Nephrology
Permanent URI for this collectionhttps://wiredspace.wits.ac.za/handle/10539/32807
This collection contains data collected in the course of clinical work in Nephrology across several hospitals
In particular , the CMJAH Living Donor Clinic has a long history . You can see that the work of the unit has inspired or directly produced many thesis. We also have a selection of work on transplants. This collection also includes data on kidney disease from other tertiary hospitals in gauteng
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PARTICIPANT NOTICE OF DATA SHARING FOR STUDY TITLED ‘EVALUATION OF POTENTIAL KIDNEY DONORS AND OUTCOMES POST-DONATION AT CHARLOTTE MAXEKE JOHANNESBURG ACADEMIC HOSPITAL (1983-2015)’.
Good day, The Division of Nephrology at Charlotte Maxeke Johannesburg Academic Hospital ( Previously JHB GEN)conducted a research study in the unit’s Living Donor Clinic. The study assessed clinical data of all individuals who presented to this clinic from January 1983 to July 2015. Written permission to access clinical records was obtained from the Human Research Ethics Committee (Medical) of the University of the Witwatersrand, Johannesburg. The purpose of the study was to analyze living kidney donation in the South African setting with the hope that the clinical findings of this research may contribute toward the future betterment of care for all potential kidney donors and that this data may expand upon the limited information available in this important field of study. As a patient belonging to this Living Donor Transplant Community, you have the right to direct how your information is shared for use by research platforms. You may engage with the principal investigator of this study should you have any queries regarding how the data from this study is being applied. You may also withdraw consent to share any information you feel is potentially identifying at any point. Should you require any further information regarding the study, please feel free to contact the principal investigator, Dr Chandni Dayal via email or telephonically on 011 489 0467. Please note that prior to accessing your clinical records, approval was obtained from the Human Research Ethics Committee (Medical) of the University of the Witwatersrand, Johannesburg. A principal function of this Committee is to safeguard the rights and dignity of all individuals who are a part of research projects and the integrity of the research. If you have any complaints or concerns over the way the study was conducted, please contact the Chairperson of this Committee who is Dr. Clement Penny, on telephone number 011 717 2301, or by e-mail The telephone numbers for the Committee secretariat are 011 717 2700/1234 and the e-mail addresses are Zanele.Ndlovu@wits.ac.za and Rhulani.Mukansi@wits.ac.za Thank you for reading this notice. 11 March 2022 Dr Chandni DayalBrowse
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Search Results
Item Data Set : Prevalence, characterization and response to chronic kidney disease in an urban and rural setting in South Africa(2016-11-18) Naicker, Saraladevi; Fabian, June; Jaya A George; Harriet R Etheredge; Manuel van Deventer; Robert Kalyesubula; Alisha N Wade; Laurie A Tomlinson; Stephen TollmanGlobally, chronic kidney disease (CKD) is an emerging public health challenge but accurate data on its true prevalence are scarce, particularly in poorly resourced regions such as sub-Saharan Africa (SSA). Limited funding for population-based studies, poor laboratory infrastructure and the absence of a validated estimating equation for kidney function in Africans are contributing factors. Consequently, most available studies used to estimate population prevalence are hospital-based, with small samples of participants who are at high risk for kidney disease. While serum creatinine is most commonly used to estimate glomerular filtration, there is considerable potential bias in the measurement of creatinine that might lead to inaccurate estimates of kidney disease at individual and population level. To address this, the Laboratory Working Group of the National Kidney Disease Education Program published recommendations in 2006 to standardize the laboratory measurement of creatinine. The primary objective of this review was to appraise implementation of these recommendations in studies conducted in SSA after 2006. Secondary objectives were to assess bias relating to choice of estimating equations for assessing glomerular function in Africans and to evaluate use of recommended diagnostic criteria for CKD. This study was registered with Prospero (CRD42017068151), and using PubMed, African Journals Online and Web of Science, 5845 abstracts were reviewed and 252 full-text articles included for narrative analysis. Overall, two-thirds of studies did not report laboratory methods for creatinine measurement and just over 80% did not report whether their creatinine measurement was