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Our patients included 5 males and 4 females with a mean age of 53&#46;5&#177;15&#46;4 years &#40;31-78&#41;&#44; a time on PD previous to TX of 19&#46;6&#177;12&#46;8 months &#40;1&#46;5-45&#46;5&#41; and time until PD after TX failure of 25&#177;23 days &#40;10-64&#41;&#46; We considered 6 cases to be primary graft failure&#46; The causes of TX failure were&#58; 5 venous thromboses with no immunological cause &#40;possible preservation failure&#41;&#44; 1 thrombotic microangiopathy &#40;preservation failure&#41;&#44; 1 arterial thrombosis&#44; 1 cortico-medullary necrosis &#40;graft mycosis&#41; and 1 of unknown cause&#46; Immunosuppressive treatment varied in accordance with the type of graft received &#40;brain death or asystole&#41;&#44; with thymoglobulin&#44; tacrolimus or basiliximab being used as induction drugs and with all patients receiving tacrolimus&#44; mycophenolate mofetil and steroids to maintain immunosuppression&#46;</p><p class="elsevierStylePara">We carried out blood test controls pre-TX&#44; immediately after PD resumption&#44; after a month on PD and after three months on PD&#46; On each occasion&#44; we studied nutrition data &#40;albumin&#44; pre-albumin&#44; transferrin&#44; total lymphocytes&#44; protein catabolic rate &#91;nPNA&#93;&#41;&#44; inflammation &#40;high-sensitivity CRP &#91;hs-CRP&#93; and fibrinogen&#41;&#44; KF with measurement of diuresis &#40;24h&#41;&#44; serum creatinine&#44; creatinine clearance&#44; glomerular filtration rate &#40;GFR&#41; and proteinuria&#46; GFR was calculated with the Adequest &#40;Baxter&#41; software in conjunction with the kinetic study before kidney TX and in conjunction with the study carried out &#8203;&#8203;three months after returning to PD&#46; Peritoneal permeability&#44; creatinine dialysate&#47;plasma &#40;D&#47;P&#41; ratio with the peritoneal equilibration test &#40;PET&#41; and dialysis efficacy &#40;weekly creatinine clearance&#44; weekly Kt&#47;V&#44; ultrafiltration &#91;UF&#93; and peritoneal protein loss&#41; were only measured in the study before TX and three months after returning to PD&#46; UF was calculated by measuring 24h drainage collected in patients at the time of the scheduled revisions and with the UF obtained in the PET study with 2&#46;3&#37; glucose solution after 4h in the peritoneum&#46; There were no episodes of peritoneal infection in the two months prior to TX&#44; in the postsurgical period or in the post-TX study months&#46; During the postsurgical period and after starting PD following kidney TX failure&#44; no haemoperitoneum episodes were observed&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">&#160;</span></span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statistical analysis</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Patient characteristics were summarised using means and ranges &#40;minimum and maximum&#41;&#46; The Wilcoxon test was used to compare samples obtained before TX and after resuming PD&#44; due to the distribution not being normal&#46; All tests were carried out using the SPSS 15&#46;0 statistical software &#40;SPSS Inc&#46; Chicago Ill&#46; USA&#41;&#46;</p><p class="elsevierStylePara">With regard to CRP&#44; we should clarify that the distribution showed a wide range of values&#44; and as such&#44; it was converted using the Napierian logarithm&#46; In all cases&#44; a <span class="elsevierStyleItalic">P</span> value &#60;&#46;05 was considered to be statistically significant&#46; We did not estimate the sample size for this pilot study&#46; All analyses were carried out by comparing up to three months on PD against pre-TX&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">All patients resumed PD after kidney TX failure&#44; but 5 required 4 to 9 HD sessions after TX failure&#46; All patients underwent transplant nephrectomy&#46; Inflammation and nutrition data pre-TX and after the three post-TX phases studied are displayed in Table 1&#46; In the nutrition parameter progression&#44; we observed that there were no differences in any of the parameters&#44; except in the total lymphocyte count&#44; which decreased on resuming PD and remained at levels below pre-TX levels during the three months of post-TX follow-up&#46; nPNA measured pre-TX and three months after TX&#44; in conjunction with the peritoneal kinetic study&#44; did not change&#46;</p><p class="elsevierStylePara">Diuresis decreased after TX &#40;Table 2&#41;&#44; with a significant volume decrease on PD resumption and in the first month after TX &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;032&#41;&#44; with low diuresis being maintained even after three months&#44; which caused a non-significant reduction in creatinine clearance&#46; One of the patients was anuric at the time of TX and 2 lost diuresis after TX&#46; Proteinuria levels remained stable throughout progression&#46;</p><p