title: Tailored dialysis start may allow persistence of residual renal function after graft failure: a case report.
abstract: BACKGROUND
  Restarting dialysis after kidney transplantation is a critical step with psychological and clinical implications. Maintenance of residual renal function a known factor affecting survival in chronic kidney disease, has so far not been investigated after a kidney transplantation.
  
  
  METHODS
  A 54-year-old woman who started dialysis in 1974 (first graft, 1975-1999) received a second "marginal" kidney graft in February 2001 (donor age, 65 years). Her chronic therapy was tacrolimus and steroids. She had a clinical history as follows: nadir creatinine level of 1.5 mg/dL, moderate-severe hypertension, progressive graft dysfunction, nonresponsiveness to addition of mycophenolate, tapering FK levels, and a rescue switch from tacrolimus to rapamycin. From October to December 2003, the creatinine level increased from 2-2.8 to 7 mg/dL. Biopsy specimen showed malignant and "benign" nephrosclerosis, posttransplantation glomerulopathy, and tacrolimus toxicity. Chronic dialysis was started (GFR <3 mL/min). Rapamycin was discontinued. Dialysis was tailored to reach an equivalent renal clearance of >15 mL/min (2 sessions/wk). Blood pressure control improved, nephrotoxic drugs were avoided, and fluid loss was minimized (maximum 500 mL/hr). By this policy, renal function progressively increased to GFR >10 mL/min in May 2004, allowing a once or twice weekly dialysis schedule, with good clinical balance, and obvious advantages for the quality of life.
  
  
  CONCLUSIONS
  This long-term patient, who restarted dialysis with severely reduced renal function, regained sufficient renal function to allow once weekly dialysis. Thus, careful tailoring of dialysis sessions at the restart of dialysis may allow preservation of residual kidney function, at least in individuals for whom a subsequent graft is unlikely.
authors.affiliation: Nephrology, University of Torino, 101260 Torino, Italy. gbpiccoli@hotmail.com
authors.forename: G B
authors.initials: GB
authors.lastname: Piccoli
authors.forename: D
authors.initials: D
authors.lastname: Motta
authors.forename: M
authors.initials: M
authors.lastname: Gai
authors.forename: E
authors.initials: E
authors.lastname: Mezza
authors.forename: E
authors.initials: E
authors.lastname: Maddalena
authors.forename: M
authors.initials: M
authors.lastname: Bravin
authors.forename: F
authors.initials: F
authors.lastname: Tattoli
authors.forename: V
authors.initials: V
authors.lastname: Consiglio
authors.forename: M
authors.initials: M
authors.lastname: Burdese
authors.forename: D
authors.initials: D
authors.lastname: Bilucaglia
authors.forename: A
authors.initials: A
authors.lastname: Ferrari
authors.forename: G P
authors.initials: GP
authors.lastname: Segoloni
mesh_terms: D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000276:immunology / Q000473:pathology; D008875:Middle Aged; D006435:Renal Dialysis; D017211:Treatment Failure
chemical_list: D007166:Immunosuppressive Agents