Transplantation in diabetic kidney failure patients: modalities, outcomes, and clinical management.


:Diabetes mellitus (DM) is a common and devastating disease, affecting up to 19.3 million Americans. It is the leading cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in the United States. Diabetic patients with ESRD have a high incidence of cardiovascular disease and death. For those kidney transplant patients with no history of DM prior to transplantation, the development of new onset diabetes after transplantation (NODAT) also poses a serious threat to both graft and patient survival. Kidney transplantation is the best renal replacement option for diabetic ESRD and has the potential to halt the progression of cardiovascular diseases. Early referral for transplant evaluation is essential for pre-emptive or early kidney transplantation in this cohort of patients. In type 1 DM patients with ESRD, simultaneous pancreas and kidney transplantation (SPK) should be encouraged; and in patients facing prolonged waiting time for SPK transplantation but with an available living donor, living donor kidney transplantation followed by pancreas after kidney transplantation (PAK) is a suitable alternative. Islet transplantation in type 1 diabetics is deemed experimental by Medicare, and easy access to this modality remains restricted to qualified patients enrolled in clinical trials or with private insurance. The optimal management of kidney transplant patients with pre-existent DM or NODAT involves a multi-pronged approach consisting of pharmacological and nonpharmacological intervention to address all potential cardiovascular risk factors such as glycemic and lipid control, blood pressure control, weight loss, and smoking cessation. Finally, re-transplantation should be recommended in suitable kidney transplant patients when the kidney allograft demonstrates continuous and progressive decline in function.


Semin Dial


Seminars in dialysis


Luan FL,Samaniego M




Has Abstract


2010-03-01 00:00:00














  • Surface-area-normalized Kt/V: a method of rescaling dialysis dose to body surface area-implications for different-size patients by gender.

    abstract::Dialysis is measured as Kt/V, which scales the dose (Kt) to body water content (V). Scaling dialysis dose to body surface area (S(dub)) has been advocated, but the implications of such rescaling have not been examined. We developed a method of rescaling measured Kt/V to S(dub) and studied the effect of such alternativ...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Daugirdas JT,Depner TA,Greene T,Kuhlmann MK,Levin NW,Chertow GM,Rocco MV

    更新日期:2008-09-01 00:00:00

  • Assessing the approach to a thrombosed AV graft.

    abstract::The patency of the vascular access (VA) is a fight for the attending nephrologist. A retrospective observational study was conducted to compare the success rate of surgical versus endovascular technique percutaneous transluminal angioplasty (PTA) for graft thrombosis treatment. Of 3008 patients, 22.1% patients were di...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Ponce P,Carvalho T,Messias H,Neves F,Lisbon VAC Interventional Nephrology Team.

    更新日期:2014-09-01 00:00:00

  • Banding of hemodialysis access to treat hand ischemia or cardiac overload.

    abstract::A hemodialysis access may lead to cardiac overload (CO) or hand ischemia [hemodialysis access induced distal ischemia (HAIDI). Surgical banding restricts access flow and promotes distal perfusion. Aim of the study was to investigate short- and long-term clinical success of banding in these patient groups. After evalua...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: van Hoek F,Scheltinga M,Luirink M,Pasmans H,Beerenhout C

    更新日期:2009-03-01 00:00:00

  • Removal of Phosphorus by Hemodialysis.

    abstract::The control of serum phosphorus by dialysis is made difficult by the fact that intradialytic blood levels tend to be low, and because phosphorus is removed almost exclusively from the plasma during its passage through the dialyzer. The most practical way to increase phosphorus removal is to extend dialysis time, altho...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Daugirdas JT

    更新日期:2015-11-01 00:00:00

  • Hyperhomocysteinemia in uremia--a red flag in a disrupted circuit.

    abstract::Hyperhomocysteinemia is an independent cardiovascular risk factor, according to most observational studies and to studies using the Mendelian randomization approach, utilizing the common polymorphism C677T of methylene tetrahydrofolate reductase. In contrast, the most recent secondary preventive intervention studies, ...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Perna AF,Ingrosso D,Violetti E,Luciano MG,Sepe I,Lanza D,Capasso R,Ascione E,Raiola I,Lombardi C,Stenvinkel P,Massy Z,De Santo NG

