Incidence, Predictors, and Associated Outcomes of Prostatism after Kidney Transplantation

被引:28
作者
Hurst, Frank P. [1 ,3 ]
Neff, Robert T. [3 ]
Falta, Edward M. [2 ,3 ]
Jindal, Rahul M. [2 ]
Lentine, Krista L. [4 ]
Swanson, John S. [5 ]
Agodoa, Lawrence Y. [6 ]
Abbott, Kevin C. [3 ]
机构
[1] Walter Reed Army Med Ctr, Dept Nephrol, Serv Nephrol, Washington, DC 20307 USA
[2] Walter Reed Army Med Ctr, Organ Transplantat Serv, Washington, DC 20307 USA
[3] Uniformed Serv Univ Hlth Sci, F Edward Hebert Sch Med, Bethesda, MD 20814 USA
[4] St Louis Univ, Sch Med, Div Nephrol, Ctr Outcomes Res, St Louis, MO USA
[5] Christiana Care Hlth Network, Organ Transplantat Serv, Newark, DE USA
[6] NIDDK, NIH, Bethesda, MD USA
来源
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2009年 / 4卷 / 02期
关键词
ACUTE URINARY RETENTION; RENAL-TRANSPLANTATION; UNITED-STATES; UROLOGICAL COMPLICATIONS; CLINICAL PROGRESSION; NATURAL-HISTORY; HYPERPLASIA; DISEASE; RISK; FINASTERIDE;
D O I
10.2215/CJN.04370808
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background and objectives: Renal transplantation is increasingly performed in elderly patients, and the incidence of benign prostatic hyperplasia (BPH) increases with age. Anuric males on dialysis may have occult BPH and not develop obstructive symptoms until urine flow is restored after transplantation. If left untreated, BPH poses a risk for numerous complications, including acute urinary retention (AUR), recurrent urinary tract infections (UTI), and renal failure. The authors hypothesized that incident BPH after renal transplantation would adversely affect allograft survival. Design, setting, participants, & measurements: Medicare claims for BPH, AUR, UTI, and prostate resection procedures (transurethral resection of the prostate; TURP) were assessed in a retrospective cohort of 23,622 adult male Medicare primary renal transplant recipients in the United States Renal Data System database who received transplants from 1 January 2000 to 31 July 2005 and followed through 31 December 2005. Results: The 3-yr incidence of BPH post-transplant was 9.7%. The incidences of AUR, UTI, and TURP after BPH diagnosis (up to 3 yr posttransplant) were 10.3%, 6.5%, and 7.3% respectively, and each was significantly associated with BPH. Cox regression analysis showed that recipient age per year, later year of transplant, and dialysis vintage were associated with incident BPH. Using Cox nonproportional hazards regression, BPH was significantly associated with renal allograft loss (including death). Conclusions: BPH is common in males after renal transplant and is independently associated with AUR, UTI, and graft loss. It is unknown whether treatment of BPH, either medical or surgical, attenuates these risks.
引用
收藏
页码:329 / 336
页数:8
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