Journal Article Annotations
2023, 4th Quarter
Annotations by Sarah Andrews, MD and Gregory Nikogosyan, DO
The cross-sectional study aimed to examine how kidney transplant recipients were affected by daytime sleepiness and quality of life. Daytime sleepiness was associated with obesity and diabetes mellitus. Social support was positively associated with decreased perceived memory and pain symptoms, and its effect might be mediated by depression. Furthermore, hospitalizations within the past year and depression were correlated with lower health-related quality of life (HRQoL) scores, while enhanced kidney function and perceived social support were correlated with higher HRQoL scores.
Strengths and weaknesses:
This study focuses on the Middle Eastern or North African (MENA) demographic, which was grouped into the white race category in most research studies due to the current limited U.S. Census classification. Unfortunately, study participants were from Lebanon, which may confound other variations with different MENA ethnicities. This cross-sectional design limited understanding of post-transplant sleepiness, given there was no data on pre-transplant sleep disorders for participants. Furthermore, the study had a small sample size, limiting generalizability and possible false negatives due to the inability to detect other factors associated with daytime sleepiness. The study did not have a healthy control comparison or objective measures such as polysomnographic sleep tests.
This study helps highlight what appears to be modifiable factors to improve sleep quality and quality of life. Given the sleep disruption association with obesity and diabetes, among other factors such as psychosocial outcomes, healthcare providers may standardize the assessment and management of such issues to improve health outcomes.
This retrospective study examined the clinical utility of phosphatidylethanol (PEth) in liver transplantation evaluations. Positive PEth results identified alcohol use that uEtG would have missed in up to half of all cases. A discrepancy of the PEth results with patients’ self-reports influenced clinical decision-making, resulting in a change in level-of-care recommendations and deferring or denial of transplantation in most cases.
Strength and weaknesses:
This study is one of the few that addresses how uniform PEth testing impacts liver transplant candidacy decisions. Other past studies ordered PEth testing at providers’ discretion. Furthermore, it looked at pre- and post-liver-transplant outcomes. The overall number of participants with a positive PEth test was a small percentage of the overall participant number, limiting the power of the study results. Another limitation includes varying cut-off scores for alcohol intake across studies. The higher threshold in this study would increase the false negatives.
PEth testing is further identified as an important tool in assessing for alcohol use which has significant clinical impact for transplant listing. This further supports the notion for standardized uniform PEth testing for liver transplant candidates given discrepancy of self-report and false negative uEtG testing. The authors discuss a combination of uEtG and PEth testing would be best given PEth can have false negatives if alcohol intake is only shortly before testing.