    更新日期:2009-07-01 00:00:00

  • Comments on plasma parathyroid hormone levels and their relationship to bone histopathology among patients undergoing dialysis.

    abstract::Measurements of the concentration of parathyroid hormone (PTH) in serum or plasma are used widely for the initial diagnostic assessment of patients with renal bone disease, to monitor disease progression, and to gauge responses to treatment. Several analytical methods are used to measure plasma PTH levels, and a varie...

    journal_title:Seminars in dialysis

    pub_type: 社论,评审


    authors: Goodman WG

    更新日期:2007-01-01 00:00:00

  • Assessment of nutritional status in maintenance hemodialysis patients: A multicenter cross-sectional study in Iran.

    abstract:INTRODUCTION:Protein-energy wasting (PEW) is common in hemodialysis patients and is linked with a high rate of morbidity and mortality. Regarding importance of nutrition in these patients, a recent study was administered to evaluate the nutritional status of hemodialysis patients. MATERIALS:In this cross-sectional stu...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Akhlaghi Z,Sharifipour F,Nematy M,Safarian M,Malekahmadi M,Barkhidarian B,Norouzy A

    更新日期:2020-10-14 00:00:00

  • Starting a home hemodialysis program.

    abstract::Home hemodialysis is not a new therapy; rather it is a therapy in which interest has been rekindled due to both the continually growing end-stage renal disease population and concern about poor outcomes in patients on conventional thrice-weekly in-center dialysis. The practical issues to be considered when starting a ...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Moran J,Kraus M

    更新日期:2007-01-01 00:00:00

  • Is there an established hemoglobin target range for patients undergoing chronic dialysis?

    abstract::Anemia is a common complication of advanced chronic kidney disease (CKD). Treatment with erythropoiesis-stimulating agents (ESAs) remains a common approach in managing anemia of CKD. The 2012 Kidney Disease Improving Global Outcomes Clinical Practice Guideline for Anemia in CKD suggests avoiding ESA therapy use to mai...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Shah HH,Fishbane S

    更新日期:2018-07-01 00:00:00

  • Dietary phosphorus restriction in advanced chronic kidney disease: merits, challenges, and emerging strategies.

    abstract::Hyperphosphatemia is an independent risk factor for mortality in patients on maintenance dialysis. Since phosphorus clearance by standard three times-weekly dialysis is insufficient to balance ongoing dietary phosphorus intake, strategies to prevent absorption of dietary phosphorus are essential for attenuating increa...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Gutiérrez OM,Wolf M

    更新日期:2010-07-01 00:00:00

  • We Do Too Many Parathyroidectomies for Calciphylaxis.

    abstract::Calciphylaxis, a disorder of dermal arteriolar calcification with a distinct predilection for patients with advanced kidney disease, remains an enigmatic condition that challenges clinicians. Observations regarding positive associations between levels of circulating parathyroid hormone (PTH) and the risk of calciphyla...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Nigwekar SU,Sprague SM

    更新日期:2016-07-01 00:00:00

  • Convective therapies for removal of middle molecular weight uremic toxins in end-stage renal disease: a review of the evidence.

    abstract::The increasing number of patients requiring renal replacement therapy poses a challenge to maintain quality of care in the setting of limited resources. The commonly used modalities include hemodialysis and peritoneal dialysis, and using a "urea-centric" model to increase the clearance of small molecular weight uremic...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Thomas G,Jaber BL

    更新日期:2009-11-01 00:00:00

  • Consolidation in dialysis Markets-Causes, consequences, and the role of policy.

    abstract::The dialysis industry is one of the most highly concentrated healthcare sectors in the United States. Despite decades of growth in the number of patients with end-stage renal disease and in the size of dialysis markets, two large dialysis organizations currently care for more than two-thirds of the dialysis population...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Saeed MK,Ho V,Erickson KF

    更新日期:2020-01-01 00:00:00

  • Influence of temporal variation in wall shear stress on intima-media thickening in arteriovenous fistulae.

