MARCH 2015
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VO L U M E 14, IS SU E N U M BE R 2
Study: Every Hour of CIT Matters Longer cold ischemia time means higher risks
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www.renalandurologynews.com
HOW COLD ISCHEMIA TIMES INFLUENCE GRAFT SURVIVAL According to a new study, the risk of graft failure increases as cold ischemia time (CIT) increases. Shown here are the 1- and 10-year risks of graft failure associated with varying CIT. 40
36%
35 30
25%
25
20%
20
GRAFT FAILURE and mortality risk among kidney transplant recipients increases along with cold ischemia time (CIT), according to French researchers. “Even though CIT is a well-known risk factor among the renal transplantation community, its precise etiological role on mid-term graft outcomes is still under debate as illustrated by the wide heterogeneity of results observed in the literature,” Agnes Debout, MD, of CHU Nantes, RTRS, and colleagues noted. In a study of 3,839 adult recipients of a first deceased-donor kidney, Dr. Debout’s team found that each addi-
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tional hour of CIT was associated with a significant 1.3% increased risk of graft failure and 1.8% increased risk of death. Patients who received a kidney with a CIT of 30 hours had a significant 40% higher risk of graft failure and 53% higher risk of death than patients who received a kidney with a CIT of 6 hours, the researchers reported in Kidney International (2015;87:343-349). The risk of graft failure was 4% at 1 year and 20% at 10 years for CIT less than 16 hours and 5% and 25%, respectively, for CIT of 16 to 36 hours. When CIT was more than 36 hours,
<16 hours 16–36 hours >36 hours
15 10 5
4%
0
5%
8%
1 year
10 years
Source: Debout A et al. Each additional hour of cold ischemia time significantly increases the risk of graft failure and mortality following renal transplantation. Kidney Int. 2015;87:343-349).
the risk of graft failure was 8% at 1 year and 36% at 10 years. “These findings are of practical clinical interest, as cold ischemia time is among one of the main modifiable pretransplantation risk factors that can be minimized by improved management
of the peri-transplantation period,” Dr. Debout and her colleagues wrote. The mean CIT for study subjects was 20.6 hours. CIT duration was 6 to 16 hours for 1,274 patients (33.2%), 16 to 24 hours for 1,531 (39.9%), 24 to 36 continued on page 9
Hypothyroidism AVF Use Increasing in the U.S. Risk Rises As ARTERIOVENOUS FISTULA (AVF) remained stable at 18%. The U.S. had has increased and catheter use has the highest proportion of HD patients eGFR Declines use decreased among hemodialysis (HD) with AVGs of all the DOPPS countries. AS KIDNEY FUNCTION decreases in patients with moderate-to-severe chronic kidney disease (CKD), the risk of hypothyroidism increases, according to a new study. In a study looking at a nationally representative cohort of 461,607 veterans with Stage 3–5 CKD, researchers found that each 10 mL/min/1.73 m2 lower estimated glomerular filtration rate (eGFR) was associated with an 18% increased risk of hypothyroidism in adjusted analyses. Hypothyroidism was determined by laboratory tests or receipt of thyroid hormone supplementation.
patients in the United States, according to a study. The use of AVFs at HD initiation remains low, however. Using data from patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS) Practice Monitor, Ronald L. Pisoni, PhD, MS, of Arbor Research Collaborative for Health in Ann Arbor, Mich., and colleagues found that from August 2010 to August 2013, AVF use increased from 63% to 68% while central venous catheter (CVC) use decreased from 19% to 15% and arteriovenous graft (AVG) use
AVF use in the United States did not differ greatly across broad age groups, but AV access use differed considerably by race, the investigators reported online ahead of print in the American Journal of Kidney Diseases. AVF use was 58% among blacks compared with 74% among Hispanics and 70% among non-Hispanic whites. AVG use was 2-fold higher among blacks than non-black U.S. patients (26% vs. 13%) in 2013. CVC use was similar across the 3 racial/ethnic groups. continued on page 9
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