Estimated Glomerular Filtration Rate Decline as a Predictor of Dialysis in Kidney Transplant Recipients

Abstract

Background: It is now common for individuals to require dialysis following the failure of a kidney transplant. Management of complications and preparation for dialysis are suboptimal in this group. To aid planning, it is desirable to estimate the time to dialysis requirement. The rate of decline in the estimated glomerular filtration rate (eGFR) may be used to this end. Methods: This study compared the rate of eGFR decline prior to dialysis commencement between individuals with failing transplants and transplant-naïve patients. The rate of eGFR decline was also compared between transplant recipients with and without graft failure. eGFR was calculated using the four-variable MDRD equation with rate of decline calculated by least squares linear regression. Results: The annual rate of eGFR decline in incident dialysis patients with graft failure exceeded that of the transplant-naïve incident dialysis patients. In the transplant cohort, the mean annual rate of eGFR decline prior to graft failure was 7.3 ml/min/1.73 m² compared to 4.8 ml/min/1.73 m² in the transplant-naïve group (p < 0.001) and 0.35 ml/min/1.73 m² in recipients without graft failure (p < 0.001). Factors associated with eGFR decline were recipient age, decade of transplantation, HLA mismatch and histological evidence of chronic immunological injury. Conclusions: Individuals with graft failure have a rapid decline in eGFR prior to dialysis commencement. To improve outcomes, dialysis planning and management of chronic kidney disease complications should be initiated earlier than in the transplant-naïve population.

Decline of kidney function during the pre-dialysis period in chronic kidney disease patients: a systematic review and meta-analysis

“…In these studies, the reported annual eGFR decline for the whole CKD population ranged between 1.5 and 2.1 mL/min/1.73 m 2 , and for patients who initiated dialysis, it ranged between 3.9 and 7.3 mL/min/1.73 m 2 . 15 , 17 , 18 Previous literature is in line with our finding that the mean annual rates of kidney function decline in CKD 3–5 cohorts are much lower than in dialysis-based studies.…”

Factors influencing survival after kidney transplant failure

“…Transplant recipients may exhibit a more rapid loss of kidney function in the months prior to ESRD than the transplant-naïve CKD population [24]. This study demonstrates that the median survival time after commencing dialysis is short, and presumably, the window of opportunity for transplantation is shorter again; this, combined with the rapidity of decline in graft function prior to transplant failure, necessitates a degree of urgency in the management of these recipients.…”

Dynamic prediction of renal survival among deeply phenotyped kidney transplant recipients using artificial intelligence: an observational, international, multicohort study

“…3 Additionally, several studies have found that repeated measurements of allograft function can add value when predicting clinical outcomes. 4,5 Hence, capturing a comprehensive set of risk factors for allograft failure requires not only large, well annotated, deeply phenotyped cohorts 6 of kidney transplant recipients but also a dynamic and integrative method that uses repeated and diverse measures recorded throughout patient follow-up.…”