    abstract::Arteriovenous fistula (AVF) failure is mainly due to venous stenosis characterized by significant amount of intima-media thickening (IMT), probably in the presence of negative (inward) remodeling. Our hypothesis is that the longitudinal changes in wall shear stress (WSS) within different configurations of AVF can infl...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Rajabi-Jagahrgh E,Krishnamoorthy MK,Wang Y,Choe A,Roy-Chaudhury P,Banerjee RK

    更新日期:2013-07-01 00:00:00

  • Management of the Dialysis Patient with Sickle Cell Disease.

    abstract::While patients with sickle cell disease currently constitute a very small minority of the US dialysis population (0.1%), there is anticipated growth of this group as the life expectancy of those with sickle cell disease (SCD) increases. SCD patients suffer a high burden of morbidity, which is enhanced by the presence ...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Boyle SM,Jacobs B,Sayani FA,Hoffman B

    更新日期:2016-01-01 00:00:00

  • Coronary-subclavian steal syndrome in a hemodialysis patient, a case report and review of literature.

    abstract::Dialysis vascular access associated coronary-subclavian steal or hypoperfusion syndrome is an uncommon but potentially life threatening condition. Awareness of this syndrome is important in the management of vascular access in hemodialysis patients. We report a case of dialysis vascular access associated coronary-subc...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Tan CS,Fintelmann F,Joe J,Ganguli S,Wu S

    更新日期:2013-09-01 00:00:00

  • Uremia-related metabolic cardiac risk factors in chronic kidney disease.

    abstract::Growing evidence has been gathered over the last 15 years regarding the role of nontraditional or uremia-related risk factors in the pathogenesis of atherosclerosis in subjects with renal failure. Among those factors, dyslipidemia, inflammation, hyperhomocysteinemia, and oxidant stress have been extensively studied. H...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Madore F

    更新日期:2003-03-01 00:00:00

  • Assessing the Adequacy of Small Solute Clearance for Various Dialysis Modalities, with Inclusion of Residual Native Kidney Function.

    abstract::Measurement of small molecule clearance remains important in the clinical care of patients requiring long-term dialysis. Many patients maintain a significant degree of residual native kidney function and may have nontraditional schedules with or without combined dialysis modalities. In this review, we examine and outl...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Chin AI,Depner TA,Daugirdas JT

    更新日期:2017-05-01 00:00:00

  • The risk of sedation/analgesia in hemodialysis patients undergoing interventional procedures.

    abstract::Data derived from a large cohort of hemodialysis patients (12,896) undergoing dialysis access maintenance procedures being performed by interventional nephrologists were analyzed to determine the safety of sedation/analgesia (S/A) in a freestanding facility. Data collected included patient demographics, procedures per...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Beathard GA,Urbanes A,Litchfield T,Weinstein A

    更新日期:2011-01-01 00:00:00

  • Controversies in timing of dialysis initiation and the role of race and demographics.

    abstract::Dialysis remains the predominant form of renal replacement therapy in the United States, but the optimal timing for the initiation of dialysis remains poorly defined. Not only clinical factors such as signs/symptoms of uremia, co-existing cardiovascular disease, and presence of diabetes but also key demographic charac...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Streja E,Nicholas SB,Norris KC

    更新日期:2013-11-01 00:00:00

  • Therapeutic plasma exchange for renal-related conditions in the elderly: ten years experience in one center.

    abstract::The elderly people, 65 years old and above, are growing in number. The structural and functional changes associated with aging place the elderly at risk when challenged by extracorporeal therapies, such as therapeutic plasma exchange (TPE). We retrospectively analyzed data on all patients who underwent TPE for renal i...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Hayes JS,Balogun RA,Chang J,Abdel-Rahman EM

    更新日期:2012-03-01 00:00:00

  • Surgical Management of Complications with Peritoneal Dialysis.

    abstract::This report reviews the most common surgical interventions and complications of chronic peritoneal dialysis (PD) patients. Based on the current knowledge as well as our experience we detail the role of these surgical procedures. We supplement the reported knowledge in the field with our own experience in this area. Th...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Ratajczak A,Lange-Ratajczak M,Bobkiewicz A,Studniarek A