isotope dilution mass spectroscopy (IDMS) traceable. For those reporting a method, Jaffe was the most common (93%). The four-variable Modification of Diet in Renal Disease (4-v MDRD) equation was most frequently used (42%), followed by the CKD Epidemiology Collaboration (CKD-EPI) equation for creatinine (26%). For the 4-v MDRD equation and CKD-EPI equations, respectively, one-third to one half of studies clarified use of the coefficient for African-American (AA) ethnicity. When reporting CKD prevalence, <15% of studies fulfilled Kidney Disease: Improving Global Outcomes criteria and even fewer used a population-based sample. Six studies compared performance of estimating equations to measured glomerular filtration rate (GFR) demonstrating that coefficients for AA ethnicity used in the 4-v MDRD and the CKD-EPI equations overestimated GFR in Africans. To improve on reporting in future studies, we propose an 'easy to use' checklist that will standardize reporting of kidney function and improve the quality of studies in the region. This research contributes some understanding of the factors requiring attention to ensure accurate assessment of the burden of kidney disease in SSA. Many of these factors are difficult to address and extend beyond individual researchers to health systems and governmental policy, but understanding the burden of kidney disease is a critical first step to informing an integrated public health response that would provide appropriate screening, prevention and management of kidney disease in countries from SSA. This is particularly relevant as CKD is a common pathway in both infectious and non-communicable diseases, and multimorbidity is now commonplace, and even more so when those living with severe kidney disease have limited or no access to renal replacement therapy.Item WDGMC Paediatric Liver Transplant Research Database(REDcap, 2019-12-09) Fabian, June; Botha, Jean; Van der Schyff, Francisca.; Terblanche, Alberta JBiliary atresia (BA) is a progressive fibrosing cholangiopathy of infancy, the most common cause of cholestatic jaundice in infants and the top indication for liver transplantation in children. Kasai portoenterostomy (KPE) when successful may delay the requirement for liver transplantation, which in the majority offers the only cure. Good outcomes demand early surgical intervention, appropriate management of liver cirrhosis, and in most cases, liver transplantation. These parameters were audited of children with BA treated at the Steve Biko Academic Hospital (SBAH) in Pretoria, South Africa.Item The use of chronic dialysis in a resource-poor environment: demographic features and transplant readiness at Helen Joseph Hospital renal unit(2019) Parbhoo, DinenBackground Chronic kidney disease (CKD) places a considerable economic strain on health care systems. In South Africa resource limitations in the public sector mandate that patients with end stage renal disease (ESRD) are only offered dialysis if they qualify for renal transplant. Thus, chronic dialysis serves as a bridge to transplantation. Objectives The primary objective of this study was to describe the patients on the chronic dialysis program with regards to demographic features, aetiology of renal failure, associated chronic comorbidities and transplant readiness. Secondary objectives included the determination of the type and duration of dialysis used and the documentation of any possible differences between the haemodialysis (HD) and peritoneal dialysis (PD) groups and the HIV positive and negative patients. Methods A cross-sectional record review was conducted of all patients receiving chronic dialysis at the Helen Joseph Hospital’s Renal Unit as at September 2016. Information regarding demographic features, disease profile, year of initiation of dialysis, year of presentation, Human Immunodeficiency Virus (HIV) status and transplant readiness was collected. All data was analysed at a 95% confidence interval and a p value of <0.05 was considered significant. Results There were 92 patients on chronic dialysis, 46 each on PD and HD. The mean (SD) age of patients in this study was 43.8 years (10.8). There was a slight female predominance (51.1%). The predominant ethnic group was African (64.1%). The leading causes of ESRD were hypertension (35.9%) followed by diabetes mellitus (10.9%). The most frequent comorbidity was hypertension (98.9%) followed by HIV infection (36.1%). The median time that patients spent on dialysis before presentation for transplant listing was 2 years (range 0-9 years). At the time of analysis, 27 patients (29.4%) were eligible for transplant and 38 patients (41.3%) were in the process of transplant eligibility evaluation. Twenty-seven patients (29.4%) were ineligible for transplant. Of those eligible for transplant, 21 were listed for transplant and 6 were awaiting presentation for listing. There were no differences between the HD and PD groups or the