SUPPLEMENT 3 VOL 9 - KDIGO
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ajt 9 11-mast head9/24/0917:57Page 3EDITOR-IN-CHIEFPhilip F. Halloran, CanadaDEPUTY EDITORSJonathan S. Bromberg, USARobert L. Fairchild, USASandy Feng, USABruce Kaplan, USAMark L. Barr, USAJohn O’Grady, UKEDITORIAL OFFICEDellice BerezanGillian HughesEditorial Office AdministratorsUniversity of Alberta250 Heritage Medical Research CentreEdmonton, Alberta T6G 2S02Phone: 1-780-492-1752Fax: 1-780-407-3417E-mail:amjtrans@ualberta.caASSOCIATE EDITORSBryan Becker, USAEmily Blumberg, USAJ. Andrew Bradley, UKDaniel Brennan, USADavid M. Briscoe, USAGinny L. Bumgardner, USARonald W. Busuttil, USAJ. Michael Cecka, USAPierre-Alain Clavien, SwitzerlandRobert L. Colvin, USAConnie Davis, USAAnthony D’Apice, AustraliaFrancis L. Delmonico, USAThomas Dengler, GermanyJames D. Eason, USAHenrik Ekberg, SwedenRobert B. Ettenger, USAJay Fishman, USARichard B. Freeman, Jr., USAAlberto Sánchez-Fueyo, SpainEdward R. Garrity, Jr., USAHoward M. Gebel, USAJohn Gill, CanadaRonald G. Gill, USAJosep M. Grinyo, SpainGregg Hadley, USADouglas Hanto, USAPeter S. Heeger, USABenjamin Hippen, USAHans H. Hirsch, SwitzerlandAtul Humar, CanadaShaf Keshavjee, CanadaAllan D. Kirk, USAGoran B. Klintmalm, USAChristophe Legendre, FranceChungMau Lo, Hong KongJoaquim Madrenas, CanadaJohn C. Magee, USARosalyn Mannon, USAArthur J. Matas, USAHerwig-Ulf Meier-Kriesche, USAMichael Mengel, CanadaBrian J. Nankivell, AustraliaJosé Oberholzer, USAGerhard Opelz, GermanyScott Palmer, USATom Pearson, USAMark D. Pescovitz, USARutger J. Ploeg, The NetherlandsHeather Ross, CanadaDaniel R. Salomon, USAMillie Samaniego, USARon Shapiro, USAMark D. Stegall, USADebra L. Sudan, USAStuart Sweet, USADavid O. Taylor, USAAngus Thomson, USAJames F. Trotter, USAYves Vanrenterghem, BelgiumHans-Dieter Volk, GermanyRussell H. Wiesner, USADavid Wilkes, USACONSULTING EDITORSRobert Gentleman, USAGuiseppe Remuzzi, ItalyJesse Schold, USADISCLAIMERThe Publisher, American Society of Transplantation and the AmericanSociety of Transplant Surgeons, and Editors cannot be held responsible forerrors or any consequences arising from the use of information containedin this journal; the views and opinions expressed do not necessarily reflectthose of the Publisher, American Society of Transplantation and theAmerican Society of Transplant Surgeons, and Editors, neither does thepublication of advertisements constitute any endorsement by thePublisher, American Society of Transplantation and the American Societyof Transplant Surgeons, and Editors of the products advertised.Copyright and Photocopying 2009 American Society ofTransplantation and the American Society of Transplant Surgeons. Allrights reserved. 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Tel: 1 518 537 4700, Fax: 1 518 537 5899, Email: psc@periodicals.comAmerican Journal of Transplantation, (ISSN 1600-6135), is published monthly on behalf of American Society of Transplantation and the American Society ofTransplant Surgeons by Wiley Subscription Services, Inc., a Wiley Company, 111 River St., Hoboken, NJ 07030-5774.Periodical Postage Paid at Hoboken, NJ and additional offices.Postmaster: Send all address changes to AMERICAN JOURNAL OF TRANSPLANTATION, Journal Customer Services, John Wiley & Sons Inc., 350 Main St.,Malden, MA 02148-5020.PUBLISHERAmerican Journal of Transplantation is published byWiley Periodicals, Inc. 350 Main St. Malden, MA 02148JOURNAL CUSTOMER SERVICESFor ordering information, claims and any enquiry concerning your journal subscription please go to interscience.wiley.com/support or contact your nearest office:Americas: Email cs-journals@wiley.com; Tel: 1 781 388 8598 or 1 800 835 6770 (Toll free in the USA & Canada).Europe, Middle East and Africa: Email: cs-journals@wiley.com; Tel: 44 (0) 1865 778315Asia Pacific: Email: cs-journals@wiley.com; Tel: 65 6511 8000INFORMATION FOR SUBSCRIBERSAmerican Journal of Transplantation is published in 12 issues per year. Institutional