Showing papers by "Lawrence Y. Agodoa published in 1998"

Prognosis after primary renal transplant failure and the beneficial effects of repeat transplantation: multivariate analyses from the United States Renal Data System

Abstract: Background Survival of transplant recipients after primary renal allograft failure has not been well studied. Methods. A cohort of 19,208 renal transplant recipients with primary allograft failure between 1985 and 1995 were followed from the date of allograft loss until death, repeat transplantation, or December 31, 1996. The mortality, wait-listing, and repeat transplantation rates were assessed. The mortality risks associated with repeat transplantation were estimated with a time-dependent survival model. Results. In total, 34.5% (n=6,631) of patients died during follow-up. Of these deaths, 82.9% (n=5,498) occurred in patients not wait-listed for repeat transplantation, 11.9% (n=789) occurred in wait-listed patients, and 5.2% (n=344) occurred in second transplant recipients. Before repeat transplantation, the adjusted 5-year patient survival was 36%, 49%, and 65% for type I diabetes mellitus (DM), type II DM, and nondiabetic end-stage renal disease, respectively (P<0.001; DM vs. nondiabetics). The adjusted 5-year patient survival was lower in Caucasians (57%, P<0.001) compared with African-Americans (67%) and other races (64%). The 5-yr repeat transplantation rate was 29%, 15%, and 19%, whereas the median waiting time for a second transplant was 32, 90, and 81 months for Caucasians, African-Americans, and other races, respectively (P<0.0001 each). Repeat transplantation was associated with 45% and 23% reduction in 5-year mortality for type I DM and nondiabetic end-stage renal disease, respectively, when compared with their wait-listed dialysis counterparts with prior transplant failure. Conclusions. The loss of a primary renal allograft was associated with significant mortality, especially in recipients with type I DM. Repeat transplantation was associated with a substantial improvement in 5-year patient survival. Recipients with type I DM achieved the greatest proportional benefit from repeat transplantation.

African American Study of Kidney Disease and hypertension (AASK)--clinical trial update.

Abstract: African Americans are disproportionately afflicted with end-stage kidney failure (ESRD). Whereas they constitute approximately 12 percent of the US population, they comprise 32 percent of the prevalent ESRD population. Diabetes mellitus is the predominant cause of ESRD in the U.S. population. However, hypertension is the most frequently reported cause of ESRD in African Americans. In 1990, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health launched an initiative to investigate the underlying cause, and to study mechanisms that could slow progression of hypertensive kidney disease in African Americans. An important component of this initiative is the clinical trial African American Study of Kidney Disease and Hypertension (AASK). This report provides an update on the Institute's initiative on hypertensive kidney disease in African Americans and, specifically, on the clinical trial.

Renal histopathology in US African‐Americans with presumed hypertensive nephrosclerosis

Abstract: Summary: African-Americans have, in comparison with Caucasians, excess hypertension and end-stage renal disease, which has been presumed to be due to hypertension. However, systematic renal biopsy assessment of lesions in this population and verification of this clinical impression have not been done. During the pilot phase of the AASK trial, 46 hypertensive (diastolic BP > 95 mmHg) non-diabetic African-American patients between the ages of 18–70 years, with glomerular filtration rate (GFR) between 25 and 70 mL/min per 1.73m2 and without marked proteinuria were therefore biopsied to assess underlying lesions. Adequate biopsy material was obtained in 39 (29 men and 10 women), on average 53.0 ± 11.0 years old, with MAP of 109 ± 15 mmHg and GFR 51.7 ± 13.6 mL/min per 1.73 m2. of these 39 biopsies, 38 showed arteriosclerosis and/or arteriolosclerosis, severity on average 1.5 ± 0.9 and 1.5 ± 0.8, respectively, on a 0–3+ scale. Interstitial fibrosis was moderate, 1.3 ± 0.9 (0–3+ scale). Segmental glomerulosclerosis was present in five biopsies, and in one patient, biopsy and clinical findings were consistent with idiopathic focal segmental glomerulosclerosis. Additional lesions included mesangiopathic glomerulonephritis in one patient, basement membrane thickening suggestive of diabetic nephropathy in one, and cholesterol emboli in two cases. Arteriolar and arterial sclerosis were tightly linked, and correlated with interstitial fibrosis and the reciprocal of serum creatinine. Global glomerulosclerosis was extensive, involving on average 43 ± 26% of glomeruli. the extent of this lesion did not correlate with degree of arteriolar or arterial thickening, but did correlate with systolic blood pressure (P 0.0174), the reciprocal of serum creatinine (P= 0.0009), serum cholesterol (P= 0.0129) and interstitial fibrosis (P < 0.0001). These data underscore that the clinical diagnosis of hypertensive nephrosclerosis based on strict clinical criteria in non-diabetic African-Americans with mild to moderate renal insufficiency without marked proteinuria is strongly correlated with renal biopsy vascular lesions consistent with this clinical diagnosis. However, the mechanism(s) for this clinicopathologic constellation remains undetermined. Current studies are focused on possible genetic contributions to the development of hypertension and renal lesions in this population.

Patterns of end-stage renal disease in US African-Americans

Abstract: Summary: Although African-Americans constitute only about 12.4% of the population of the United States of America (USA), they comprise over 30% of the end-stage renal disease (ESRD) patient population. Diabetes mellitus (predominantly type 2) is the most frequently reported cause of ESRD in all racial and ethnic groups in the USA. However, hypertensive renal disease is reported as the dominant cause of ESRD in African-Americans. In general, all racial and ethnic minority groups in the USA have greater incidence and prevalence rates of ESRD than Caucasians. However, survival probabilities in all ESRD patients, dialysis patients, and cadaveric renal allograft recipients are greater in African-Americans than in Caucasians. the suggested reasons for these racial and ethnic disparities are discussed.