HIV positive and negative groups with regards to qualification for transplant. Conclusion The demographic features and underlying aetiologies of our cohort are similar to national figures with only the racial composition being different. The proportion of patients listed for transplantation (22.8%) and median time for work-up (2 years) are both sub-optimal. Improved efficiency in the evaluation of transplant eligibility is required in order to optimize the appropriate allocation of dialysis in a resource-limited setting.Item Evaluation of potential kidney donors and outcomes post-donation at Charlotte Maxeke Johannesburg acdemic hospital (1983 - 2015) a(2019) Dayal, ChandniBackground Living kidney donation has emerged as a key therapeutic modality for end-stage kidney disease due to the global chronic shortage of renal allografts. However, the potential benefits to the recipient of a living donor kidney must be balanced against donor safety. In demographically diverse populations, there is a paucity of data regarding the living donor evaluation process and outcomes following donation. Objectives This study was undertaken to describe donation patterns, characterise reasons for nondonation and evaluate long-term morbidity and mortality following living kidney donation in the South African context. Methods A retrospective analysis of all Potential Living Donors (PLDs) evaluated at a single centre over a 32-year period was conducted. Of the total cohort of 1208 PLDs, 298 were Accepted Living Donors (ALDs), resulting in 910 Failed Living Donors (FLDs). Data collected included donor demographics. In addition, in the ALD group, clinical and laboratory parameters at various points in donor follow-up, as well as mortality data was noted. In the FLD group reason for donor exclusion was documented. Results Of the 1208 PLDs, 697 (58%) were female. The majority (559; 46%) were of Black African descent, and related to the intended recipient (991; 82%). Outcome of PLD evaluation varied significantly by race (p<0.001), with only a third of Black PLDs being accepted for donation. Black vs. Caucasian PLDs were more likely to fail workup (52.1% vs. 39.3%; p<0.001) and be excluded for medical reasons (44% vs. 35%; p<0.001). Leading medical exclusions included hypertension, HIV and obesity. In the ALD cohort, median follow-up time was 44 months (IQR 13.8 – 93.5 months). Hypertension was documented in 12.8% of ALDs at most recent follow-up compared to 4.7% of ALDs pre-donation (p=0.06). There was a significant increase in Albumin Excretion Rate (AER) following donation (p<0.001). There was a significant decline in the CKD-EPI eGFR between pre-donation (91.7 ± 19.1 ml /min/1.73 m2) and the most recent visit postdonation (72.5 ± 20 ml/min/1.73 m2; p<0.001). 27% of ALDs had a CKD-EPI eGFR<60 ml/min/1.73 m2 at most recent visit, however none required renal replacement therapy. There were 5 documented deaths, all unrelated to the development of renal dysfunction. Black ethnicity was not associated with increased risk of adverse outcome following donation. Conclusions There is a high exclusion rate for PLDs. Black PLDs are more likely to be excluded than Caucasian counterparts due to significant comorbidity. Although limited by high rates of donors lost to follow-up, it is concerning that a quarter of ALDs developed an eGFR<60 ml/min/1.73 m2 at last follow-up, with a significant increase in AER.Item Relationship of Chronic Inflammatory Markers and Dyslipidaemia to Atherosclerotic vascular disease in different categories of chronic kidney disease patients(2018) Oguntola, Stephen OlawaleBackground: Cardiovascular disease (CVD) is the leading cause of mortality among CKD patients, responsible for 40-50 % of all-cause mortality in CKD. Chronic kidney disease patients have been shown to be more likely to succumb to CVD than progress to ESKD. Atherosclerotic vascular disease (AsVD) has been described as an inflammatory disease because of the central role of chronic inflammation and lipid disorders in its aetiopathogenesis. The contributions of these two risk factors have not been well studied in a broad spectrum of CKD patients among black Africans. This study evaluated the relationship of chronic inflammation, dyslipidaemia and APOL1 risk variants to AsVD among black South Africans with CKD stage 3, peritoneal dialysis (PD) and haemodialysis (HD) patients and kidney transplant recipients (KTRs). Methods This was a cross-sectional study of 40 adult (18-65 years) non-diabetic CKD patients, kidney disease outcome quality initiative (KDOQI stage 3), 40 PD patients, 40 HD patients, 41 KTRs and 41 age- and sex-matched healthy controls. An interviewer-administered questionnaire was used to obtain information on participants’ sociodemographic and cardiovascular risk factors. Anthropometric parameters were measured. Blood samples were obtained and serum was analysed for baseline tests, lipoprotein and inflammatory