title: Dialysis after kidney transplant failure: do patients start in a worse condition than the general population with chronic kidney disease?
abstract: BACKGROUND
  Patients with renal graft dysfunction constitute an increasingly prevalent group of end-stage kidney disease (ESKD) patients that require dialysis therapy. These patients have special characteristics that set them apart from the ESKD general population. The aim of this study was to analyse the clinical condition and evolution of patients entering dialysis with a failed kidney graft at the time of restarting dialysis and over a year of therapy according to the K/DOQI guidelines, and to compare them with incidental patients with end-stage kidney disease. We also investigated whether the modality of kidney replacement therapy may determine the clinical improvement of transplant patients.
  
  
  METHODS
  This is a retrospective observational study of 106 patients with ESKD followed up in the Ramon y Cajal Hospital. They were classified in two groups. Group one was made up of 50 failed native kidney patients who started dialysis between 2000 and 2009. Group two was comprised of 56 transplant patients with graft dysfunction who returned to dialysis between 1997 and 2009. We studied parameters of kidney function, anaemia, calcium-phosphorus metabolism, cardiovascular risk factors and nutritional status at the time both groups started on dialysis and one year later.
  
  
  RESULTS
  Both groups had a similar clinical status at the time they started on dialysis in most of the parameters analysed with the exception of anaemia. This was more severe in transplant patients, despite the fact that transplant patients received a higher dose of erythropoietin than non-transplant patients. One year later the main difference between both groups was the residual kidney function rate, higher in non-transplant patients. There were no significant differences in the parameters analysed in patients with a failed graft according to the modality of kidney replacement therapy.
  
  
  CONCLUSIONS
  Failed transplant patients start dialysis with more severe anaemia than patients entering dialysis for the first time. Twelve months later both groups present a similar clinical condition with the exception of residual kidney function, higher in failed native kidney patients. The method of dialysis treatment after kidney transplant failure did not have a bearing on the clinical improvement of our patients.
authors.affiliation: Nephrology Department, Ramón y Cajal Hospital, Madrid, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Caldés Ruisánchez
authors.forename: R
authors.initials: R
authors.lastname: Marcén Letosa
authors.forename: Y
authors.initials: Y
authors.lastname: Amezquita Orjuela
authors.forename: M
authors.initials: M
authors.lastname: Fernández Lucas
authors.forename: M
authors.initials: M
authors.lastname: Rivera Gorrin
authors.forename: C
authors.initials: C
authors.lastname: Galeano Álvarez
authors.forename: A
authors.initials: A
authors.lastname: Fernández Rodríguez
authors.forename: J L
authors.initials: JL
authors.lastname: Teruel Briones
authors.forename: C
authors.initials: C
authors.lastname: Quereda Rodríguez-Navarro
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000188:drug therapy / Q000209:etiology; D002118:Calcium / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000150:complications; D002908:Chronic Disease; D000068256:Darbepoetin alfa; D004921:Erythropoietin / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data; D010758:Phosphorus / Q000378:metabolism; D011183:Postoperative Complications / Q000378:metabolism / Q000628:therapy*; D012008:Recurrence; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D004921:Erythropoietin; D000068256:Darbepoetin alfa; D010758:Phosphorus; D002118:Calcium