Browsing by Author "Aldo Torres-Ortiz"

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    Effects of denosumab on bone metabolism and bone mineral density in kidney transplant patients: a systematic review and meta-analysis
    (2019-12-01) Charat Thongprayoon; Prakrati Acharya; Narothama Reddy Aeddula; Aldo Torres-Ortiz; Tarun Bathini; Konika Sharma; Patompong Ungprasert; Kanramon Watthanasuntorn; Maria Lourdes Gonzalez Suarez; Sohail Abdul Salim; Wisit Kaewput; Jirat Chenbhanich; Michael A. Mao; Wisit Cheungpasitporn; Faculty of Medicine, Siriraj Hospital, Mahidol University; University of Arizona; Indiana University School of Medicine Evansville; Phramongkutklao College of Medicine; MetroWest Medical Center; Mayo Clinic; University of Mississippi Medical Center; Bassett Medical Center
    © 2019, International Osteoporosis Foundation and National Osteoporosis Foundation. Objective: The use of immunosuppressive agents, especially glucocorticoids, are associated with increased risks of bone loss in kidney transplant patients. Denosumab, a potent antiresorptive agent, has been shown to increase bone mineral density (BMD) in patients with CKD. However, its effects on bone metabolism and BMD in kidney transplant patients remain unclear. Methods: A literature search was conducted using MEDLINE, EMBASE, and Cochrane Database from inception through April 2018 to identify studies evaluating denosumab’s effect on changes in bone metabolism and BMD from baseline to post-treatment course in kidney transplant patients. Study results were pooled and analyzed utilizing random-effects model. The protocol for this systematic review is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42018095055). Results: Five studies (a clinical trial and four cohort studies) with a total of 162 kidney transplant patients were identified. The majority of patients had a baseline eGFR ≥ 30 mL/min/1.73 m2. After treatment (≥ 6 to 12 months), there were significant increases in BMD with standardized mean differences (SMDs) of 3.26 (95% CI 0.88–5.64) and 1.83 (95% CI 0.43 to 3.22) for lumbar spine and femoral neck, respectively. There were also significant increases in T scores with SMDs of 0.92 (95% CI 0.58 to 1.25) and 1.14 (95% CI 0.17 to 2.10) for lumbar spine and femoral neck, respectively. After treatment, there were no significant changes in serum calcium (Ca) or parathyroid hormone (PTH) from baseline to post-treatment course (≥ 6 months) with mean differences (MDs) of 0.52 (95% CI, − 0.13 to 1.16) mmol/L and − 13.24 (95% CI, − 43.85 to 17.37) ng/L, respectively. The clinical trial data demonstrated more asymptomatic hypocalcemia in the denosumab (12 episodes in 39 patients) than in the control (1 episode in 42 patients) group. From the cohort studies, the pooled incidence of hypocalcemia following denosumab treatment was 1.7% (95% CI 0.4 to 6.6%). All reported hypocalcemic episodes were mild and asymptomatic, but the majority of patients required Ca and vitamin D supplements. Conclusion: Among kidney transplant patients with good allograft function, denosumab effectively increases BMD and T scores in the lumbar spine and femur neck. From baseline to post-treatment, there are no differences in serum Ca and PTH. However, mild hypocalcemia can occur following denosumab treatment, requiring monitoring and titration of Ca and vitamin D supplements.