class="elsevierStylePara">In the short period of time between the pre-TX peritoneal kinetic study &#40;45&#177;14 days&#41; and that which was carried out three months after resuming PD after kidney graft failure&#44; no differences were observed in the peritoneal membrane permeability or in dialysis efficacy &#40;Table 3&#41;&#46; The creatinine D&#47;P ratio did not change after the short space of time between TX and the return to PD&#44; with 57&#46;1&#37; high and medium-high transporters before TX and 62&#46;5&#37; after TX&#59; in only one patient before TX and another in the tests carried out after three months on PD did we observe a creatinine D&#47;P ratio of 0&#46;80&#46; Weekly urea Kt&#47;V or total weekly clearance of creatinine decreased&#44; but dialysis efficacy levels remained high&#46; Peritoneal protein loss increased after patients resumed PD&#44; but did not reach statistical significance&#46; Only UF decreased significantly&#44; from mean levels of 1407ml&#47;day in the phase before TX to 951ml&#47;day three months after PD was resumed &#40;<span class="elsevierStyleItalic">p</span>&#61;&#46;022&#41;&#44; and from 314ml&#47;4h to 260ml&#47;4h &#40;<span class="elsevierStyleItalic">p</span>&#61;&#46;018&#41; in the PET study&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The results of our study seem to indicate that patients who had been on PD before having a kidney TX for a short period and then suffered graft failure&#44; did not have major changes in their clinical situation or in membrane permeability behaviour or dialysis efficacy&#46; The small patient sample probably means that some trends observed could not reach statistical significance&#46; A decrease in total lymphocytes was observed&#44; which may be explained by immunosuppression induction with thymoglobulin&#44; with major T lymphocyte-depleting effects&#46;</p><p class="elsevierStylePara">It is definitely a short follow-up period&#44; but the purpose of the study was really to discover whether the trauma suffered by the patient in order to save KF of a graft at risk&#44; in some cases&#44; and to keep the patient in a stable clinical condition after the trauma of major surgery&#44; in others&#44; could cause clinical or laboratory changes in the patient that would influence their return to PD&#46;</p><p class="elsevierStylePara">Potential peritoneal membrane involvement in its permeability and efficacy does not seem unthinkable given the measures taken to save the postoperative situation&#44; with major antibiotic therapy in some cases and aggressive immunosuppression in others&#44; as well as systemic inflammation and malnutrition typical of prolonged hospitalisation etc&#46;</p><p class="elsevierStylePara">It is important to know the peritoneal membrane condition of patients who are resuming PD after TX failure&#44; because some authors have reported that the type of peritoneal permeability may influence patient and technique survival&#46;<span class="elsevierStyleSup">15</span> We found very few references in the literature with respect to the behaviour of peritoneal permeability in patients on PD after TX failure&#46; In some studies&#44; such as that by Duman et al&#46;&#44; there were no changes in membrane behaviour&#44;<span class="elsevierStyleSup">6</span> and they observed no differences in the PET between new PD patients and those who had had a TX&#46; Other authors observed an early increasing trend in the transportation of solutes in PD patients who had undergone kidney TX&#46;<span class="elsevierStyleSup">2</span> It has also been reported that a high percentage of patients who start PD after TX behave as high transporters&#46;<span class="elsevierStyleSup">16</span> Our results did not show changes in peritoneal permeability and there was only 1 patient before and one after TX who would be at the limit of what we consider to be high transporters&#46; Only UF reduction experienced by our patients seems to indicate a moderate decrease in dialysis efficacy&#46; Of interest is the reduction in diuresis&#44; with a major decrease being observed in the post-TX period studied&#44; which was maintained until three months after the return to PD&#46; Although time on HD after TX in some patients was short&#44; we cannot rule out its potential influence on diuresis reduction&#46; The reduction of KF in dialysis patients who had a non-functional TX was higher than in patients who did not receive a transplant&#46;<span class="elsevierStyleSup">17 </span>Recently&#44; the Peritoneal Dialysis Centre Group published results of PD patients who had received a TX&#44; in which&#44; despite considering it to be a good dialysis option after TX failure&#44; worse clinical progression was observed with a rapid decrease in KF&#46;<span class="elsevierStyleSup">18</span> None of the studies reviewed establish a design such as that which we introduced in our