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Stefanos Zenios

Publications and source records attributed to Stefanos Zenios.

4 recordsLinked to original sources
PubMed2005

Health-related quality of life and estimates of utility in chronic kidney disease.

BACKGROUND: Health-related quality of life and estimates of utility have been carefully evaluated in persons with end-stage renal disease. Fewer studies have examined these parameters in persons with chronic kidney disease (CKD). METHODS: To determine the relations among kidney function, health-related quality of life, and estimates of utility, we administered the Kidney Disease Quality of Life Short Form 36 (KDQOL-36), Health Utilities Index (HUI)-3, and Time Trade-off (TTO) questionnaires to 205 persons with CKD. Persons with CKD stages 4 and 5 (estimated GFR <30 mL/min/1.73 m2, N= 115) were tested two to eight times over the subsequent two years. The relations among estimated glomerular filtration rate (eGFR), and changes in health-related quality of life and utility over time were estimated using mixed effect regression models. Models were adjusted for age, sex, race, and diabetes. RESULTS: Mean scores on the KDQOL-36 generic components, HUI-3, and TTO suggested considerable loss of function and well-being in CKD relative to population norms. On cross-sectional analysis, lower levels of kidney function were associated with significantly lower scores on the SF-12 Physical Health Composite (P= 0.002), the Burden of Kidney Disease subscale (P < 0.0001), and the Effects of Kidney Disease subscale (P < 0.0001) of the KDQOL-36trade mark. Kidney function was significantly associated with the TTO (P= 0.008) and global HUI-3 utility (P= 0.016) although these associations were attenuated after adjustment for diabetes. A decline in eGFR was associated with a significant increase in the reported Burden of Kidney Disease (5.0 point change per year per mL/min/1.73 m2 decline in eGFR) and with marginally significant changes in the Dexterity and Pain attributes of the HUI-3. Mean HUI-3 scores for persons with CKD stages 4 and 5, absent dialysis, were in the range previously reported for persons with stroke and severe peripheral vascular disease. CONCLUSION: Health-related quality of life and estimates of utility are distressingly low in persons with CKD. Self-reported outcomes should be considered when evaluating health policy decisions that affect this population.

Adult↗
PubMed2004

Restricting living-donor-cadaver-donor exchanges to ensure that standard blood type O wait-list candidates benefit.

Region 1 of the United Network for Organ Sharing created a consortium that allows a person waiting for a kidney transplant to take a higher priority on the list when a relative makes a living donation to another waiting recipient. This can be done by exchanging kidneys between two living-donor-recipient pairs (living paired exchange) or by exchanging kidneys through a living-donor-cadaver-donor exchange (list paired exchange). In this article, the authors argue that a list paired exchange that allows ABO-incompatible donor-recipient pairs to participate is morally problematic because it harms standard blood type O wait-list candidates who already have the longest waiting times. We propose and model restrictions on who can participate in such exchanges to ensure that the standard blood type O wait-list candidates are made better off. We restrict list paired exchanges to (1) ABO-incompatibilities between living donors and recipients for potential recipients with blood types A, B, and AB; and (2) all recipients who have an ABO-compatible, positive-crossmatch living donor. Although these restrictions do not allow for the maximization of the number of organs potentially procured by means of list paired exchanges, they increase the number of kidneys available in an ethically fair manner.

ABO Blood-Group System↗