients were eligible, and the mean observational period was 83.2 months (standard deviation, 50.5). Thirteen patients reached the endpoint.Cox proportional hazards regression analysis showed that pre-transplantation serum phosphate level was a risk factor for renal death (p<0.05), while serum potassium levels and weight gain were not. In addition, fluctuation of calcineurin inhibitor concentration was observed in patients with higher phosphate levels before transplantation (p=0.03). Weight gain after transplantation was not associated with the hemodialysis nonadherence factors. CONCLUSIONS High pre-transplantation serum phosphate levels are considered to represent poor drug adherence and/or an unhealthy lifestyle. Patient education that conveys the importance of adhering to medications and provides nutritional guidance is crucial for improving post-transplantation renal prognosis.
Keywords: Dialysis / Kidney Transplantation / medication adherence / Patient Compliance
URI: http://hdl.handle.net/10069/39225
DOI: 10.12659/AOT.914909
Rights: This paper has been published under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
Type: Journal Article
Text Version: publisher
Appears in Collections:Articles in academic journal

Citable URI : http://hdl.handle.net/10069/39225

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