Introduction:
Kidney transplantation (KTx) is the treatment of choice for most patients with end-stage kidney disease (ESKD). As patients with kidney disease often have significant comorbidities, the evaluation of a potential kidney transplant recipient should be as efficient and cost-effective as possible. The initial evaluation of the potential recipient should include a thorough medical, surgical, and psychosocial history and a detailed physical examination to identify comorbidities that could affect candidate survival after the transplantation. The aim of this study was to examine demographic and comorbidity factors of patients with end-stage renal disease on the kidney transplantation waiting list in regard to their status (active vs. temporarily disqualified) in an unselected large population of patients with ESKD treated with hemodialysis (HD) throughout the country.
Methods:
From the population of 5886 hemodialyzed patients (60% of men), originated from one of the biggest providers of hemodialysis in the country we extracted 449 waitlisted hemodialyzed patients, 4619 patients not considered for potential kidney transplantation and . 820 patients either temporary disqualified or being in the process of qualification for KTx were not considered for analysis. We assessed demographic data, basal biochemical data, cardiovascular disease prevalence, dialysis vintage. Patients were divided in two groups: active, and non-active on kidney transplantation list.
Results:
The waitlisted patients encompassed 8.85% of the whole population and were significantly younger than non-listed patients (53,2±14.2 vs 67,2 ± 13.3 years, p<0,001). Proportion of females and males in both groups did not differ significantly. Peptic ulcer disease had similar prevalence in both groups (7.57 % in actively waitlisted vs 6.08% in non-listed, p=0.25). History of malignancy was found in 823 patients in the whole studied population, 842 patients were in non-listed group (18.22%), only 19 patients with prior malignancy were actively waitlist (4.23%, p<0.001). Of interest is that group with malignancy was significantly older that population without malignancy (66 ± 14 years, vs 71± 11 years, p<0.001). The same applies to the malignancy non-listed vs actively listed patients. Similarly, Charlson comorbidity score was significantly higher in patients with malignancy vs all patients (6.09± 2.02 vs 4.32±1.91, p<0.001). In addition, in the non-listed population, 42 patients (5%) had stage 4 malignancy (with distant metastases). Prevalence of other comorbidities were as follows: cardiovascular disease (46.5% vs 66.8%, p<0.001) and diabetes (20.5% vs 37,8%, p<0.001). Mean dialysis vintage, mean number of hypotensive medications (mean 2.5), eKt/v, mean serum hemoglobin, mean transferrin saturation were similar, while serum ferritin was significantly higher in non-listed group (p<0.001) as well as Charlson comorbidity score (p<0001).
Conclusions:
In the real-life world, presence of comorbidities impact significantly evaluation for potential kidney transplantation. It appears that beside well know comorbidities i.e. cardiovascular disease and diabetes, malignancy affect significantly the waitlisting procedure. As our dialyzed population getting older and sicker, we need to perform more thoughtful evaluation in particular in regard to screening for malignancy as it may affect the outcomes .
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.