Post-Tx Anemia Linked to Higher Graft Loss Risk

ANEMIA AFTER kidney transplantation may increase the risk of graft loss, cardiovascular events, and death from cardiovascular and other causes, investigators reported in Progress in Transplantation

Poemlarp Mekraksakit, MD, of Texas Tech University Health Sciences Center

KDIGO guidelines update

continued from page 1 those on dialysis and receiving kidney transplant.

“Since the publication of the KDIGO 2018 HCV guideline, evidence has mounted that sofosbuvir, a key component of several regimens, is safe for all stages of CKD, including for individuals with low glomerular filtration rate (GFR) or undergoing dialysis,” the authors wrote. “This development is important because in many nations, the only available DAA regimens are those that are sofosbuvir-based.”

If pangenotypic regimens are not available, determine the patient’s hepatitis C genotype and use the genotypespecific treatment. The full report lists DAA regimens with evidence of effectiveness for various CKD populations. Protease inhibitors such as simeprevir, paritaprevir, and grazoprevir are contraindicated in patients with ChildPugh B and C cirrhosis.

DAA regimens can interact with immunosuppressive agents, such as calcineurin

Stone risk link

continued from page 1 in the android region, Guoxiang Li of The First Affiliated Hospital of Anhui Medical University in Hefei, China, and colleagues explained in Frontiers in Endocrinology. The authors cited research showing that fat accumulation in Lubbock, Texas, and colleagues conducted a systematic review and metaanalysis of 17 studies published from August 2006 to April 2019 including 16,463 kidney transplant recipients.

Post-transplant anemia was significantly associated with a 2.3-fold increased risk of graft loss and a 1.7-fold increased and mTOR inhibitors. The guideline suggests consulting http://www.hepdruginteractions.org before using these regimens in kidney transplant recipients.

Since the publication of the KDIGO 2018 HCV guideline, evidence has mounted that sofosbuvir, a key component of several regimens, is safe for all stages of CKD, including for individuals with low glomerular filtration rate (GFR) or undergoing dialysis. This development is important because in many nations, the only available DAA regimens are those that are sofosbuvir-based.

Test for Hepatitis B Virus

Hepatitis B virus can reactivate during and after treatment with DAAs, so the guideline recommends testing beforehand for serologic markers, such as hepatitis B surface antigen, total core antibody, and antibody to hepatitis B surface antigen. If hepatitis B surface antigen is present, clinicians should assess the patient for hepatitis B therapy. If hepatitis B surface antigen is absent, but markers of prior hepatitis B infection (positive for total core antibody risk of all-cause mortality. Anemia occurring within 6 months of transplantation carried greater risks of graft loss (2.96- vs 2.22-fold increased risk) and all-cause mortality (2.63- vs 1.73-fold increased risk) compared with anemia that occurred later, the investigators reported. Post-transplant anemia was significantly associated with a 1.3-fold increased risk of major adverse cardiovascular events and a 2.1-fold increased risk of cardiovascular death compared with no anemia. As post-transplant anemia has myriad causes, prompt assessment and appropriate management are crucial, according to Dr Mekraksakit’s team. ■ with or without antibody to hepatitis B surface antigen) are detected, clinicians should perform hepatitis B DNA testing if levels of liver function tests rise during direct-acting antiviral therapy.

Subgroup analyses revealed that the association between high A/G ratio and increased kidney stone risk was more pronounced among women than men, individuals without vs with diabetes, Mexican-American and White adults vs Black adults and other races, participants aged 40 to 59 years, and patients with hypertension.

When analyzed by diabetes status, the investigators found no correlation between A/G ratio and KSD among patients with diabetes. “This may be because several glucose-lowering drugs can prevent kidney stone formation,” they wrote.

Transplant Candidates

In addition, kidney transplant candidates with hepatitis C should be screened for liver disease severity and portal hypertension. Results from this assessment will help guide the decision between kidney transplantation alone and simultaneous kidney-liver transplantation.

The guideline recommends administering DAA therapy to all kidney transplant candidates infected with hepatitis C. The decision to treat before or after transplantation should be guided by donor type (living vs deceased donor), wait-list times by donor type, center-specific policies, and the severity of liver fibrosis.

Living kidney donors should be screened for hepatitis C with immunoassay and undergo nucleic acid testing if seropositive.

Kidneys from hepatitis C-infected donors can be offered to potential

ESKD, retinal age gap

continued from page 1 defined as the difference between the retinal age predicted by artificial intelligence and chronological age. The mean age of the cohort was 56.8 years, and 93.2% were White. recipients who are positive or negative in accordance with national and regional laws.

Research shows that kidney transplantation from hepatitis C-infected donors to uninfected recipients who are treated immediately or early with direct-acting antivirals leads to favorable outcomes. Education and informed consent are required.

Patients with hepatitis C presenting with immune-complex glomerulonephritis do not need a confirmatory kidney biopsy, according to the guideline. They should be treated with DAAs. Clinicians should consider biopsy if kidney function or proteinuria worsens, and before immunosuppressive therapy.

Patients with cryoglobulinemic flare or rapidly progressive glomerulonephritis can be treated with both DAAs and immunosuppressive agents, with or without plasma exchange. Rituximab is generally used as the first-line immunosuppressive treatment, although steroids should also be considered in rapidly progressive glomerulonephritis. ■ low compliance rate to kidney disease screening,” Dr Zhu’s team concluded. The predictive ability of retinal age gap has been demonstrated for other diseases. For example, in a 2022 paper in Stroke, investigators reported study in the liver, pancreas, and kidneys can have adverse effects. For example, fat accumulation in the liver and pancreas is associated with indicators of inflammation, and inflammation is strongly linked to kidney stone formation, they wrote.

“Based on a cross-sectional study of a US population, we found that a high A/G ratio was associated with an increased prevalence of kidney stones,” the authors concluded. “This may have significant implications for the prevention and treatment of kidney stones.” ■

After a median 11 years, 115 (0.32%) individuals were diagnosed with ESKD. Each 1-year increase in retinal age gap was independently associated with a 10% increase in ESKD risk, Dr Zhu and colleagues reported in the American Journal of Kidney Diseases. Patients with higher retinal age gaps in the fourth quartile had a significant 2.8-fold increased risk of developing ESKD compared with those in the first quartile.

“The non-invasive, fast and costeffective features of retinal imaging enable the utility of retinal age gap as a screening and triage tool for ESKD, thus potentially improving the current findings showing that each 1-year increase in retinal age gap was associated with a 3% increased risk for incident cardiovascular disease. In another study, described in a 2022 paper in Age and Ageing, researchers found that each 1-year increase in retinal age gap was associated with a 10% increased risk for Parkinson’s disease. ■