subscription prices for 2009 are:Print & Online: US 2139 (US), US 2493(Rest of World), 1615 (Europe), 1272 (UK). Prices are exclusive of tax. Asia-Pacific GST, Canadian GST and European VAT will be applied at the appropriate rates.For more information on current tax rates, please go to www3.interscience.wiley.com/aboutus/journal ordering and payment.html#Tax. The price includes onlineaccess to the current and all online back files to January 1st 1997, where available. For other pricing options, including access information and terms and conditions,please visit www.interscience.wiley.com/journal-infoPRODUCTION EDITORCatherine Krendel (email: ajt@oxon.blackwellpublishing.com)ADVERTISINGEamon Wood (email: ewood@pminy.org)Commercial reprints: medsalesusa@wiley.comThis journal is available online at Wiley InterScience. Visit www.interscience.wiley.com to search the articles and register for table of contents e-mail alerts.Access to this journal is available free online within institutions in the developing world through the HINARI initiative with the WHO. For information, visitwww.healthinternetwork.orgPrinted in the United States by The Sheridan PressAIMS AND SCOPEThe aim of the American Journal of Transplantation is the rapid publication of new high quality data in organ and tissue transplantation and the related sciences. Thejournal reflects the field and is an agent for advancing the it through critical reviews and news features, and consensus documents and guidelines. The journal isdirected at scientists and clinicians in transplantation but also at those in other fields who wish to follow transplantation. The scope is the international discipline oftransplantation. This includes organ and tissue donation and preservation; tissue injury, repair, inflammation, and aging; immune recognition, regulation, effectormechanisms, and opportunities for induction of tolerance; histocompatibility; drugs and pharmacology relevant to transplantation; graft survival and prevention ofgraft dysfunction and failure; clinical trials and population analyses; transplant complications; xenotransplantation; and ethical and societal issues. The sciencesincludes relevant aspects of cell biology, medicine, surgery, pediatrics, and infectious diseases. The journal includes thoracic transplantation (heart, lung), abdominaltransplantation (kidney, liver, pancreas, islets), transplantation of tissues and related topics. The American Journal of Transplantation serves as a forum for debate andreassessment, an agent of change, and a major new platform for promoting understanding, improving results, and advancing science in this dynamic field.The Journal is indexed by Chemical Abstracts, CAB Abstracts, CAB health, Science Citation Index Expanded (and therefore the Web of Science), ISI AlertingServices, Current Contents/Clinical Medicine, EMBASE, the Excerpta Medica database, Elsevier BIOBASE (Current Awareness in Biological Sciences), MEDLINE/Index MedicusISSN 1600-6135 (Print)ISSN 1600-6143 (Online)For submission instructions, subscription and all other information visit: www.blackwellpublishing.com/ajtAmerican Society of TransplantationAmerican Society of Transplant SurgeonsMAY 2009 - MAY 2010MAY 2009 - JUNE 2010PRESIDENTJoren C. MadsenPRESIDENTRobert M. MerionPAST PRESIDENTBarbara MurphyPRESIDENT-ELECTMichael M. AbecassisPRESIDENT-ELECTMaryl R. JohnsonSECRETARY-TREASURERRobert S. GastonCOUNCILORS-AT-LARGEMaria-Luisa AlegreEmily A. BlumbergKimberly A. BrownDavid J. CohenMichael GreenAnthony M. JevnikarMichelle A. JosephsonAllan D. KirkDianne L. LaPointe RudowRoslyn B. MannonEXECUTIVE VICE PRESIDENTSusan J. NelsonEXECUTIVE DIRECTORLibby McDannellIMMEDIATE PAST PRESIDENTJohn P. RobertsPAST PRESIDENTGoran B. KlintmalmSECRETARYKim M. OlthoffTREASURERAlan N. LangnasCOUNCILLORS-AT-LARGERichard B. FreemanDixon B. KaufmanTimothy L. PruettJames D. EasonCharles M. MillerPeter G. StockR. Mark GhobrialRobert S. HigginsElizabeth A. PomfretEXECUTIVE DIRECTORKatrina Crist