biomarkers. Genomic DNA was extracted from whole blood by modified salting out method and APOL1 genotyping was carried out using restriction fragment length polymorphism. Echocardiography was performed on all patients and carotid intima media thickness (CIMT) was assessed in both right and left carotid arteries at 1cm proximal to the carotid bulb. Atherosclerotic vascular disease was defined by the combination of increased CIMT values (> 0.55 mm) and the presence of carotid plaques. Results: Prevalence of AsVD was highest among PD patients (70 %), and occurred in 47.5 % of stage 3CKD and HD patients, 46.3 % of KTRs and 17.1 % of controls, (p < 0.01). Comparison of the kidney disease groups (CKD stage 3, PD and HD) with controls showed significant difference in waist-hip ratio (WHR), systolic blood pressure (SBP), mean arterial blood pressure (MABP), serum creatinine (Scr), estimated glomerular filtration rate (eGFR), total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL-C), high density lipoprotein (HDL-C-C), Castelli 1, Castelli 2, atherogenic coefficient (AC), non-HDL-C cholesterol, calcium, phosphate, calcium-phosphate products (CaXPO4), serum albumin, ejection fraction (EF), left atrial diameter (LAD) and left ventricular mass index (LVMI). Comparison between the kidney disease group (CKD stage 3, PD and HD) who had AsVD with those who did not, showed significantly higher age, WHR, LAD, mitral valve deceleration time, LVMI and serum creatinine. Among KTRs, positive correlation was seen between CIMT and LAD, LVMI, Castelli 2 and Lipoprotein combined index (LCI). Pentraxin-3 levels were significantly higher in all the kidney disease groups (stage 3 CKD, PD, HD and KTRs) compared to controls. high sensitivity C-reactive protein (hsCRP) and tumour necrosis factor-alpha (TNF-α) levels were significantly higher in ESKD patients compared to controls. Pentraxin-3 correlated positively with CIMT among KTRs (r = 0.336, p = 0.032) and with other inflammatory markers when all kidney disease groups were combined (except for hsCRP). An inverse correlation was seen between pentraxin-3 and eGFR (r = -0.171, p = 0.030) and serum albumin (r = -0.168, p = 0.033). The levels of Lp (a) and Lp-PLA2 were increased while levels of APO A1 were reduced in all kidney disease groups compared to controls. On multivariate analysis, age (> 40 years), male gender, low HDL-C levels and elevated Lp (a) levels independently predicted AsVD after adjusting for BMI, WHR, TC, TG, HDL-C, LDL C, inflammatory markers, Lp-PLA2 and APO A1. Lipoprotein (a) predicted AsVD better than other lipid markers evidenced by higher area under the curve (AUC). No significant difference was seen in the utility of the lipid biomarkers in predicting AsVD (except when female kidney disease patients were analysed separately). The odds of AsVD was more than 11-fold increased in patients who had hypertension attributable CKD with high risk APOL1 variants, [OR 11.85, 95 % CI – (1.08 – 129.91), p = 0.043]; this relationship was lost when all kidney disease patients, regardless of aetiology was used in the analysis, (OR 0.84 (95 % CI – 0.22 – 3.28; p – 0.802). Conclusion: Atherosclerotic vascular disease is common in kidney disease patients and most prevalent among PD patients compared to CKD stage 3, HD and KTRs. Dyslipidaemia and inflammation are common among kidney disease patients. Lipoprotein(a) predicted AsVD better than other lipid biomarkers (Lp-PLA2, APO A1) and lipid profile parameters (LDL-C, TG, TC). Age (> 40 years), male gender, low HDL-C and elevated Lp (a) independently predicted AsVD when all kidney disease patients were combined, while APOL1 risk variants independently predicted AsVD among patients with hypertension attributable kidney disease.Item Assessment of GFR in the evaluation of potential living kidney donors at the Wits Donald Dordon Medical Center (WDGMC) and Charlotte Maxeke Johannesburg Academic Hospital (CMJAH)(2018) Okuthe, Jacktone OdhiamboEquations that estimate GFR (eGFR) are widely used in clinical practice to estimate kidney function in sub-Saharan Africa, but have not been validated for use in this region. This study assessed the performance of eGFR equations in adults evaluated for suitability for live kidney donation against a gold standard radionuclear GFR measurement (mGFR) and determined their usefulness for screening live kidney donors in South Africa. This study was a retrospective record review of 350 adults evaluated for living kidney donation from 1996 – 2013 at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Wits Donald Gordon Medical Centre (WDGMC). Their eGFR was calculated using CG, 4-v MDRD and CKD-EPI equations. Plasma clearance of 51Cr-EDTA was used as a reference method for mGFR. The 4-v MDRD (with and without ethnicity adjustment) and the CKD-EPI (without ethnicity adjustment) equations underestimated the mGFR (negative bias of -8 mL/min/1.73m2, -16 