study&#44; in which we analysed the changes that can occur after early failure and which&#44; with the limitations mentioned&#44; offers a new approach&#46; Similar but more comprehensive studies with a greater number of patients should be carried out and they would probably require the collaboration of various hospitals with active TX units&#46;</p><p class="elsevierStylePara">In conclusion&#44; all our PD patients who had kidney TX failure resumed PD in a relatively short space of time&#44; without significant changes being observed in general laboratory parameters or in peritoneal permeability and dialysis efficacy&#44; which was maintained at adequate levels&#46; Although no major differences were observed&#44; except in the reduction of diuresis and UF between the pre-TX data and those observed when PD was resumed and in the trend found in different parameters in our study&#44; a collaborative study on a higher number of patients is necessary&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11732&#95;16025&#95;54597&#95;en&#95;t111732&#46;jpg" class="elsevierStyleCrossRefs"><img src="11732_16025_54597_en_t111732.jpg" alt="Progression of inflammation and nutrition parameters after kidney transplant failure and a return to peritoneal dialysis "></img></a></p><p class="elsevierStylePara">Table 1&#46; Progression of inflammation and nutrition parameters after kidney transplant failure and a return to peritoneal dialysis </p><p class="elsevierStylePara"><a href="grande&#47;11732&#95;16025&#95;54598&#95;en&#95;t211732&#46;jpg" class="elsevierStyleCrossRefs"><img src="11732_16025_54598_en_t211732.jpg" alt="Progression of kidney function parameters after kidney transplant failure and a return to peritoneal dialysis "></img></a></p><p class="elsevierStylePara">Table 2&#46; Progression of kidney function parameters after kidney transplant failure and a return to peritoneal dialysis </p><p class="elsevierStylePara"><a href="grande&#47;11732&#95;16025&#95;54599&#95;en&#95;t311732&#46;jpg" class="elsevierStyleCrossRefs"><img src="11732_16025_54599_en_t311732.jpg" alt="Progression of dialysis efficacy and peritoneal permeability after kidney transplant failure and a return to peritoneal dialysis "></img></a></p><p class="elsevierStylePara">Table 3&#46; Progression of dialysis efficacy and peritoneal permeability after kidney transplant failure and a return to peritoneal dialysis </p>"
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        "resumen" => "<p class="elsevierStylePara">La vuelta a di&#225;lisis tras fallo de trasplante renal &#40;TX&#41; es una situaci&#243;n cada vez m&#225;s frecuente&#46; En la vuelta a di&#225;lisis tras TX fallido suele darse una situaci&#243;n cl&#237;nica similar o peor a la de los pacientes nuevos en hemodi&#225;lisis o di&#225;lisis peritoneal &#40;DP&#41;&#46; Aunque existen bastantes estudios sobre la situaci&#243;n cl&#237;nica de los pacientes que vuelven a DP tras per&#237;odos largos con TX funcionante&#44; no hay apenas informaci&#243;n sobre la evoluci&#243;n de un subgrupo de pacientes que vuelven a DP tras fallo de TX a los pocos d&#237;as o semanas de su realizaci&#243;n&#46; <span class="elsevierStyleBold">Objetivo&#58;</span> Evaluar si un corto per&#237;odo de tiempo con TX sub&#243;ptimo y tratamientos&#47;medidas agresivas pueden influir en la permeabilidad de membrana&#44; la situaci&#243;n cl&#237;nica y la eficacia dial&#237;tica al volver a DP&#46; <span class="elsevierStyleBold">Pacientes y m&#233;todos</span>&#58; En 9 pacientes &#40;53&#44;5&#160;&#177;&#160;15&#44;4 a&#241;os&#44; 5 hombres&#44; 4 mujeres&#41; procedentes de DP con fallo precoz de TX y vuelta a DP &#40;25&#160;&#177;&#160;23 d&#237;as&#44; rango 10-64&#41; de los cinco &#250;ltimos a&#241;os&#44; se estudian datos anal&#237;ticos de inflamaci&#243;n&#44; nutrici&#243;n&#44; funci&#243;n renal&#44; permeabilidad y eficacia de DP&#44; en cuatro momentos de la evoluci&#243;n&#58; previo al TX&#44; inmediatamente a la vuelta a DP&#44; al primer mes y al tercer mes de DP&#46; <span class="elsevierStyleBold">Resultados&#58; </span>No se detectan diferencias significativas en la evoluci&#243;n de los par&#225;metros de nutrici&#243;n e inflamaci&#243;n&#46; <span class="elsevierStyleItalic">La diuresis desciende de forma significativa del volumen previo al trasplante al de la vuelta a DP y al primer mes en DP &#40;p&#160;&#61;&#160;0&#44;032&#41;&#44;</span> manteni&#233;ndose en niveles reducidos a los tres meses en DP&#46; La UF se reduce de <span class="elsevierStyleItalic">1407 a 951 ml&#47;d&#237;a &#40;p&#160;&#61;&#160;0&#44;022&#41; y de 314 a 260 ml&#47;4 h &#40;p&#160;&#61;&#160;0&#44;018&#41;</span> en el test de equilibrio peritoneal al tercer mes en DP&#44; sin cambios en el cociente dializado&#47;plasma de creatinina&#46; Kt&#47;V y aclaramiento semanal de creatinina descienden ligeramente&#44; manteni&#233;ndose en niveles