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Related Concept Videos

Kidney Transplant I: Introduction01:28

Kidney Transplant I: Introduction

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A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
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Kidney Transplant II: Surgical Procedure01:26

Kidney Transplant II: Surgical Procedure

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Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
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Kidney Transplant III: Nursing Management01:16

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Postoperative Nursing Management for Kidney Transplant PatientsPostoperative nursing management care includes monitoring the surgical site, encouraging early movement, and promoting lung health through breathing exercises. Nurses also administer prescribed medications like H2-blockers, such as famotidine, or proton pump inhibitors, like omeprazole, to help prevent gastrointestinal ulcers and bleeding. Fungal infections in the mouth and bladder can result from immunosuppressive and antibiotic...
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Kidney Structure01:45

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The kidneys are two large bean-shaped organs located in the upper abdomen. They filter the blood several times a day to remove toxins and rebalance water and electrolytes of the circulatory system via the renal veins. The kidneys receive blood directly from the heart via the renal arteries. These arteries enter the kidney at the hilum, the concave surface of the bean, where they branch and divide into smaller vessels and capillaries.
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External Anatomy of the Kidney01:21

External Anatomy of the Kidney

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The kidneys are a pair of bean-shaped organs in the human body that play a critical role in maintaining overall health. They filter out waste products from the blood, regulate blood pressure, maintain electrolyte balance, and stimulate the production of red blood cells.
The kidneys are located in the retroperitoneal space on either side of the vertebral column, protected posteriorly by the 11th and 12th ribs. The right kidney sits slightly lower than the left owing to the presence of the liver...
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Internal Anatomy of the Kidney01:12

Internal Anatomy of the Kidney

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The kidneys are essential organs in the human body, performing a myriad of tasks that maintain homeostasis and overall health.
Anatomical Position and Dimensions
The kidneys are retroperitoneal organs positioned against the posterior abdominal wall on either side of the spine, roughly between the twelfth thoracic and third lumbar vertebrae. Each kidney is typically 10-12 cm long, 5-6 cm wide, and 3-4 cm thick, weighing about 150 grams.
Renal Cortex
The outermost region of the kidney is the...
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Robot-Assisted Kidney Transplantation
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Frailty and Access to Kidney Transplantation.

Christine E Haugen1, Nadia M Chu2,1, Hao Ying1

  • 1Department of Surgery.

Clinical Journal of the American Society of Nephrology : CJASN
|March 21, 2019
PubMed
Summary

Frailty significantly reduces kidney transplant listing and transplant rates in patients with end-stage kidney disease (ESKD). Identifying and addressing frailty may improve access to kidney transplantation for these vulnerable individuals.

Keywords:
Accidental FallsCognitionComorbidityCounselingFrailtyHand StrengthIncidenceKidney Failure, ChronicOutpatientsProspective StudiesTransplantsWalking SpeedWeight Losshospitalizationkidney transplantationoutcomesrenal dialysisrisk factors

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Area of Science:

  • Nephrology
  • Geriatrics
  • Transplantation Medicine

Background:

  • Frailty is a distinct clinical syndrome characterized by decreased resistance to stressors, affecting up to 35% of patients with end-stage kidney disease (ESKD).
  • Frailty is linked to adverse outcomes including falls, hospitalizations, cognitive decline, mortality, and poorer results post-kidney transplant.
  • Existing challenges in identifying frailty hinder timely clinical intervention and equitable access to kidney transplantation.

Purpose of the Study:

  • To investigate the association between frailty and access to kidney transplantation among candidates with ESKD.
  • To quantify differences in kidney transplant listing and transplantation rates between frail and nonfrail candidates.

Main Methods:

  • A prospective cohort study involving 7078 kidney transplant candidates across three centers from 2009 to 2018.
  • Utilized the Fried frailty phenotype criteria (weight loss, grip strength, walking speed, exhaustion, activity level) assessed during outpatient transplant evaluation.
  • Employed Cox proportional hazards and Poisson regression models to estimate time to listing and transplant rates, adjusting for demographic and health covariates.

Main Results:

  • The study cohort had a mean age of 54 years, with 21% identified as frail.
  • Frail candidates were 38% less likely to be listed for kidney transplantation (HR 0.62; P<0.001) compared to nonfrail candidates, independent of other factors.
  • Frail individuals received kidney transplants at a 32% lower rate than nonfrail candidates (IRR 0.68; P<0.001).

Conclusions:

  • Frailty is significantly associated with reduced likelihood of kidney transplant listing and lower transplantation rates.
  • These findings highlight frailty as a critical factor impacting kidney transplant access for ESKD patients.
  • Frailty represents a potentially modifiable risk factor that warrants clinical attention to improve transplant equity.