AJT-FM:ajt10/8/094:11 PMPage iTABLE OF CONTENTSSiiiDisclaimerSivWork Group MembershipSviKDIGO Board MembersSviiAbbreviations and AcronymsSviiiReference KeysS1AbstractS2ForewordS3Guideline Scope and Intended UsersS6Chapter 1: Induction TherapyS10Chapter 2: Initial Maintenance Immunosuppressive MedicationsS14Chapter 3: Long-Term Maintenance Immunosuppressive MedicationsS16Chapter 4: Strategies to Reduce Drug CostsS19Chapter 5: Monitoring Immunosuppressive MedicationsS21Chapter 6: Treatment of Acute RejectionS23Chapter 7: Treatment of Chronic Allograft InjuryS27Chapter 8: Monitoring Kidney Allograft FunctionS30Chapter 9: Kidney Allograft BiopsyS33Chapter 10: Recurrent Kidney DiseaseS38Chapter 11: Preventing, Detecting, and Treating NonadherenceS41Chapter 12: VaccinationS44Chapter 13: Viral DiseasesS4413.1: BK Polyoma VirusS4613.2: CytomegalovirusS4813.3: Epstein-Barr Virus and Post-Transplant Lymphoproliferative DiseaseS5013.4: Herpes Simplex Virus 1, 2 and Varicella Zoster VirusS5213.5: Hepatitis C VirusS5313.6: Hepatitis B VirusS57S59S5913.7: Human Immunodeficiency VirusChapter 14: Other Infections14.1: Urinary Tract InfectionS6014.2: Pneumocystis Jirovecii PneumoniaS6114.3: TuberculosisS6214.4: Candida ProphylaxisS66S66Chapter 15: Diabetes Mellitus15.1: Screening for New-Onset Diabetes after TransplantationS6815.2: Managing NODAT or Diabetes Present at TransplantationS71Chapter 16: Hypertension, Dyslipidemias, Tobacco Use, and ObesityS7116.1: HypertensionS7316.2: DyslipidemiasS7516.3: Tobacco UseS7716.4: ObesityS80Chapter 17: Cardiovascular Disease ManagementS84Chapter 18: Cancer of the Skin and LipS86Chapter 19: Non–Skin MalignanciesS89Chapter 20: Managing Cancer with Reduction of Immunosuppressive MedicationS93Chapter 21: Transplant Bone DiseaseS97Chapter 22: Hematological ComplicationsS102Chapter 23: Hyperuricemia and Gout
AJT-FM:ajt10/8/094:11 PMPage iiS104Chapter 24: Growth and DevelopmentS106Chapter 25: Sexual Function and FertilityS10625.1: Sexual FunctionS10725.2: Female FertilityS10825.3: Male FertilityS110Chapter 26: LifestyleS111Chapter 27: Mental HealthS112Appendix: Methods for Guideline DevelopmentS125Biographic and Disclosure InformationS129AcknowledgmentsS131References
AJT-FM:ajt10/8/093:16 PMPage TableTableTableTableTableTableTableTableTable1. Risk of acute rejection in multivariate analyses2. Toxicity profiles of immunosuppressive medications3. CNI cost reduction from the concomitant use of ketoconazole4. Routine screening after kidney transplantation5. Some causes of proteinuria after kidney transplantation6. Definitions of proteinuria and albuminuria7. Diagnostic criteria for acute kidney injury8. Screening for recurrent diseases9. Assessment of medication adherence10. Risk factors for medication nonadherence11. A summary of interventions aimed at improving medication adherence12. Recommended vaccines after kidney transplantation13. Contraindicated vaccinations after transplantation14. Treatment of BKV nephropathy by modification of maintenance immunosuppression15. Categories of PTLD16. Outcomes of clinical trials of lamivudine therapy17. Antimicrobial agents for the prevention of PCP in KTRs18. Independent predictors of CVD in KTRs19. Criteria for the diagnosis of diabetes20. Risk factors for NODAT21. Pharmacological management of diabetes in KTRs22. Guideline definitions of hypertension23. Adult blood pressure thresholds for defining hypertension24. Advantages and disadvantages of major antihypertensive agent classes in KTRs25. Pharmacological therapies for cigarette smoking cessation in KTRs26. Definition and classification of obesity in adults27. Definition and classification of obesity for children and adolescents 6 years of age and older28. National Heart Lung Blood Institute weight-loss treatment guidelines29. Cancers categorized by SIR for kidney transplant patients and cancer incidence30. Viral-associated cancers31. Medications associated with hematologic abnormalities32. Systematic review topics and screening criteria33. Literature search yield of RCTs34. Hierarchy of outcomes35. Classification of study quality36. Example of an evidence profile37. GRADE system for grading quality of evidence38. Final grade for overall quality of evidence39. Balance of benefits and harm40. KDIGO nomenclature and description for grading recommendations41. Determinants of strength of recommendationsAdditional information in the form of Supporting tables can be found online 9698/tocAmerican Journal of Transplantation 2009; 9 (Suppl 3): Si–SiSi