adecuados de eficacia&#46; <span class="elsevierStyleBold">Conclusiones</span>&#58; En esta peque&#241;a muestra de pacientes que vuelven a DP tras fallo precoz de TX&#44; no parece que las medidas que comporta el manejo de un injerto en riesgo en un corto espacio de tiempo afecten <span class="elsevierStyleItalic">de forma importante</span> a par&#225;metros cl&#237;nicos y de permeabilidad o eficacia peritoneal&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara">The return to dialysis after kidney transplant &#40;TX&#41; failure is increasingly common&#46; On returning to dialysis after TX failure&#44; there is usually a similar or worse clinical situation than in patients who are on haemodialysis or peritoneal dialysis &#40;PD&#41; for the first time&#46; Although there are several studies on the clinical situation of patients who return to PD after long periods with a functioning TX&#44; there is hardly any information on the progression of a patient subgroup returning to PD after TX failure a few days or weeks after transplantation&#46; <span class="elsevierStyleBold">Objective&#58;</span> Assess whether a short period of time on suboptimal TX and aggressive treatment&#47;measures may influence membrane permeability&#44; the clinical situation and dialysis efficacy on returning to PD&#46; <span class="elsevierStyleBold">Patients and method&#58;</span> In 9 patients &#40;53&#46;5&#177;15&#46;4 years of age&#44; 5 males and 4 females&#41; who had previously been on PD before early TX failure and had returned to PD &#40;25&#177;23 days&#44; range 10-64&#41; over the last five years&#44; we studied laboratory data including inflammation&#44; nutrition&#44; kidney function&#44; permeability and PD efficacy&#44; at four points during progression&#58; before TX&#44; immediately after returning to PD and after one month and three months on PD&#46; <span class="elsevierStyleBold">Results&#58;</span> We did not detect significant differences in the progression of nutrition and inflammation parameters&#46; <span class="elsevierStyleItalic">Diuresis decreased significantly from pre-TX volume to diuresis on return to PD and after one month on PD &#40;p&#61;&#46;032&#41;</span>&#44; remaining at low levels after three months on PD&#46; UF decreased from <span class="elsevierStyleItalic">1407 to 951ml&#47;day &#40;p&#61;&#46;022&#41; and from 314 to 260ml&#47;4h &#40;p&#61;&#46;018&#41;</span> in the peritoneal equilibration test after three months on PD&#44; without changes being observed in the creatinine dialysate&#47;plasma ratio&#46; Kt&#47;V and weekly creatinine clearance decreased slightly and remained at adequate efficacy levels&#46; <span class="elsevierStyleBold">Conclusions&#58;</span> In this small sample of patients&#44; who returned to PD after early TX failure&#44; it does not appear that the measures involved in managing a graft at risk over a short period of time have a major effect on clinical parameters and permeability or peritoneal efficacy&#46;</p>"
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Early kidney transplant failure and return to peritoneal dialysis: preliminary study of permeability and dialysis efficacy
Fallo precoz de trasplante renal y vuelta a diálisis peritoneal: estudio preliminar de permeabilidad y eficacia de diálisis
Francisco Coronela, Enrique Florita, Secundino Cigarrán-Guldrísb, José A. Herrero-Calvoa, Margarita Delgado-Córdovaa, Beatriz Rodríguez-Cubilloa
a Servicio de Nefrología. Hospital Clínico San Carlos, Madrid,
b Sección de Nefrología, Hospital da Costa, Burela, Lugo,
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Kidney transplant &#40;TX&#41; failure with transfer to dialysis is an increasingly common situation&#44; and as such&#44; 20&#37;-25&#37; of patients on the TX waiting list have had TX failure&#46;<span class="elsevierStyleSup">1</span> Some are treated with peritoneal dialysis &#40;PD&#41;&#44; and they are almost always patients who had been on PD before TX&#46; However&#44; most TX failure patients return to haemodialysis &#40;HD&#41; or begin HD even if they had previously been on PD&#44; despite it being known that survival and complications in patients who are on PD or HD following kidney TX failure are similar&#46;<span class="elsevierStyleSup">2-4</span> Most studies establish that survival in patients who are treated with PD after kidney TX failure is equal to that of new PD patients&#46;<span class="elsevierStyleSup">2&#44;5-8</span></p><p class="elsevierStylePara">Transfer to dialysis after kidney TX failure is usually marked by a similar or worse clinical situation than that of new HD or PD patients&#46; There is a lot of information in the literature about resuming dialysis in kidney TX failure patients after quite a long period with a functioning renal graft&#44; and much of the information highlights the poor clinical situation that many of these patients display due