title: Residual renal function in peritoneal dialysis with failed allograft and minimum immunosuppression.
abstract: Immunosuppression (IS) is often withdrawn in patients with end stage renal disease secondary to a failed renal allograft, and this can lead to an accelerated loss of residual renal function (RRF). As maintenance of RRF appears to provide a survival benefit to peritoneal dialysis (PD) patients, it is not clear whether this benefit of maintaining RRF in failed allograft patients returning to PD outweigh the risks of maintaining IS. A 49 year-old Caucasian male developed progressive allograft failure nine years after living-donor renal transplantation. Hemodialysis was initiated via tunneled dialysis catheter (TDC) and IS was gradually withdrawn. Two weeks after IS withdrawal he developed a febrile illness, which necessitate removal of the TDC and conversion to PD. He was maintained on small dose of tacrolimus (1 mg/d) and prednisone (5 mg/d). Currently (1 year later) he is doing exceedingly well on cycler-assisted PD. Residual urine output ranges between 600-1200 mL/d. Total weekly Kt/V achieved 1.82. RRF remained well preserved in this patient with failed renal allograft with minimal immunosuppressive therapy. This strategy will need further study in well-defined cohorts of PD patients with failed allografts and residual RRF to determine efficacy and safety.
authors.affiliation: Nadear Elmahi, Éva Csongrádi, Kenneth Kokko, Jamie Davison, Tibor Fülöp, Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, United States.
authors.forename: Nadear
authors.initials: N
authors.lastname: Elmahi
authors.forename: Eva
authors.initials: E
authors.lastname: Csongrádi
authors.forename: Kenneth
authors.initials: K
authors.lastname: Kokko
authors.forename: Jack R
authors.initials: JR
authors.lastname: Lewin
authors.forename: Jamie
authors.initials: J
authors.lastname: Davison
authors.forename: Tibor
authors.initials: T
authors.lastname: Fülöp
keywords: Immunosuppression; Kidney transplantation; Nephrectomy; Peritoneal dialysis; Renal function reserve