AJT-FM:ajt10/8/093:16 PMPage SiiFIGURESS56S118SiiFigure 1. HBeAg clearance vs. lamivudine duration.Figure 2. Literature search diagram for systematically reviewed RCTs.American Journal of Transplantation 2009; 9 (Suppl 3): Sii–Sii
AJT-FM:ajt10/8/093:16 PMPage SiiiDisclaimerSECTION I: USE OF THE CLINICALPRACTICE GUIDELINEThis Clinical Practice Guideline document is based uponthe best information available as of March 2009. It isdesigned to provide information and assist decisionmaking. It is not intended to define a standard of care, andshould not be construed as one, nor should it be interpreted as prescribing an exclusive course of management.Variations in practice will inevitably and appropriatelyoccur when clinicians take into account the needs ofindividual patients, available resources, and limitations unique to an institution or type of practice. Everyhealth-care professional making use of these recommendations is responsible for evaluating the appropriateness of applying them in the setting of any particular clinical situation. The recommendations forresearch contained within this document are generaland do not imply a specific protocol.SECTION II: DISCLOSUREKidney Disease: Improving Global Outcomes (KDIGO)makes every effort to avoid any actual or reasonablyperceived conflicts of interest that may arise as aresult of an outside relationship or a personal, professional, or business interest of a member of the WorkGroup.All members of the Work Group are required to complete, sign, and submit a disclosure and attestationform showing all such relationships that might beperceived or actual conflicts of interest. This document is updated annually and information is adjusted accordingly. All reported information is publishedin its entirety at the end of this document in the WorkGroup members’ Biographic and DisclosureInformation section, and is on file at the NationalKidney Foundation (NKF), Managing Agent forKDIGO.KDIGO gratefully acknowledges the following sponsors that make our initiatives possible: Abbott, Amgen, BeloFoundation, Coca-Cola Company, Dole Food Company, Genzyme, Hoffmann-LaRoche, JC Penney, NATCO-TheOrganization for Transplant Professionals, National Kidney Foundation-Board of Directors, Novartis, Robertand Jane Cizik Foundation, Shire, Transwestern Commercial Services, and Wyeth. KDIGO is supported by aconsortium of sponsors and no funding is accepted for the development of specific guidelines.American Journal of Transplantation 2009; 9 (Suppl 3): Siii–SiiiSiii
AJT-FM:ajt10/8/093:16 PMPage SivWork Group MembershipWork Group Co-ChairsBertram L. Kasiske, MDHennepin County Medical CenterMinneapolis, MNMartin G. Zeier, MD, FASNUniversity Hospital of HeidelbergHeidelberg, GermanyWork GroupJonathan C. Craig, MBChB, MM (Clin Epi), DCH,FRACP, PhDThe Children's Hospital at WestmeadWestmead, AustraliaHenri A. Kreis, MDUniversité Paris Descartes &Hôpital NeckerParis, FranceHenrik Ekberg, MD, PhDLund UniversityMalmö, SwedenRuth A. McDonald, MDUniversity of WashingtonSeattle Children’s HospitalSeattle, WACatherine A. Garvey, RN, BA, CCTCUniversity of MinnesotaMinneapolis MNMichael D. Green, MD, MPHChildren’s Hospital of PittsburghPittsburgh, PAVivekanand Jha, MD, FRCPPostgraduate Medical InstituteChandigarh, IndiaMichelle A. Josephson, MDUniversity of ChicagoChicago, ILBryce A. Kiberd, MDDalhousie UniversityHalifax, CanadaJohn M. Newmann, PhD, MPHHealth Policy Research & AnalysisReston, VAGregorio T. Obrador, MD, MPHUniversidad