to the late initiation of dialysis&#46; The poor clinical situation is based on worse kidney function &#40;KF&#41; in these patients compared to that of <span class="elsevierStyleItalic">de novo</span> dialysis patients&#44;<span class="elsevierStyleSup">1&#44;9&#44;10</span> or in relation to associated comorbidity<span class="elsevierStyleSup">1&#44;11&#44;12 </span>or laboratory data on dialysis after TX&#46;<span class="elsevierStyleSup">1&#44;9&#44;13&#44;14</span> These patients have a higher degree of anaemia&#44; more systemic inflammation and more commonly have dyslipidaemia&#46; The drug load&#44; the significant loss of KF and the extended periods in TX clinics and not in pre-dialysis clinics may be some of the reasons for this situation&#46;</p><p class="elsevierStylePara">There is little information on the clinical situation of patient subgroups in which TX failure occurs a few days or weeks after transplantation and there is a return to PD&#46; We do not know if surgical aggression&#44; the difficult postoperative situation in patients with a suboptimal graft and immunosuppression affect the peritoneal membrane&#44; the efficacy of dialysis and the clinical situation on returning to PD within a short period of time&#46; As such&#44; the objective of the study was to assess whether a short time on suboptimal TX and aggressive treatments&#47;measures could have an influence on membrane permeability&#44; the clinical situation and dialysis efficacy on returning to PD&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">PATIENTS AND METHODS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Out of the patients who had received a TX in the last five years in our Nephrology Department&#44; we selected 9 PD patients who had experienced early TX failure &#40;defined as failure within a few hours or days of transplantation&#41; and who returned to PD a short time afterwards&#46; Our patients included 5 males and 4 females with a mean age of 53&#46;5&#177;15&#46;4 years &#40;31-78&#41;&#44; a time on PD previous to TX of 19&#46;6&#177;12&#46;8 months &#40;1&#46;5-45&#46;5&#41; and time until PD after TX failure of 25&#177;23 days &#40;10-64&#41;&#46; We considered 6 cases to be primary graft failure&#46; The causes of TX failure were&#58; 5 venous thromboses with no immunological cause &#40;possible preservation failure&#41;&#44; 1 thrombotic microangiopathy &#40;preservation failure&#41;&#44; 1 arterial thrombosis&#44; 1 cortico-medullary necrosis &#40;graft mycosis&#41; and 1 of unknown cause&#46; Immunosuppressive treatment varied in accordance with the type of graft received &#40;brain death or asystole&#41;&#44; with thymoglobulin&#44; tacrolimus or basiliximab being used as induction drugs and with all patients receiving tacrolimus&#44; mycophenolate mofetil and steroids to maintain immunosuppression&#46;</p><p class="elsevierStylePara">We carried out blood test controls pre-TX&#44; immediately after PD resumption&#44; after a month on PD and after three months on PD&#46; On each occasion&#44; we studied nutrition data &#40;albumin&#44; pre-albumin&#44; transferrin&#44; total lymphocytes&#44; protein catabolic rate &#91;nPNA&#93;&#41;&#44; inflammation &#40;high-sensitivity CRP &#91;hs-CRP&#93; and fibrinogen&#41;&#44; KF with measurement of diuresis &#40;24h&#41;&#44; serum creatinine&#44; creatinine clearance&#44; glomerular filtration rate &#40;GFR&#41; and proteinuria&#46; GFR was calculated with the Adequest &#40;Baxter&#41; software in conjunction with the kinetic study before kidney TX and in conjunction with the study carried out &#8203;&#8203;three months after returning to PD&#46; Peritoneal permeability&#44; creatinine dialysate&#47;plasma &#40;D&#47;P&#41; ratio with the peritoneal equilibration test &#40;PET&#41; and dialysis efficacy &#40;weekly creatinine clearance&#44; weekly Kt&#47;V&#44; ultrafiltration &#91;UF&#93; and peritoneal protein loss&#41; were only measured in the study before TX and three months after returning to PD&#46; UF was calculated by measuring 24h drainage collected in patients at the time of the scheduled revisions and with the UF obtained in the PET study with 2&#46;3&#37; glucose solution after 4h in the peritoneum&#46; There were no episodes of peritoneal infection in the two months prior to TX&#44; in the postsurgical period or in the post-TX study months&#46; During the postsurgical period and after starting PD following kidney TX failure&#44; no haemoperitoneum episodes were observed&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">&#160;</span></span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statistical analysis</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Patient characteristics were summarised using means and ranges &#40;minimum and maximum&#41;&#46; The Wilcoxon test was used to compare samples obtained before TX and after resuming PD&#44; due to the distribution not