Coming back to dialysis after kidney transplant failure

Ponticelli, Claudio; Berardinelli, L

doi:10.1093/ndt/gfn313

Cited by 38 publications

(30 citation statements)

References 29 publications

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“…Some studies [27,28] suggest that patients with allograft loss often start dialysis at GFR levels far below the optimal suggested threshold and the delay in starting dialysis after graft loss might negatively influence morbidity [29]. Our study findings are in contrast with this observation, as increased GFR at initiation of dialysis in our cohort was associated with increased mortality.…”

Section: Discussioncontrasting

confidence: 97%

Mortality after Renal Allograft Failure and Return to Dialysis

Brar

Markell²,

Stefanov³

et al. 2017

Am J Nephrol

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Introduction: The outcomes of patients who fail their kidney transplant and return to dialysis (RTD) has not been investigated in a nationally representative sample. We hypothesized that variations in management of transplant chronic kidney disease stage 5 leading to kidney allograft failure (KAF) and RTD, such as access, nutrition, timing of dialysis, and anemia management predict long-term survival. Methods: We used an incident cohort of patients from the United States Renal Data System who initiated hemodialysis between January 1, 2003 and December 31, 2008, after KAF. We used Cox regression analysis for statistical associations, with mortality as the primary outcome. Results: We identified 5,077 RTD patients and followed them for a mean of 30.9 ± 22.6 months. Adjusting for all possible confounders at the time of RTD, the adjusted hazards ratio (AHR) for death was increased with lack of arteriovenous fistula at initiation of dialysis (AHR 1.22, 95% CI 1.02-1.46, p = 0.03), albumin <3.5 g/dL (AHR 1.33, 95% CI 1.18-1.49, p = 0.0001), and being underweight (AHR 1.30, 95% CI 1.07-1.58, p = 0.006). Hemoglobin <10 g/dL (AHR 0.96, 95% CI 0.86-1.06, p = 0.46), type of insurance, and zip code-based median household income were not associated with higher mortality. Glomerular filtration rate <10 mL/min/1.73 m² at time of dialysis initiation (AHR 0.83, 95% CI 0.75-0.93, p = 0.001) was associated with reduction in mortality. Conclusions: Excess mortality risk observed in patients starting dialysis after KAF is multifactorial, including nutritional issues and vascular access. Adequate preparation of patients with failing kidney transplants prior to resuming dialysis may improve outcomes.

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Section: Discussioncontrasting

confidence: 97%

Mortality after Renal Allograft Failure and Return to Dialysis

Brar

Markell²,

Stefanov³

et al. 2017

Am J Nephrol

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“…The authors concluded that maintaining long-term immunosuppression may prolong life expectancy of patients commencing PD after chronic graft failure. However, Messa et al (10) recently proposed that immunosuppression should be discontinued relatively rapidly upon return to dialysis, with immediate cessation of antiproliferative drugs and complete withdrawal of calcineurin inhibitors within 1 -8 weeks. The variety of the proposed protocols reflects the absence of good evidence with respect to manage-ment of these patients and the need for randomized controlled studies.…”

Section: Discussionmentioning

confidence: 99%

Residual Renal Function in Peritoneal Dialysis after Renal Transplant Failure

et al. 2010

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out of the question to perform any randomized studies to evaluate the effect of declining RRF on endothelial function.In conclusion, this study showed that the decline in RRF in incident CAPD patients is associated with worsened endothelial dysfunction, while a stable RRF seems not to affect endothelial function significantly. This study not only provided new understanding of the association between RRF and cardiovascular disease in dialysis patients, but also highlighted the justification of protecting RRF in this population.

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“…Allograft failure was defined as any cause leading to resumption of maintenance dialysis, new waitlisting, or repeat transplantation (16).…”

Section: Data Sourcesmentioning

confidence: 99%

Validating Early Post–Transplant Outcomes Reported for Recipients of Deceased Donor Kidney Transplants

Potluri

Parikh

Hall

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives Data reported to the Organ Procurement and Transplantation Network (OPTN) are used in kidney transplant research, policy development, and assessment of center quality, but the accuracy of early post-transplant outcome measures is unknown.Design, setting, participants, & measurements The Deceased Donor Study (DDS) is a prospective cohort study at five transplant centers. Research coordinators manually abstracted data from electronic records for 557 adults who underwent deceased donor kidney transplantation between April of 2010 and November of 2013. We compared the post-transplant outcomes of delayed graft function (DGF; defined as dialysis in the first posttransplant week), acute rejection, and post-transplant serum creatinine reported to the OPTN with data collected for the DDS.Results Median kidney donor risk index was 1.22 (interquartile range [IQR], 0.97-1.53). Median recipient age was 55 (IQR, 46-63) years old, 63% were men, and 47% were black; 93% had received dialysis before transplant. Using DDS data as the gold standard, we found that pretransplant dialysis was not reported to the OPTN in only 11 (2%) instances. DGF in OPTN data had a sensitivity of 89% (95% confidence interval [95% CI], 84% to 93%) and specificity of 98% (95% CI, 96% to 99%). Surprisingly, the OPTN data accurately identified acute allograft rejection in only 20 of 47 instances (n=488; sensitivity of 43%; 95% CI, 17% to 73%). Across participating centers, sensitivity of acute rejection varied widely from 23% to 100%, whereas specificity was uniformly high (92%-100%). Six-month serum creatinine values in DDS and OPTN data had high concordance (n=490; Lin concordance correlation =0.90; 95% CI, 0.88 to 0.92).Conclusions OPTN outcomes for recipients of deceased donor kidney transplants have high validity for DGF and 6-month allograft function but lack sensitivity in detecting rejection. Future studies using OPTN data may consider focusing on allograft function at 6 months as a useful outcome.

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Coming back to dialysis after kidney transplant failure

Cited by 38 publications

References 29 publications

Mortality after Renal Allograft Failure and Return to Dialysis

Mortality after Renal Allograft Failure and Return to Dialysis

Residual Renal Function in Peritoneal Dialysis after Renal Transplant Failure

Validating Early Post–Transplant Outcomes Reported for Recipients of Deceased Donor Kidney Transplants

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