mL/min/-1.73m2 and -6.4 mL/min/1.73m2 respectively).However, the bias associated with the average mGFR using the CG and CKD-EPI (with ethnicity adjustment) equations was not significant (2.3 mL/min/1.73m2 and 0.6 respectively).Use of the ethnicity factor resulted in overestimation of mGFR for both the 4v-MDRD equation (by 24.2ml/min/1.73m2 compared to 6.8 ml/min/1.73m2 without it) and the CKD-EPI equation (by 21.8ml/min/1.73m2, compared to 7.6ml/min/1.73m2, without the ethnicity factor). In conclusion, this study showed that almost half of adults screened for living donation in Johannesburg were not eligible due to comorbid hypertension, diabetes and unexplained kidney disease. In addition, the error statistics worsened as mGFR increased and all four prediction equations had a low sensitivity for determining individuals with a GFR <80 ml/min/1.73m2. Based on the findings in this study, use of a gold standard measured GFR should be the preferred method for assessing kidney function in potential living kidney donors in South Africa.Item Modelling graft survival after kidney transplantation using semi-parametric and parametric survival models(2017) Achilonu, Okechinyere JulietThis study presents survival modelling and evaluation of risk factors of graft survival in the context of kidney transplant data generated in South Africa. Beyond the Kaplan-Meier estimator, the Cox proportional hazard (PH) model is the standard method used in identifying risk factors of graft survival after kidney transplant. The Cox PH model depends on the proportional hazard assumption, which is rarely met. Assessing and accounting for this assumption is necessary before using this model. When the PH assumption is not valid, modi cation of the Cox PH model could o er more insight into parameter estimates and the e ect of time-varying predictors at di erent time points. This study aims to identify the survival model that will e ectively describe the study data by employing the Cox PH and parametric accelerated failure time (AFT) models. To identify the risk factors that mediate graft survival after kidney transplant, secondary data involving 751 adults that received a single kidney transplant in Charlotte Maxeke Johannesburg Academic Hospital between 1984 and 2004 was analysed. The graft survival of these patients was analysed in three phases (overall, short-term and long-term) based on the follow-up times. The Cox PH and AFT models were employed to determine the signi cant risk factors. The purposeful method of variable selection based on the Cox PH model was used for model building. The performance of each model was assessed using the Cox-Snell residuals and the Akaike Information Criterion. The t of the appropriate model was evaluated using deviance residuals and the delta-beta statistics. In order to further assess how appropriately the best model t the study data for each time period, we simulated a right-censored survival data based on the model parameter-estimates. Overall, the PH assumption was violated in this study. By extending the standard Cox PH model, the resulting models out-performed the standard Cox PH model. The evaluation methods suggest that the Weibull model is the most appropriate in describing the overall graft survival, while the log-normal model is more reasonable in describing short-and long-term graft survival. Generally, the AFT models out-performed the standard Cox regression model in all the analyses. The simulation study resulted in parameter estimates comparable with the estimates from the real data. Factors that signi cantly in uenced graft survival are recipient age, donor type, diabetes, delayed graft function, ethnicity, no surgical complications, and interaction between recipient age and diabetes. Statistical inferences made from the appropriate survival model could impact on clinical practices with regards to kidney transplant in South Africa. Finally, limitations of the study are discussed in the context of further studies.Item Mycophenalate mofetil in renal transplant recipients: predisposition to gastrointestinal intolerance(2017) Chen, Min-ShienObjective Renal transplantation is the ideal therapeutic option for patients that reach end-stage renal failure. However, patients require long term immunosuppression following surgical transplantation to prevent graft rejection [1,2,4]. Mycophenolate mofetil (MMF) had proven to be an effective immunosuppressant in transplant patients[8,9,10], although it is associated with an increase in gastrointestinal adverse effects, which may result in dose adjustment or termination of use [22]. There is a paucity of data regarding gastrointestinal side effects of MMF in South Africa. This study attempts to describe the incidence of gastrointestinal complications, incidence of dose adjustment and discontinuation of MMF due to side effects, to compare the incidence of GI complications between those that had prior gastrointestinal