being normal&#46; All tests were carried out using the SPSS 15&#46;0 statistical software &#40;SPSS Inc&#46; Chicago Ill&#46; USA&#41;&#46;</p><p class="elsevierStylePara">With regard to CRP&#44; we should clarify that the distribution showed a wide range of values&#44; and as such&#44; it was converted using the Napierian logarithm&#46; In all cases&#44; a <span class="elsevierStyleItalic">P</span> value &#60;&#46;05 was considered to be statistically significant&#46; We did not estimate the sample size for this pilot study&#46; All analyses were carried out by comparing up to three months on PD against pre-TX&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">All patients resumed PD after kidney TX failure&#44; but 5 required 4 to 9 HD sessions after TX failure&#46; All patients underwent transplant nephrectomy&#46; Inflammation and nutrition data pre-TX and after the three post-TX phases studied are displayed in Table 1&#46; In the nutrition parameter progression&#44; we observed that there were no differences in any of the parameters&#44; except in the total lymphocyte count&#44; which decreased on resuming PD and remained at levels below pre-TX levels during the three months of post-TX follow-up&#46; nPNA measured pre-TX and three months after TX&#44; in conjunction with the peritoneal kinetic study&#44; did not change&#46;</p><p class="elsevierStylePara">Diuresis decreased after TX &#40;Table 2&#41;&#44; with a significant volume decrease on PD resumption and in the first month after TX &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;032&#41;&#44; with low diuresis being maintained even after three months&#44; which caused a non-significant reduction in creatinine clearance&#46; One of the patients was anuric at the time of TX and 2 lost diuresis after TX&#46; Proteinuria levels remained stable throughout progression&#46;</p><p class="elsevierStylePara">In the short period of time between the pre-TX peritoneal kinetic study &#40;45&#177;14 days&#41; and that which was carried out three months after resuming PD after kidney graft failure&#44; no differences were observed in the peritoneal membrane permeability or in dialysis efficacy &#40;Table 3&#41;&#46; The creatinine D&#47;P ratio did not change after the short space of time between TX and the return to PD&#44; with 57&#46;1&#37; high and medium-high transporters before TX and 62&#46;5&#37; after TX&#59; in only one patient before TX and another in the tests carried out after three months on PD did we observe a creatinine D&#47;P ratio of 0&#46;80&#46; Weekly urea Kt&#47;V or total weekly clearance of creatinine decreased&#44; but dialysis efficacy levels remained high&#46; Peritoneal protein loss increased after patients resumed PD&#44; but did not reach statistical significance&#46; Only UF decreased significantly&#44; from mean levels of 1407ml&#47;day in the phase before TX to 951ml&#47;day three months after PD was resumed &#40;<span class="elsevierStyleItalic">p</span>&#61;&#46;022&#41;&#44; and from 314ml&#47;4h to 260ml&#47;4h &#40;<span class="elsevierStyleItalic">p</span>&#61;&#46;018&#41; in the PET study&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The results of our study seem to indicate that patients who had been on PD before having a kidney TX for a short period and then suffered graft failure&#44; did not have major changes in their clinical situation or in membrane permeability behaviour or dialysis efficacy&#46; The small patient sample probably means that some trends observed could not reach statistical significance&#46; A decrease in total lymphocytes was observed&#44; which may be explained by immunosuppression induction with thymoglobulin&#44; with major T lymphocyte-depleting effects&#46;</p><p class="elsevierStylePara">It is definitely a short follow-up period&#44; but the purpose of the study was really to discover whether the trauma suffered by the patient in order to save KF of a graft at risk&#44; in some cases&#44; and to keep the patient in a stable clinical condition after the trauma of major surgery&#44; in others&#44; could cause clinical or laboratory changes in the patient that would influence their return to PD&#46;</p><p class="elsevierStylePara">Potential peritoneal membrane involvement in its permeability and efficacy does not seem unthinkable given the measures taken to save the postoperative situation&#44; with major antibiotic therapy in some cases and aggressive immunosuppression in others&#44; as well as systemic inflammation and malnutrition typical of prolonged hospitalisation etc&#46;</p><p class="elsevierStylePara">It is important to know the peritoneal membrane condition of patients who are resuming PD after TX failure&#44; because some authors have reported that the type of peritoneal permeability may influence patient and technique survival&#46;<span class="elsevierStyleSup">15</span> We found very few references in the