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01.02.2018 | Original Article

CKD complications in kidney-transplanted patients going back to dialysis: impact on patients outcomes

verfasst von: Julien Aniort, Saleh Kaysi, Cyril Garrouste, Mohamed Hadj Abdelkader, Myriam Isnard, Didier Aguilera, Youssef Ali, Marc Bouiller, Aurelien Mulliez, Anne Elisabeth Heng

Erschienen in: Journal of Nephrology | Ausgabe 1/2018

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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.

Agence de la biomédecine (2007) Rapport qualité de vie—REIN Volet Greffe. https://www.agencebiomedecine.fr

Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, Held PJ, Port FK (1999) Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 341(23):1725–1730. doi:10.1056/NEJM199912023412303 CrossRefPubMed

Ojo AO, Hanson JA, Meier-Kriesche H, Okechukwu CN, Wolfe RA, Leichtman AB, Agodoa LY, Kaplan B, Port FK (2001) Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates. J Am Soc Nephrol 12(3):589–597PubMed

Kaplan B, Meier-Kriesche HU (2002) Death after graft loss: an important late study endpoint in kidney transplantation. Am J Transplant 2(10):970–974CrossRefPubMed

Gill JS, Abichandani R, Kausz AT, Pereira BJ (2002) Mortality after kidney transplant failure: the impact of non-immunologic factors. Kidney Int 62(5):1875–1883. doi:10.1046/j.1523-1755.2002.00640.x CrossRefPubMed

Arias M, Escallada R, de Francisco AL, Rodrigo E, Fernandez-Fresnedo G, Setien MA, Pinera C, Ruiz JC, Herraez I, Cotorruelo J (2002) Return to dialysis after renal transplantation. Which would be the best way? Kidney Int Suppl (80):85–88

Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group (2012) KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int Suppl 2:337–414

Kidney Disease: Improving Global Outcomes (KDIGO) Anemia Work Group (2012) KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney Int Suppl 2:279–335

Kidney Disease: Improving Global Outcomes (KDIGO) Lipid Work Group (2013) KDIGO clinical practice guideline for lipid management in chronic kidney disease. Kidney Int Suppl 3:259–305

10.

Kidney Disease: Improving Global Outcomes (KDIGO) CKD–MBD Work Group (2017) KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease–mineral and bone disorder (CKD–MBD). Kidney Int Suppl 7:1–59

11.

Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group (2012) KDIGO clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 3:1–150

12.

Ikizler TA, Cano NJ, Franch H, Fouque D, Himmelfarb J, Kalantar-Zadeh K, Kuhlmann MK, Stenvinkel P, TerWee P, Teta D, Wang AY, Wanner C (2013) Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism. Kidney Int 84(6):1096–1107. doi:10.1038/ki.2013.147 CrossRefPubMed

13.

Slinin Y, Guo H, Gilbertson DT, Mau LW, Ensrud K, Rector T, Collins AJ, Ishani A (2010) Meeting KDOQI guideline goals at hemodialysis initiation and survival during the first year. Clin J Am Soc Nephrol 5(9):1574–1581. doi:10.2215/CJN.01320210 CrossRefPubMedPubMedCentral

14.

Akbari A, Hussain N, Karpinski J, Knoll GA (2007) Chronic kidney disease management: comparison between renal transplant recipients and nontransplant patients with chronic kidney disease. Nephron Clin Pract 107(1):c7–c13. doi:10.1159/000105138 CrossRefPubMed

15.

Jimenez Alvaro S, Marcen R, Teruel JL, Fernandez Rodriguez A, Pascual J, Galeano C, Villacorta J, Burgos FJ, Ortuno J (2009) Management of chronic kidney disease after renal transplantation: is it different from nontransplant patients? Transplant Proc 41(6):2409–2411. doi:10.1016/j.transproceed.2009.06.107 CrossRefPubMed

16.

Tenenhaus M, Vinzi VE, Chatelin YM, Lauro C (2005) PLS path modeling. Comput Stat Data Anal 48(1):159–205. doi:10.1016/j.csda.2004.03.005 CrossRef

17.

Lopez-Gomez JM, Perez-Flores I, Jofre R, Carretero D, Rodriguez-Benitez P, Villaverde M, Perez-Garcia R, Nassar GM, Niembro E, Ayus JC (2004) Presence of a failed kidney transplant in patients who are on hemodialysis is associated with chronic inflammatory state and erythropoietin resistance. J Am Soc Nephrol 15(9):2494–2501. doi:10.1097/01.ASN.0000137879.97445.6E CrossRefPubMed

18.

Kamel KS, Ethier JH, Quaggin S, Levin A, Albert S, Carlisle EJ, Halperin ML (1992) Studies to determine the basis for hyperkalemia in recipients of a renal transplant who are treated with cyclosporine. J Am Soc Nephrol 2(8):1279–1284PubMed

19.

