title: Survival after dialysis initiation: a comparison of transplant patients after graft loss versus nontransplant patients.
abstract: BACKGROUND
  A substantial number of patients return to dialysis therapy after a renal transplant fails. It is not clear whether mortality increases among patients with graft failure relative to those who initiate dialysis but who have not yet received a kidney transplant.
  
  
  METHODS
  We compared the outcomes of an incident cohort of patients (n = 194) with a cohort of renal transplant patients who returned to dialysis after graft loss (n = 74). We analyzed the morbidity and mortality after dialysis initiation and the parameters during the year beforehand.
  
  
  RESULTS
  Mortality among post-graft loss dialysis patients was higher than transplant-naive patients (relative risk [RR]: 2.05; 95% confidence interval [CI]: 1.26-3.35). Additionally, complications, such as the number of hospitalizations during the first year after dialysis initiation, were higher (29% vs 57%; P > .001). At dialysis initiation no differences were found in glomerular filtration rate, although hemoglobin and albumin levels were lower and C-reactive protein was higher in post-graft loss dialysis patients.
  
  
  CONCLUSIONS
  Mortality among patients on dialysis therapy after graft loss increased significantly compared with mortality among patients who initiated dialysis for the first time, despite specialty physicians being aware of them. Additional studies are urgently needed to define the mechanisms of the increased risk and strategies to decrease mortality.
authors.affiliation: Nephrology Service, University Hospital Marqués de Valdecilla, Santander, Spain. nefffg@humv.es
authors.forename: G
authors.initials: G
authors.lastname: Fernández Fresnedo
authors.forename: J C
authors.initials: JC
authors.lastname: Ruiz
authors.forename: C
authors.initials: C
authors.lastname: Gómez Alamillo
authors.forename: A L M
authors.initials: AL
authors.lastname: de Francisco
authors.forename: M
authors.initials: M
authors.lastname: Arias
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality; D016030:Kidney Transplantation / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D017582:Renal Replacement Therapy / Q000401:mortality*; D012086:Reoperation / Q000401:mortality / Q000706:statistics & numerical data; D016019:Survival Analysis; D017741:Survivors; D014850:Waiting Lists