    更新日期:2017-01-01 00:00:00

  • Outcomes of arteriovenous grafts following simultaneous thrombectomy and stent graft placement across the venous anastomosis.

    abstract::Arteriovenous grafts (AVGs) suffer from high thrombosis rates. It is not known whether placement of stent grafts at the venous anastomosis (VA) of thrombosed AVGs would impact future thrombosis. This is a retrospective study evaluating a group of AVGs that underwent endovascular thrombectomy with placement of a stent ...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Nassar GM,Suki D,Rhee E,Khan AJ,Nguyen B,Achkar K

    更新日期:2014-11-01 00:00:00

  • Calcific uremic arteriolopathy: advances in pathogenesis and treatment.

    abstract::Calcific uremic arteriolopathy (CUA) is a rare but serious life-threatening complication of CRF that manifests as painful nonhealing eschars in association with panniculitis and dermal necrosis. This condition is being increasingly recognized and reported as a contributing factor to death in dialysis patients. The pat...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Rogers NM,Teubner DJ,Coates PT

    更新日期:2007-03-01 00:00:00

  • The medical-legal responsibilities of a dialysis unit medical director.

    abstract::The specialty of Nephrology, by virtue of its relationship with the dialysis procedure, is highly vulnerable to litigation. As is the case with all nephrologists, a dialysis unit medical director is not immune to medical malpractice suits, and can be held liable for any act of perceived or potential harm to any dialys...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Vaqar S,Murray B,Panesar M

    更新日期:2014-09-01 00:00:00

  • Methods of assessment of volume status and intercompartmental fluid shifts in hemodialysis patients: implications in clinical practice.

    abstract::Determining dry weight and assessing extracellular fluid volume in hemodialysis (HD) patients is one of the greatest challenges to practicing nephrologists. The clinical examination has limited accuracy, so different strategies have been investigated to aid in this evaluation. Biochemical markers of volume overload (A...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Ishibe S,Peixoto AJ

    更新日期:2004-01-01 00:00:00

  • Should the target hemoglobin for patients with chronic kidney disease treated with erythropoietic replacement therapy be changed?

    abstract::Recombinant human erythropoietin (rHuEPO, epoetin) revolutionized the treatment of anemia in patients with chronic kidney disease (CKD) when it was approved for use in the United States in 1989. Among dialysis patients, the mean hemoglobin (Hb) in patients undergoing dialysis rose from 7-8 g/dl prior to 1989 to 11-12 ...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Berns JS

    更新日期:2005-01-01 00:00:00

  • Blood Pressure Management in Hemodialysis Patients: What We Know And What Questions Remain.

    abstract::Despite having thousands of blood pressure (BP) readings on individual dialysis patients over the course of a year, our knowledge about the optimal assessment of BP, the mechanisms underlying hypertension and its management remain incomplete. Observational studies reveal that BP is lower at home than when measured in ...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Miskulin DC,Weiner DE

    更新日期:2017-05-01 00:00:00

  • How I do it: directional atherectomy for in-stent restenosis of a PTFE arteriovenous graft.

    abstract::We describe the use of directional atherectomy (DA) to restore patency of a thrombosed polytetrafluoroethylene arteriovenous graft with an in-stent restenosis at the venous anastomosis. Technically, the procedure described is not an atherectomy per se, but rather the removal of fibrosis and intimal hyperplasia with sh...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Yevzlin AS,Guttormsen B,Chan MR,Gimelli G

    更新日期:2008-05-01 00:00:00

  • Inadequate treatment of congestive heart failure in dialysis patients.

    abstract::Congestive heart failure (CHF) is highly prevalent in patients on renal replacement therapy and is a leading cause of death in such patients. Several studies suggest that therapeutic agents for the treatment of CHF, particularly angiotensin converting enzyme inhibitors and beta-blockers, are underused in end-stage ren...

    journal_title:Seminars in dialysis

    pub_type: 社论


    authors: Bouchard J,Madore F

    更新日期:2007-09-01 00:00:00