Bailey JL, Zheng B, Hu Z, Price SR, Mitch WE (2006) Chronic kidney disease causes defects in signaling through the insulin receptor substrate/phosphatidylinositol 3-kinase/Akt pathway: implications for muscle atrophy. J Am Soc Nephrol 17(5):1388–1394. doi:10.1681/ASN.2004100842 CrossRefPubMed

20.

Gill JS, Abichandani R, Khan S, Kausz AT, Pereira BJ (2002) Opportunities to improve the care of patients with kidney transplant failure. Kidney Int 61(6):2193–2200. doi:10.1046/j.1523-1755.2002.00373.x CrossRefPubMed

21.

Ansell D, Udayaraj UP, Steenkamp R, Dudley CR (2007) Chronic renal failure in kidney transplant recipients. Do they receive optimum care?: data from the UK renal registry. Am J Transplant 7(5):1167–1176. doi:10.1111/j.1600-6143.2007.01745.x CrossRefPubMed

22.

Lobbedez T, Cousin M, Hurault de Ligny B, Ficheux M, El Haggan W, Ryckelynck JP (2009) Failed transplant patients: dialysis initiation and short-term outcome. Nephrol Ther 5(3):188–192. doi:10.1016/j.nephro.2008.10.005 CrossRefPubMed

23.

Beltran S, Gavela E, Kanter J, Sancho A, Avila A, Gorriz JL, Crespo JF, Pallardo LM (2009) Beginning hemodialysis: do patients with a failed renal transplant start in worse condition? Transplant Proc 41(6):2129–2131. doi:10.1016/j.transproceed.2009.06.006 CrossRefPubMed

24.

Caldes Ruisanchez S, Marcen Letosa R, Amezquita Orjuela Y, Fernandez Lucas M, Rivera Gorrin M, Galeano Alvarez C, Fernandez Rodriguez A, Teruel Briones JL, Quereda Rodriguez-Navarro C (2011) Dialysis after kidney transplant failure: do patients start in a worse condition than the general population with chronic kidney disease? Nefrologia 31(1):51–57. doi:10.3265/Nefrologia.pre2010.Nov.10610 PubMed

25.

Knoll G, Muirhead N, Trpeski L, Zhu N, Badovinac K (2005) Patient survival following renal transplant failure in Canada. Am J Transplant 5(7):1719–1724. doi:10.1111/j.1600-6143.2005.00921.x CrossRefPubMed

26.

Rao PS, Schaubel DE, Jia X, Li S, Port FK, Saran R (2007) Survival on dialysis post-kidney transplant failure: results from the Scientific Registry of Transplant Recipients. Am J Kidney Dis 49(2):294–300. doi:10.1053/j.ajkd.2006.11.022 CrossRefPubMed

27.

Mourad G, Minguet J, Pernin V, Garrigue V, Peraldi MN, Kessler M, Jacquelinet C, Couchoud C, Duny Y, Daures JP (2014) Similar patient survival following kidney allograft failure compared with non-transplanted patients. Kidney Int 86(1):191–198. doi:10.1038/ki.2014.6 CrossRefPubMed

28.

Choukroun G, Kamar N, Dussol B, Etienne I, Cassuto-Viguier E, Toupance O, Glowacki F, Moulin B, Lebranchu Y, Touchard G, Jaureguy M, Pallet N, Le Meur Y, Rostaing L, Martinez F (2012) Correction of postkidney transplant anemia reduces progression of allograft nephropathy. J Am Soc Nephrol 23(2):360–368. doi:10.1681/ASN.2011060546 CrossRefPubMedPubMedCentral

29.

Holdaas H, Fellstrom B, Jardine AG, Holme I, Nyberg G, Fauchald P, Gronhagen-Riska C, Madsen S, Neumayer HH, Cole E, Maes B, Ambuhl P, Olsson AG, Hartmann A, Solbu DO, Pedersen TR (2003) Effect of fluvastatin on cardiac outcomes in renal transplant recipients: a multicentre, randomised, placebo-controlled trial. Lancet 361(9374):2024–2031. doi:10.1016/S0140-6736(03)13638-0 CrossRefPubMed

30.

Cross NB, Webster AC, Masson P, O’Connell PJ, Craig JC (2009) Antihypertensives for kidney transplant recipients: systematic review and meta-analysis of randomized controlled trials. Transplantation 88(1):7–18. doi:10.1097/TP.0b013e3181a9e960 CrossRefPubMed

Titel: CKD complications in kidney-transplanted patients going back to dialysis: impact on patients outcomes
verfasst von: Julien Aniort
Saleh Kaysi
Cyril Garrouste
Mohamed Hadj Abdelkader
Myriam Isnard
Didier Aguilera
Youssef Ali
Marc Bouiller
Aurelien Mulliez
Anne Elisabeth Heng
Publikationsdatum: 01.02.2018
Verlag: Springer International Publishing
Erschienen in: Journal of Nephrology / Ausgabe 1/2018
Print ISSN: 1121-8428
Elektronische ISSN: 1724-6059
DOI: https://doi.org/10.1007/s40620-017-0449-z

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CKD complications in kidney-transplanted patients going back to dialysis: impact on patients outcomes

Abstract