Julien Aniort1, Saleh Kaysi2, Cyril Garrouste2, Mohamed Hadj Abdelkader2, Myriam Isnard3, Didier Aguilera4, Youssef Ali5, Marc Bouiller6, Aurelien Mulliez7, Anne Elisabeth Heng2. 1. Nephrology, Dialysis and Transplantation Department, Gabriel Montpied University Hospital, 54 rue Montalembert, BP69, 63003, Clermont-Ferrand Cedex 1, France. janiort@chu-clermontferrand.fr. 2. Nephrology, Dialysis and Transplantation Department, Gabriel Montpied University Hospital, 54 rue Montalembert, BP69, 63003, Clermont-Ferrand Cedex 1, France. 3. Dialysis Center, Association pour l'Utilisation du Rein artificiel (AURA) Auvergne, Clermont-Ferrand, France. 4. Nephrology and Dialysis Department, Jacques Lacarin Hospital, Vichy, France. 5. Nephrology and Dialysis Department, Hospital of Montluçon, Montluçon, France. 6. Nephrology and Dialysis Department, Emile Roux Hospital, Puy en Velay, France. 7. Biostatistics Unit (DRCI), University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
Abstract
AIMS: The management of chronic kidney disease (CKD) complications is not always adequate in patients with a failed kidney transplant. We aimed to evaluate the frequency of CKD complications and assess whether they may lead to worse outcomes in this patient population. METHOD: We analyzed 49 kidney transplant recipients with a failed transplant (T+) and matched non-transplanted patients (T-) starting dialysis between 2000 and 2010 in five dialysis centers in France. CKD complications at dialysis initiation, hospitalizations and death were recorded and compared between the two groups. RESULTS: At dialysis initiation, T+ patients were more likely to have bicarbonate < 22 mmol/l (77.6 vs. 22.0%, p < 0.01), phosphate > 1.5 mmol/l (77.6 vs. 59.2%, p = 0.03), arterial blood pressure > 130/80 mmHg (75.5 vs. 93.9%, p = 0.01), body mass index < 23 (59.2 vs. 32.7%, p = 0.01) and albumin < 38 g/l (69.4 vs. 36.7%) than T- patients. T+ patients were hospitalized more frequently in the year following dialysis initiation (40.8 ± 7.0 vs. 16.3 ± 5.3%, log rank p = 0.01) and 5-year survival rate was lower than in T- patients (82.1 ± 6.2 vs. 64.0 ± 7.4%, log rank p = 0.02). However risk of hospitalization and mortality was lesser after adjustments for CKD complications. CONCLUSION: Despite regular follow-up by nephrologists, CKD complications before initiation of dialysis are more frequent in T+ patients than in T- patients. A better management of CKD complications in T+ patients could improve outcomes after dialysis initiation.
AIMS: The management of chronic kidney disease (CKD) complications is not always adequate in patients with a failed kidney transplant. We aimed to evaluate the frequency of CKD complications and assess whether they may lead to worse outcomes in this patient population. METHOD: We analyzed 49 kidney transplant recipients with a failed transplant (T+) and matched non-transplanted patients (T-) starting dialysis between 2000 and 2010 in five dialysis centers in France. CKD complications at dialysis initiation, hospitalizations and death were recorded and compared between the two groups. RESULTS: At dialysis initiation, T+ patients were more likely to have bicarbonate < 22 mmol/l (77.6 vs. 22.0%, p < 0.01), phosphate > 1.5 mmol/l (77.6 vs. 59.2%, p = 0.03), arterial blood pressure > 130/80 mmHg (75.5 vs. 93.9%, p = 0.01), body mass index < 23 (59.2 vs. 32.7%, p = 0.01) and albumin < 38 g/l (69.4 vs. 36.7%) than T- patients. T+ patients were hospitalized more frequently in the year following dialysis initiation (40.8 ± 7.0 vs. 16.3 ± 5.3%, log rank p = 0.01) and 5-year survival rate was lower than in T- patients (82.1 ± 6.2 vs. 64.0 ± 7.4%, log rank p = 0.02). However risk of hospitalization and mortality was lesser after adjustments for CKD complications. CONCLUSION: Despite regular follow-up by nephrologists, CKD complications before initiation of dialysis are more frequent in T+ patients than in T- patients. A better management of CKD complications in T+ patients could improve outcomes after dialysis initiation.
Authors: S Caldés Ruisánchez; R Marcén Letosa; Y Amezquita Orjuela; M Fernández Lucas; M Rivera Gorrin; C Galeano Álvarez; A Fernández Rodríguez; J L Teruel Briones; C Quereda Rodríguez-Navarro Journal: Nefrologia Date: 2011 Impact factor: 2.033
Authors: Akinlolu O Ojo; Julie A Hanson; Herwig-Ulf Meier-Kriesche; Chike N Okechukwu; Robert A Wolfe; Alan B Leichtman; Lawrence Y Agodoa; Bruce Kaplan; Friedrich K Port Journal: J Am Soc Nephrol Date: 2001-03 Impact factor: 10.121
Authors: S Beltrán; E Gavela; J Kanter; A Sancho; A Avila; J L Górriz; J F Crespo; L M Pallardó Journal: Transplant Proc Date: 2009 Jul-Aug Impact factor: 1.066
Authors: Hallvard Holdaas; Bengt Fellström; Alan G Jardine; Ingar Holme; Gudrun Nyberg; Per Fauchald; Carola Grönhagen-Riska; Søren Madsen; Hans-Hellmut Neumayer; Edward Cole; Bart Maes; Patrice Ambühl; Anders G Olsson; Anders Hartmann; Dag O Solbu; Terje R Pedersen Journal: Lancet Date: 2003-06-14 Impact factor: 79.321