ailments and those that had no prior gastrointestinal ailments and finally to determine possible risk factors (age, gender, ethnicity, donor type, pre-transplant GI diagnosis, pre-transplant diabetes and combination of MMF with tacrolimus) of gastrointestinal adverse effects. Method Data was collected retrospectively from the file records of the renal transplant unit at CMJAH (Charlotte Maxeke Johannesburg Academic Hospital) on adult patients who had received kidney transplants between 1998 and 2010 and who had received MMF as part of the immunosuppressive regimen for at least the one year post-transplant. Relevant data was captured in an anonymous fashion on a collection sheet. Descriptive analysis of the data was carried out. Time-to-event data were analysed by Kaplan-Meier survival analysis. The assessment of the effect of prior gastrointestinal ailments, as well as risk factors, was carried out by Cox Proportional Hazards regression to estimate the Hazard Ratios. Results A total of 188 patients were included in the study group, which comprised 65.4% males and 32.4% females (2.1% missing data). The mean age at transplant was 38.1 years. The patients were predominantly black (69.1%). Donors were predominantly deceased donors. Of the 24.5% of donors who were living donors, 76.1% were related living donors, while the rest were non-related living donors. The majority of patients (82%) were induced with MMF dose of 2 grams per day. After 5 years, 13.8% of patients discontinued MMF while 86.2% of the patients were still on MMF. 48.1% had a dose adjustment due to gastrointestinal side effects. 61% of patients had had a diarrhoeal adverse event by 5 years. 21.8% of the patients had gastrointestinal side effects other than diarrhoea by 5 years. The combination of tacrolimus and MMF was found to be a significant risk factor for diarrhoeal adverse events (Hazard Ratio 1.82; 95% CI 1.21-2.73). Having a living donor graft reduced the chance of non-diarrhoeal gastrointestinal adverse event (Hazard Ratio 0.33; 95% CI 0.13-0.84, p<0.02). A trend towards significance was seen in living donors having less diarrhoeal events although it did not reach statistical significance (Hazard Ratio 1.32; 95% CI 0.87-2.00, p=0.20). Conclusion As far as the authors are aware, this is the first local study on MMF and GIT adverse effect. We found the combination of MMF and tacrolimus is associated with increased risk of having diarrhoeal adverse events, which is consistent with international data[34,35]. Living donor graft is associated with a lower risk of developing non-diarrhoeal gastrointestinal events. Although non-significant, data suggest the same trend favoring living donor graft with regards to diarrhoeal events.Item "Toxic thoughts"- impact of chronic kidney disease on cognitive functioning and pyschological well-being(2016) Ansell, GlenBackground Chronic Kidney Disease (CKD) is a reality faced by many around the world. There has been much physiological study around factors associated with CKD, as well as many studies surrounding the psychosocial impacts of the disease, with relatively less attention given to neuropsychological effects the disease can have on sufferers. This paper investigates the cognitive impacts as well as psychological impacts simultaneously, impacting on sufferers of End Stage Kidney Disease (ESKD). Methods Sixteen medically stable patients aged (M = 40.56, SD = 12.52) years with ESKD, were investigated. Eight of the patients were evaluated before and after six months of successful kidney transplant, using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), which assessed immediate memory, visuospatial / constructional, language, and attention. They were also tested on a brief symptom inventory (BSI 18) to assess depression and anxiety in these patients. A further eight who remained on dialysis, and had not undergone renal transplant were evaluated in the same manner for comparative purposes. Results Between-group comparisons showed a statistically significant improvement in overall cognitive functioning, as well as in the specific cognitive domains of visuospatial / constructional, language and attention for participants who had undergone renal transplant surgery compared to their counterparts who had not. Results also found that there were no statistically significant differences between the levels of anxiety experienced between patients in the two groups. When assessing the differences in cognitive improvement within the transplant patient group before and after transplant, improvement in the delayed memory function of renal transplant patients post-transplant was found. Conclusion These data show improvements in delayed memory function of patients having undergone renal transplant therapy, while also highlighting a continued decline of overall cognitive functioning in patients remaining on hemodialysis therapy.
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