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    Efficacy and safety of anticoagulation for atrial fibrillation in patients with cirrhosis: A systematic review and meta-analysis
    (2019-04-01) Ronpichai Chokesuwattanaskul; Charat Thongprayoon; Tarun Bathini; Aldo Torres-Ortiz; Oisin A. O'Corragain; Kanramon Watthanasuntorn; Ploypin Lertjitbanjong; Konika Sharma; Somchai Preechawat; Patompong Ungprasert; Paul T. Kröner; Karn Wijarnpreecha; Wisit Cheungpasitporn; King Chulalongkorn Memorial Hospital, Faculty of Medicine Chulalongkorn University; Temple University Hospital; Faculty of Medicine, Siriraj Hospital, Mahidol University; University of Arizona; Mayo Clinic; University of Mississippi Medical Center; Mayo Clinic in Jacksonville, Florida; Bassett Medical Center
    © 2018 Editrice Gastroenterologica Italiana S.r.l. Objective: The atrial fibrillation-related stroke is clearly prevented by anticoagulation treatment, however, management of anticoagulation for AF in patients with cirrhosis represents a challenge due to bleeding concerns. To address this issue, a systematic review and meta-analysis of the literature was performed. Methods: A literature search for studies reporting the incidence of AF in patients with cirrhosis was conducted using MEDLINE, EMBASE and Cochrane Database, from inception through July 2018. Results: 7 cohort studies including 19,798 patients with AF and cirrhosis were identified. The use of anticoagulation (%) among included studies ranged from 8.3% to 53.9%. Anticoagulation use for AF in patients with cirrhosis was significantly associated with a reduced risk of stroke, with a pooled HR of 0.58 (95%CI: 0.35–0.96). When compared with no anticoagulation, the use of anticoagulation was not significantly associated with a higher risk of bleeding, with a pooled HR of 1.45 (95%CI: 0.96–2.17). Compared to warfarin, the use of direct oral anticoagulants (DOACs) was associated with a lower risk of bleeding among AF patients with cirrhosis. Conclusion: Our study demonstrates that anticoagulation use for AF in patients with cirrhosis is associated with a reduced risk of stroke, without increasing significantly the risk of bleeding, when compared to those without anticoagulation.
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    Epidemiology of parvovirus B19 and anemia among kidney transplant recipients: A meta-analysis
    (2020-07-01) Charat Thongprayoon; Nadeen J. Khoury; Tarun Bathini; Narothama Reddy Aeddula; Boonphiphop Boonpheng; Ploypin Lertjitbanjong; Kanramon Watthanasuntorn; Napat Leeaphorn; Supavit Chesdachai; Aldo Torres-Ortiz; Wisit Kaewput; Jackrapong Bruminhent; Michael A. Mao; Wisit Cheungpasitporn; University of Minnesota Twin Cities; UMKC School of Medicine; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Mahidol University; The University of Arizona; Indiana University School of Medicine-Evansville; Henry Ford Hospital; Mayo Clinic; University of Mississippi Medical Center; The Mary Imogene Bassett Hospital; Mayo Clinic in Jacksonville, Florida; East Tennessee State University
    © 2020 Urology Annals | Published by Wolters Kluwer-Medknow. Background: Persistent anemia has been described in kidney transplant (KTx) recipients with parvovirus B19 virus infection. However, the epidemiology of parvovirus B19 and parvovirus B19-related anemia after KTx remains unclear. We conducted this systematic review (1) to investigate the incidence of parvovirus B19 infection after KTx and (2) to assess the incidence of parvovirus B19 among KTx patients with anemia. Materials and Methods: A systematic review was conducted in EMBASE, MEDLINE, and Cochrane databases from inception to March 2019 to identify studies that reported the incidence rate of parvovirus B19 infection and/or seroprevalence of parvovirus B19 in KTx recipients. Effect estimates from the individual studies were extracted and combined using random-effects, generic inverse variance method of DerSimonian and Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42019125716). Results: Nineteen observational studies with a total of 2108 KTx patients were enrolled. Overall, the pooled estimated seroprevalence of parvovirus B19 immunoglobulin G was 62.2% (95% confidence interval [CI]: 45.8%-76.1%). The pooled estimated incidence rate of positive parvovirus B19 DNA in the 1st year after KTx was 10.3% (95% CI: 5.5%-18.4%). After sensitivity analysis excluded a study that solely included KTx patients with anemia, the pooled estimated incidence rate of positive parvovirus B19 DNA after KTx was 7.6% (95% CI: 3.7%-15.0%). Among KTx with anemia, the pooled estimated incidence rate of positive parvovirus B19 DNA was 27.4% (95% CI: 16.6%-41.7%). Meta-regression analysis demonstrated no significant correlations between the year of study and the incidence rate of positive parvovirus B19 DNA (P = 0.33). Egger's regression asymmetry test was performed and demonstrated no publication bias in all analyses. Conclusion: The overall estimated incidence of positive parvovirus B19 DNA after KTX is 10.3%. Among KTx with anemia, the incidence rate of positive parvovirus B19 DNA is 27.4%. The incidence of positive parvovirus B19 DNA does not seem to decrease overtime.