Return to dialysis after renal allograft loss: is dialysis treatment initiated too late?
BACKGROUND
Allograft failure is a common complication after renal transplantation. However, data describing the level of renal function and the clinical condition of patients returning to dialysis after graft failure are scarce. The purpose of this analysis was to retrospectively determine the stage of end-stage renal failure at dialysis initiation and the outcome during the first year of dialysis among patients who lost their grafts.


METHODS
We analyzed deaths with a functioning graft and graft losses among patients transplanted in our center between January 1, 1994, and December 31, 2003. Weight, blood pressure, serum albumin, hemoglobin, phosphorus-calcium levels, and vascular access for dialysis were analyzed at the beginning (D(0)) and at 1 year after initiation of dialysis (M(12)). Creatinine clearance (CrCl), and hemoglobin were also studied at 3 months before beginning renal replacement therapy (M(-3)).


RESULTS
Ninety-eight patients lost their grafts after a mean follow-up of 94 +/- 34 months; 37 died with a functioning graft and 61 returned to dialysis. Patient age was 62 +/- 10 years for the first group and 47 +/- 13 years for the second. At D(0), patients were hypertensive and anemic with a mean CrCl of 10 +/- 3 mL/min, suggesting that they were referred too late for dialysis. Surprisingly, at M(-3), CrCl was 19 +/- 7 mL/min and hemoglobin 10.6 +/- 3.6 g/dL. Four patients died during the first year of dialysis.


CONCLUSIONS
Our data suggest that transplant patients returned to dialysis too late. CrCl and hemoglobin deteriorate rapidly during the 3 months preceding dialysis initiation.
Sleiman
J
J
Department of Nephrology, Transplantation and Peritoneal Dialysis, Hôpital Lapeyronie, Université de Montpellier, 34295 Montpellier cedex 05, France.
Garrigue
V
V
Vetromile
F
F
Mourad
G
G
D000368:Aged; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data*; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016019:Survival Analysis; D017211:Treatment Failure