10.6084/m9.figshare.4580899.v1
Brar A.
Brar
A.
Markell M.
Markell
M.
Stefanov D.G.
Stefanov
D.G.
Timpo E.
Timpo
E.
Jindal R.M.
Jindal
R.M.
Nee R.
Nee
R.
Sumrani N.
Sumrani
N.
John D.
John
D.
Tedla F.
Tedla
F.
Salifu M.O.
Salifu
M.O.
PowerPoint Slides for: Mortality after Renal Allograft Failure and Return to Dialysis
Karger Publishers
2017
Mortality
Renal allograft failure
Kidney transplantation
End-stage renal disease
2017-01-24 15:15:59
Dataset
https://karger.figshare.com/articles/dataset/PowerPoint_Slides_for_Mortality_after_Renal_Allograft_Failure_and_Return_to_Dialysis/4580899
<p><b><i>Introduction:</i></b> 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. <b><i>Methods:</i></b>
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. <b><i>Results:</i></b>
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, <i>p</i> = 0.03), albumin <3.5 g/dL (AHR 1.33, 95% CI 1.18-1.49, <i>p</i> = 0.0001), and being underweight (AHR 1.30, 95% CI 1.07-1.58, <i>p</i> = 0.006). Hemoglobin <10 g/dL (AHR 0.96, 95% CI 0.86-1.06, <i>p</i>
= 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 m<sup>2</sup> at time of dialysis initiation (AHR 0.83, 95% CI 0.75-0.93, <i>p</i> = 0.001) was associated with reduction in mortality. <b><i>Conclusions:</i></b>
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.</p>