Monday, February 22, 2016

iChoose Kidney: A Clinical Decision Aid for Kidney Transpla... : Transplantation iChoose Kidney: A Clinical Decision Aid for Kidney Transpla... : Transplantation

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doi: 10.1097/TP.0000000000001019
Original Clinical Science-General

iChoose Kidney: A Clinical Decision Aid for Kidney Transplantation Versus Dialysis Treatment

Patzer, Rachel E. PhD, MPH; Basu, Mohua MPH; Larsen, Christian P. MD, DPhil; Pastan, Stephen O. MD; Mohan, Sumit MD, MPH; Patzer, Michael BS; Konomos, Michael MS, CMI; McClellan, William M. MD, MPH; Lea, Janice MD; Howard, David PhD; Gander, Jennifer PhD, MPH; Arriola, Kimberly Jacob PhD, MPH

Supplemental Author Material


Background: Despite a significant survival advantage of kidney transplantation compared with dialysis, nearly one third of end-stage renal disease (ESRD) patients are not educated about kidney transplantation as a treatment option at the time of ESRD diagnosis. Access to individualized, evidence-based prognostic information is needed to facilitate and encourage shared decision making about the clinical implications of whether to pursue transplantation or long-term dialysis.

Methods: We used a national cohort of incident ESRD patients in the US Renal Data System surveillance registry from 2005 to 2011 to develop and validate prediction models for risk of 1- and 3-year mortality among dialysis versus kidney transplantation. Using these data, we developed a mobile clinical decision aid that provides estimates of risks of death and survival on dialysis compared with kidney transplantation patients.

Results: Factors included in the mortality risk prediction models for dialysis and transplantation included age, race/ethnicity, dialysis vintage, and comorbidities, including diabetes, hypertension, cardiovascular disease, and low albumin. Among the validation cohorts, the discriminatory ability of the model for 3-year mortality was moderate (c statistic, 0.7047; 95% confidence interval, 0.7029-0.7065 for dialysis and 0.7015; 95% confidence interval, 0.6875-0.7155 for transplant). We used these risk prediction models to develop an electronic, user-friendly, mobile (iPad, iPhone, and website) clinical decision aid called iChoose Kidney.

Conclusions: The use of a mobile clinical decision aid comparing individualized mortality risk estimates for dialysis versus transplantation could enhance communication between ESRD patients and their clinicians when making decisions about treatment options.

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Transplantation. 100(3):630-639, March 2016.
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Paul I. Terasaki, PHD, 1929-2015.

AJT Paul I. Terasaki, PHD, 1929-2015.

He created the microcytotoxicity test for HLA typing (which allowed the field of histocompatibility to advance on an international scale as it required only one microliter of the rare human alloantisera used to identify HLA antigens) and was a champion of HLA matching between kidney donors and recipients to improve transplant outcomes. But Paul was as interested in the human alloantibodies that defined HLA types as he was in their targets and realized that those antibodies could damage a transplanted kidney. He developed the lymphocyte crossmatch test in the mid-1960s that dramatically reduced the incidence of catastrophic hyperacute rejections and is still used in more sensitive forms today. By reversing the microcytotoxicity test, he made it possible to identify sensitized patients awaiting a transplant and to estimate their chances of finding a crossmatch compatible donor. This article is protected by copyright. All rights reserved.

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Alberto Reino Buelvas 
Médico Internista Nefrólogo