NKF Releases Commentary on Transplant Practices

Authors support global guidelines on selecting and management of candidates

March 18, 2021 — Today, the National Kidney Foundation (NKF) unveiled a review by its Kidney Disease Outcomes Quality Initiative (KDOQI) of the global Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation. Published online in the American Journal of Kidney Diseases, it includes a general endorsement as well as additional guidelines. 

KDIGO is the global nonprofit organization developing and implementing evidence-based clinical practice guidelines in kidney disease. NKF’s Kidney Disease Quality Initiative (KDOQI), which produces guidelines and commentaries primarily for U.S. practitioners, reviewed KDIGO guidelines on evaluation and management of candidates for kidney transplantation. The team spent the last year going over the guidelines, which were published in April 2020.

The report provided recommendations that cover all major areas of pre-transplant evaluation of potential recipients. 

“We endorsed these KDIGO guidelines for evaluating transplant recipients, but our new commentary went beyond what has been published in specific areas,” said lead author Sundaram Hariharan, MD, Professor of Medicine & Surgery, University of Pittsburgh Medical Center. “Kidney transplantation is the gold standard treatment option for patients with kidney failure and offers the best chance of improving both quality and quantity of life but requires careful consideration of the risk and benefits. Therefore, it is important that even ‘high-risk’ patients be considered. We see a need for further study of ‘high-risk’ patient outcomes in the future.”

The KDOQI team of authors note that more high-quality studies are needed to better guide the approach towards kidney transplantation for “high-risk” patients such as elderly patients, patients with obesity, frailty, and cardiovascular comorbidities. 

They also suggest that advances in other disciplines such as bariatric surgery and oncology may allow for more patients to benefit from kidney transplantation but requires careful consideration of risks and benefits.  Given the lack of high-quality evidence in several key areas, they indicate that clinicians will need to pay close attention to the strength of the KDIGO recommendation and the quality of evidence while applying these guidelines to routine clinical management. 

“This KDOQI Commentary highlights the key issues in evaluation and management of transplant candidates in the U.S.,” said Kerry Willis PhD, NKF Chief Scientific Officer. “It also makes additional recommendations in a number of areas, including improving referral to transplantation, maximizing the use of available organs, and how transplant programs can improve equity of access to transplantation through better education and social support. Our challenge as a patient advocacy organization will be to educate the community on the importance of these recommendations, and how they can be successfully implemented.”

The KDOQI authors worked together despite many challenges presented by the pandemic, Dr. Hariharan said. “The entire team did an outstanding job,” he said. 

The authors included: Chethan Puttarajappa, Assistant Professor of Medicine, University of Pittsburgh Medical Center, Pittsburgh; Carrie A Schinstock, MD, Associate Professor of Medicine, Mayo Clinic, Rochester, MN; Christine M Wu, MD, Associate Professor of Medicine, University of Pittsburgh Medical Center, Pittsburgh; Nicolae Leca, MD, Associate Professor of Medicine, University of Washington, Seattle; Vineeta Kumar; MD, Professor of Medicine, University of Birmingham, Birmingham, AL; and Brahm S Vasudev, MD, Associate Professor of Medicine, Medical College of Wisconsin, Milwaukee.

World renowned for improving the diagnosis and treatment of kidney disease, the KDOQI guidelines and commentaries have helped healthcare professionals provide better care and improved many thousands of lives. KDOQI strives to make clinical practice guideline and commentary development as transparent and efficient as possible. Published KDOQI guidelines and commentaries can be accessed at www.kidney.org/kdoqi

Kidney Disease Facts

In the United States, 37 million adults are estimated to have chronic kidney disease (CKD)—and approximately 90 percent don’t know they have it.  1 in 3 adults in the U.S. is at risk for chronic kidney disease.  Risk factors for kidney disease include: diabeteshigh blood pressureheart diseaseobesity, and family history. People who are Black or African American, Hispanic or Latino, American Indian or Alaska Native, Asian American, or Native Hawaiian or Other Pacific Islander are at increased risk for developing the disease. Black or African American people are almost 4 times more likely than Whites to have kidney failure. Hispanic or Latino people are 1.3 times more likely than non-Hispanic or non-Latino people to have kidney failure.

NKF Professional Membership 

Healthcare professionals can join NKF to receive access to tools and resources for both patients and professionals, discounts on professional education, and access to a network of thousands of individuals who treat patients with kidney disease. 

About the National Kidney Foundation

The National Kidney Foundation (NKF) is the largest, most comprehensive, and longstanding patient-centric organization dedicated to the awareness, prevention, and treatment of kidney disease in the U.S. For more information about NKF, visit www.kidney.org