literature with respect to the behaviour of peritoneal permeability in patients on PD after TX failure&#46; In some studies&#44; such as that by Duman et al&#46;&#44; there were no changes in membrane behaviour&#44;<span class="elsevierStyleSup">6</span> and they observed no differences in the PET between new PD patients and those who had had a TX&#46; Other authors observed an early increasing trend in the transportation of solutes in PD patients who had undergone kidney TX&#46;<span class="elsevierStyleSup">2</span> It has also been reported that a high percentage of patients who start PD after TX behave as high transporters&#46;<span class="elsevierStyleSup">16</span> Our results did not show changes in peritoneal permeability and there was only 1 patient before and one after TX who would be at the limit of what we consider to be high transporters&#46; Only UF reduction experienced by our patients seems to indicate a moderate decrease in dialysis efficacy&#46; Of interest is the reduction in diuresis&#44; with a major decrease being observed in the post-TX period studied&#44; which was maintained until three months after the return to PD&#46; Although time on HD after TX in some patients was short&#44; we cannot rule out its potential influence on diuresis reduction&#46; The reduction of KF in dialysis patients who had a non-functional TX was higher than in patients who did not receive a transplant&#46;<span class="elsevierStyleSup">17 </span>Recently&#44; the Peritoneal Dialysis Centre Group published results of PD patients who had received a TX&#44; in which&#44; despite considering it to be a good dialysis option after TX failure&#44; worse clinical progression was observed with a rapid decrease in KF&#46;<span class="elsevierStyleSup">18</span> None of the studies reviewed establish a design such as that which we introduced in our study&#44; in which we analysed the changes that can occur after early failure and which&#44; with the limitations mentioned&#44; offers a new approach&#46; Similar but more comprehensive studies with a greater number of patients should be carried out and they would probably require the collaboration of various hospitals with active TX units&#46;</p><p class="elsevierStylePara">In conclusion&#44; all our PD patients who had kidney TX failure resumed PD in a relatively short space of time&#44; without significant changes being observed in general laboratory parameters or in peritoneal permeability and dialysis efficacy&#44; which was maintained at adequate levels&#46; Although no major differences were observed&#44; except in the reduction of diuresis and UF between the pre-TX data and those observed when PD was resumed and in the trend found in different parameters in our study&#44; a collaborative study on a higher number of patients is necessary&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11732&#95;16025&#95;54597&#95;en&#95;t111732&#46;jpg" class="elsevierStyleCrossRefs"><img src="11732_16025_54597_en_t111732.jpg" alt="Progression of inflammation and nutrition parameters after kidney transplant failure and a return to peritoneal dialysis "></img></a></p><p class="elsevierStylePara">Table 1&#46; Progression of inflammation and nutrition parameters after kidney transplant failure and a return to peritoneal dialysis </p><p class="elsevierStylePara"><a href="grande&#47;11732&#95;16025&#95;54598&#95;en&#95;t211732&#46;jpg" class="elsevierStyleCrossRefs"><img src="11732_16025_54598_en_t211732.jpg" alt="Progression of kidney function parameters after kidney transplant failure and a return to peritoneal dialysis "></img></a></p><p class="elsevierStylePara">Table 2&#46; Progression of kidney function parameters after kidney transplant failure and a return to peritoneal dialysis </p><p class="elsevierStylePara"><a href="grande&#47;11732&#95;16025&#95;54599&#95;en&#95;t311732&#46;jpg" class="elsevierStyleCrossRefs"><img src="11732_16025_54599_en_t311732.jpg" alt="Progression of dialysis efficacy and peritoneal permeability after kidney transplant failure and a return to peritoneal dialysis "></img></a></p><p class="elsevierStylePara">Table 3&#46; Progression of dialysis efficacy and peritoneal permeability after kidney transplant failure and a return to peritoneal dialysis </p>"
