Kidney Function

Background: Few risk factors for quality-of-life outcomes of simultaneous pancreas and kidney transplant recipients are known because of a paucity of data from prospective studies.Study Design: Pretransplant assessment and prospective 3-year follow-up.Setting & Participants: Consecutive potential recipients at a university teaching hospital assessed by Liaison Psychiatry.Predictors: Demographic data; pretransplant Transplant Evaluation Rating Scale scores; current, past 12 months, and prior lifetime psychiatric disorder.Outcomes & Measurements: 36-Item Short Form Health Survey (SF-36) scores.Results: 37 simultaneous pancreas and kidney transplant recipients were assessed pretransplant and at 4 months posttransplant. Posttransplant at 1 year, 29 (81% of survivors); at 2 years, 26 (79% of survivors and those reaching 2 years); and at 3 years, 22 (92% of survivors and those reaching 3 years) patients were assessed. SF-36 Mental Component Summary (MCS) scores (mean pretransplant, 46.8 ± 8.2 [SD]; 4 months, 51.7 ± 8.5; 1 year, 50.1 ± 9.7; 2 years, 51.8 ± 8.9; and 3 years, 50.8 ± 13.8) and Physical Component Summary (PCS) scores (pretransplant, 40.6 ± 10.6; 4 months, 43.6 ± 12.0; 1 year, 45.6 ± 11.3; 2 years, 48.1 ± 10.2; and 3 years, 46.8 ± 9.1) showed sustained improvement posttransplant. MCS scores became similar to population norms. Functionally significant decreases in MCS and PCS scores were seen in 4%-21% and 8%-30% at times posttransplant. Male sex predicted higher scores at 4 months for the MCS (P = 0.003; regression coefficient, −8.28 [95% CI, −13.6 to −2.9]; effect size, 0.22) and PCS (P = 0.05; regression coefficient, −6.91 [95% CI, −13.9 to 0.9]; effect size, 0.08). Current psychiatric disorder at pretransplant evaluation predicted higher PCS scores at 4 months (P = 0.002; regression coefficient, −15.42 [95% CI, −24.6 to −6.2]; effect size, 0.22) and 1 year (P = 0.002; regression coefficient, −17.3 [95% CI, −27.9 to −6.7]; effect size, 0.29). Psychiatric disorder before the 12 months before the pretransplant evaluation predicted lower PCS scores at 4 months posttransplant (P < 0.001; regression coefficient, 14.98 [95% CI, 7.1-22.8]; effect size, 0.29).Limitations: Cohort size.Conclusions: Although half experienced sustained quality-of-life improvement, up to one-third experienced a decrease. Past psychiatric disorder is a risk factor. Patients should be educated and monitored appropriately.

Background: A higher prevalence of chronic kidney disease (CKD) has been found in genetic relatives of patients with end-stage renal disease. However, the risk of CKD in nongenetic spouses of patients with end-stage renal disease is still unknown.Study Design: Cross-sectional study.Setting & Participants: 196 first- and second-degree relatives and 95 spouses of 178 hemodialysis (HD) patients were enrolled. Two sex- and age-stratified matched counterpart controls were randomly selected from the population of a community screening program for CKD.Predictors: Relatives or spouses of HD patients and kidney disease risk factors.Outcomes: Prevalence of CKD (albuminuria or low estimated glomerular filtration rate).Measurement: Albuminuria (urine albumin-creatinine ratio ≥ 30 mg/g), low estimated glomerular filtration rate (<60 mL/min/1.73 m2), and kidney disease risk factors of age, hypertension, diabetes mellitus, metabolic syndrome, and lifestyle.Results: A significantly higher prevalence of CKD was found in relatives (15.8% vs 7.5%; P = 0.01) and spouses (41.1% vs 15.8%; P < 0.001) of HD patients compared with their counterpart controls. Multiple logistic regression analysis showed that age (OR, 1.05) and hypertension (OR, 3.13) were significant independent risk factors for CKD in relatives of HD patients, whereas diabetes mellitus (OR, 3.51) was a significant risk factor for CKD in spouses of HD patients. For all pooled participants, being relatives (OR, 2.55) or spouses (OR, 2.80) of HD patients, age (OR, 1.06), female sex (OR, 1.81), diabetes mellitus (OR, 3.95), hypertension (OR, 1.85), and hyperuricemia (OR, 2.06) were independent significant risk factors for CKD.Limitations: Cross-sectional research design, single laboratory measurement, and limited numbers of participants.Conclusions: A comprehensive screening program for CKD is equally important in both relatives and spouses of HD patients, especially for participants with the renal risk factors of older age, hypertension, and diabetes mellitus. Spousal concordance of CKD suggests that the shared environmental factors and health behaviors might have important roles in the development of CKD.

Pancreatic cancer is the fourth leading cause of cancer-related death in the United States. The incidence of pancreatic cancer increased between the 1930s and 1970s, but has been relatively stable since that time. The lifetime risk of pancreatic carcinoma being diagnosed in the United States is 1.27%. With the use of adjuvant chemo- and radiotherapy, the survival rate for patients with pancreatic cancer has increased significantly. This is resulting in a new set of complications associated with either the disease or various treatment modalities. We report a case of a 54-year-old white woman with a history of metastatic pancreatic carcinoma who presented with chronic kidney disease 7 years after her primary carcinoma was diagnosed.