Panamericana School of MedicineMexico City, MexicoLiaison to The Transplantation Society and the GlobalAlliance of Transplantation:Jeremy R. Chapman, MD, FRACP, FRCPWestmead HospitalWestmead, AustraliaLiaison to the American Society of TransplantationFlavio G. Vincenti, MDUniversity of California at San FranciscoSan Francisco, CAEvidence Review TeamTufts Center for Kidney Disease Guideline Development and Implementation,Tufts Medical Center, Boston, MA, USA:Ethan M. Balk, MD, MPH, Project Director and Director, Evidence-based MedicineMartin Wagner, MD, MS, Assistant Project DirectorGowri Raman, MD, Research FellowSamuel Abariga, MD, MS, Research AssociateAmy Earley, BS, Project CoordinatorIn addition, support and supervision were provided by:Katrin Uhlig, MD, MS, Director, Guideline DevelopmentJoseph Lau, MD, Methods ConsultantSivAmerican Journal of Transplantation 2009; 9 (Suppl 3): Siv–Siv
AJT-FM:ajt10/8/093:16 PMPage SvWork Group Member Expertise and Disclosure InformationWork Group MemberBertram L. Kasiske, MDWork Group Co-Chair; USAArea of ExpertiseDisclosuresAdvisor/Consultant:Astellas; LithoLink; Novartis; WyethTransplant NephrologistGrant/Research Support:Bristol-Myers Squibb; Genzyme;Merck-Schering PloughGrant/Research Support:Astellas; Novartis; ParexelMartin G. Zeier, MD, FASNWork Group Co-Chair; GermanyTransplant NephrologistJeremy R. Chapman, MD, FRACP, FRCPAustraliaAdvisor/Consultant:Transplant Nephrologist; Liaison for The Astellas; Hoffmann-LaRoche; Novartis;WyethTransplantation Society and the GlobalAlliance for TransplantationGrant/Research Support:Bristol-Myers Squibb; Novartis; WyethJonathan C. Craig, MBChB,MM (Clin Epi), DCH, FRACP, PhDAustraliaPediatrician,Transplant NephrologistHenrik Ekberg, MD, PhDSwedenTransplant SurgeonNo relevant financial relationshipsreported.Advisor/Consultant:Astellas; Bristol-Myers Squibb;Hansa Medical; Hoffmann-LaRoche;Life Cycle Pharma; Novartis; WyethSpeaker: Astellas; Hoffmann-LaRocheCatherine A. Garvey, RN, BA, CCTCUSATransplant CoordinatorNo relevant financial relationshipsreported.Michael D. Green, MD, MPHUSAPediatrician,T
SUPPLEMENT 3 VOL 9 2009 American Journal of Transplantation Volume 9 Supplement 3 November 2009 PP. 1–156 ajt_9_S3-cover 10/8/09 17:16 Page 1
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Acute Kidney Injury as a risk factor for Chronic Kidney Disease Alan Cass, MBBS FRACP PhD Menzies School of Health Research Darwin, Australia KDIGO. KidneyDisease:ImprovingGlobalOutcomes Global burden of kidney disease Jha et al – Lancet 2013 KDIGO. KidneyDisease:ImprovingGlobalOutcomes
This Quick Reference Guide contains a number of important recommendations that have been extracted directly from the published KDIGO Guidelines. For the full version of the KDIGO . and trends of laboratory tests—rather than single BUN and creatinine thresholds alone—when making the decision to start RRT. (Not Graded)
Evidence Review Team at Tufts Medical Center, Boston ! KDIGO staff (infrastructure) Introduction .',*2. KDIGO - AKI Guidelines ! Work Group worked for two years . fluids & inotropes fluids Brienza et al, Crit Care Med 2009 Prevention and Treatment of AKI - Vasopressors .',*2. Prevention and Treatment of AKI - Vasopressors
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OPEN Executive summary of the 2020 KDIGO Diabetes Management in CKD Guideline: evidence-based advances in monitoring and treatment Ian H. de Boer1, M. Luiza Caramori2 .
Executive summary of the 2017 KDIGO Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) Guideline Update: what’s changed and why it matters Markus Ketteler1, Geoffrey A. Block2, Pieter Evenepoel3, Masafumi Fukagawa4, Charles A. Herzog5, Linda McCann6, Sharon M. Moe7,8, Rukshana Shroff9, Marcello A. Tonelli10, Nigel D. Toussaint11,
Advanced Automotive Battery Conference Las Vegas, Nevada February 6-8, 2001 ABSTRACT Thermal management of batteries in electric vehicles (EVs) and hybrid electric vehicles (HEVs) is essential for .