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        "resumen" => "<p class="elsevierStylePara">La vuelta a di&#225;lisis tras fallo de trasplante renal &#40;TX&#41; es una situaci&#243;n cada vez m&#225;s frecuente&#46; En la vuelta a di&#225;lisis tras TX fallido suele darse una situaci&#243;n cl&#237;nica similar o peor a la de los pacientes nuevos en hemodi&#225;lisis o di&#225;lisis peritoneal &#40;DP&#41;&#46; Aunque existen bastantes estudios sobre la situaci&#243;n cl&#237;nica de los pacientes que vuelven a DP tras per&#237;odos largos con TX funcionante&#44; no hay apenas informaci&#243;n sobre la evoluci&#243;n de un subgrupo de pacientes que vuelven a DP tras fallo de TX a los pocos d&#237;as o semanas de su realizaci&#243;n&#46; <span class="elsevierStyleBold">Objetivo&#58;</span> Evaluar si un corto per&#237;odo de tiempo con TX sub&#243;ptimo y tratamientos&#47;medidas agresivas pueden influir en la permeabilidad de membrana&#44; la situaci&#243;n cl&#237;nica y la eficacia dial&#237;tica al volver a DP&#46; <span class="elsevierStyleBold">Pacientes y m&#233;todos</span>&#58; En 9 pacientes &#40;53&#44;5&#160;&#177;&#160;15&#44;4 a&#241;os&#44; 5 hombres&#44; 4 mujeres&#41; procedentes de DP con fallo precoz de TX y vuelta a DP &#40;25&#160;&#177;&#160;23 d&#237;as&#44; rango 10-64&#41; de los cinco &#250;ltimos a&#241;os&#44; se estudian datos anal&#237;ticos de inflamaci&#243;n&#44; nutrici&#243;n&#44; funci&#243;n renal&#44; permeabilidad y eficacia de DP&#44; en cuatro momentos de la evoluci&#243;n&#58; previo al TX&#44; inmediatamente a la vuelta a DP&#44; al primer mes y al tercer mes de DP&#46; <span class="elsevierStyleBold">Resultados&#58; </span>No se detectan diferencias significativas en la evoluci&#243;n de los par&#225;metros de nutrici&#243;n e inflamaci&#243;n&#46; <span class="elsevierStyleItalic">La diuresis desciende de forma significativa del volumen previo al trasplante al de la vuelta a DP y al primer mes en DP &#40;p&#160;&#61;&#160;0&#44;032&#41;&#44;</span> manteni&#233;ndose en niveles reducidos a los tres meses en DP&#46; La UF se reduce de <span class="elsevierStyleItalic">1407 a 951 ml&#47;d&#237;a &#40;p&#160;&#61;&#160;0&#44;022&#41; y de 314 a 260 ml&#47;4 h &#40;p&#160;&#61;&#160;0&#44;018&#41;</span> en el test de equilibrio peritoneal al tercer mes en DP&#44; sin cambios en el cociente dializado&#47;plasma de creatinina&#46; Kt&#47;V y aclaramiento semanal de creatinina descienden ligeramente&#44; manteni&#233;ndose en niveles adecuados de eficacia&#46; <span class="elsevierStyleBold">Conclusiones</span>&#58; En esta peque&#241;a muestra de pacientes que vuelven a DP tras fallo precoz de TX&#44; no parece que las medidas que comporta el manejo de un injerto en riesgo en un corto espacio de tiempo afecten <span class="elsevierStyleItalic">de forma importante</span> a par&#225;metros cl&#237;nicos y de permeabilidad o eficacia peritoneal&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara">The return to dialysis after kidney transplant &#40;TX&#41; failure is increasingly common&#46; On returning to dialysis after TX failure&#44; there is usually a similar or worse clinical situation than in patients who are on haemodialysis or peritoneal dialysis &#40;PD&#41; for the first time&#46; Although there are several studies on the clinical situation of patients who return to PD after long periods with a functioning TX&#44; there is hardly any information on the progression of a patient subgroup returning to PD after TX failure a few days or weeks after transplantation&#46; <span class="elsevierStyleBold">Objective&#58;</span> Assess whether a short period of time on suboptimal TX and aggressive treatment&#47;measures may influence membrane permeability&#44; the clinical situation and dialysis efficacy on returning to PD&#46; <span class="elsevierStyleBold">Patients and method&#58;</span> In 9 patients &#40;53&#46;5&#177;15&#46;4 years of age&#44; 5 males and 4 females&#41; who had previously been on PD before early TX failure and had returned to PD &#40;25&#177;23 days&#44; range 10-64&#41; over the last five years&#44; we studied laboratory data including inflammation&#44; nutrition&#44; kidney function&#44; permeability and PD efficacy&#44; at four points during progression&#58; before TX&#44; immediately after returning to PD and after one month and three months on PD&#46; <span class="elsevierStyleBold">Results&#58;</span> We did not detect significant differences in the progression of nutrition and inflammation parameters&#46; <span class="elsevierStyleItalic">Diuresis decreased significantly from pre-TX volume to diuresis on return to PD and after one month on PD &#40;p&#61;&#46;032&#41;</span>&#44; remaining at low levels after three months on PD&#46; UF decreased from <span class="elsevierStyleItalic">1407 to 951ml&#47;day &#40;p&#61;&#46;022&#41; and from 314 to 260ml&#47;4h &#40;p&#61;&#46;018&#41;</span> in the peritoneal equilibration test after three months on PD&#44; without changes being observed in the creatinine dialysate&#47;plasma ratio&#46; Kt&#47;V and weekly creatinine clearance decreased slightly and remained at adequate efficacy levels&#46; <span class="elsevierStyleBold">Conclusions&#58;</span> In this small sample of patients&#44; who returned to PD after early TX failure&#44; it does not appear that the measures involved in managing a graft at risk over a short period of time have a major effect on clinical parameters and permeability or peritoneal efficacy&#46;</p>"
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