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Nephrology Kidney Replacement Therapy Remember these points regarding kidney replacement therapy: o Clinical outcomes are equivalent for patients receiving peritoneal dialysis compared with hemodialysis. o Peritoneal dialysis catheters are placed approximately 1 month before therapy is initiated. o Patients who opt for hemodialysis should be referred for arteriovenous fistula placement 2 months or more befbre their eGFR drops below 15 mLlminll.T3 m2 to allow sufficient time for arteriovenous fistula maturation. o Kidney transplantation is associated with superior quality of life and improved survival and is less expensive than long term dialysis. o All patients with ESKD are considered candidates for kidney transplantation unless they have systemic malignancy, chronic inf'ection, severe cardiovascular disease, or neuropsychiatric disorders. o Transplantation is particularly beneficial in young patients. o Suitable candidates for kidney transplantation should be referred for evaluation when their eGFR is 15 to 29 mLlminl 1.73 m2. Patients with kidney transplants must receive immunosuppressive medications to prevent their immune system from rejecting the kidney allograft. SYUDY fABLE: Common Adverse Effects of lmmunosuppressants Ctass Medication Common Side Effects Calcineurin inhibitor Cyclosporine Hypertension, decreased GFR, dyslipidemia, hirsutism Tacrolimus Diabetes, decreased GFR, hypertension Antimetabolite Mycophenolate Leukopenia, anemia Azathioprine Leukopenia mTOR inhibitor Sirolimus; everolimus Proteinuria, dyslipidemia, diabetes, anemia, leukopenia Glucocorticoid receptor a gonist Prednisone Osteopenia, hypertension, edema, diabetes Immunosuppression increases the risk for infections and cancers

SYUDY fABLE: Common Adverse Effects of lmmunosuppressants Ctass Medication Common Side Effects Calcineurin inhibitor Cyclosporine Hypertension, decreased GFR, dyslipidemia, hirsutism Tacrolimus Diabetes, decreased GFR, hypertension Antimetabolite Mycophenolate Leukopenia, anemia Azathioprine Leukopenia mTOR inhibitor Sirolimus; everolimus Proteinuria, dyslipidemia, diabetes, anemia, leukopenia Glucocorticoid receptor a gonist Prednisone Osteopenia, hypertension, edema, diabetes Immunosuppression increases the risk for infections and cancers . The most common malignancy in kidney transplant recipients is cutaneous SCC. . Kaposi sarcoma is much more common in kidney transplant recipients; reduce the immunosuppression and switch to sirolimus based immunosuppression. . Posttransplant lymphoproliferative disease is associated with EBV infection; reduce immunosuppression and adminis- tration of rituximab in patients with CD20+ tumors. 286