title: Opportunities to improve the care of patients with kidney transplant failure.
abstract: BACKGROUND
  Patients initiating dialysis after a failed kidney transplant are a subgroup of chronic kidney disease (CKD) patients who have not been characterized. Exposure to immunosuppressive medications differentiates these patients from the general incident end-stage renal disease (ESRD) population.
  
  
  METHODS
  Data from the Health Care Financing Administration 2728 form were used to determine the hematocrit, erythropoietin use, serum albumin and glomerular filtration rate (GFR) among 4643 patients with failed kidney transplants who initiated dialysis between April 1995 and December 1998.
  
  
  RESULTS
  At dialysis initiation, the mean hematocrit, serum albumin and GFR were 27.5%, 3.3 g/dL, and 8.4 mL/min/1.73 m2, respectively, and only 35% of patients had received erythropoietin. In a multivariate analysis, patients <45 years, females, patients of non-White race, non-diabetic patients, hemodialysis patients and patients with a lower serum albumin had a higher odds for hematocrit <30%. Erythropoietin use was associated with female gender, White race, increased time since transplantation, being employed, peritoneal dialysis, and higher serum albumin. Patients >/=45 years and patients with diabetes or congestive heart failure had higher odds for hypoalbuminemia, while employed patients, peritoneal dialysis patients, patients with higher hematocrit and patients who had received erythropoietin had lower odds of hypoalbuminemia.
  
  
  CONCLUSIONS
  Despite being known to specialty physicians, patients with failed kidney transplants initiate dialysis at levels of hematocrit, serum albumin, and GFR that may be suboptimal and similar to those in the general incident ESRD population. Socioeconomic factors remain important barriers to the provision of CKD care even among these patients with established specialty physician contact. Improved CKD care could improve the outcomes of this unique subgroup of CKD patients.
authors.affiliation: Division of Nephrology, New England Medical Center, Boston, Massachusetts 02111, USA. Bpereira@lifespan.org
authors.forename: John S
authors.initials: JS
authors.lastname: Gill
authors.forename: Rekha
authors.initials: R
authors.lastname: Abichandani
authors.forename: Samina
authors.initials: S
authors.lastname: Khan
authors.forename: Annamaria T
authors.initials: AT
authors.lastname: Kausz
authors.forename: Brian J G
authors.initials: BJ
authors.lastname: Pereira
mesh_terms: D000328:Adult; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D005919:Glomerular Filtration Rate; D006400:Hematocrit; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D006435:Renal Dialysis; D019233:Retreatment; D012709:Serum Albumin / Q000032:analysis; D017211:Treatment Failure
chemical_list: D012709:Serum Albumin; D004921:Erythropoietin