IMPACT OF ADVANCED KIDNEY DISEASE ON TRANSPLANTED PATIENTS AND THEIR RETURN TO DIALYSIS

Cubero, Juan José; Fernández Fresnedo, Gema; Luna, Enrique; Hernández-Gallego, Román; Arias, Manuel

doi:10.3265/Nefrologia.2009.29.S.1.5631.en.full

Article information

Abstract

Bibliography

Aunque los resultados del trasplante han mejorado, la pérdida de injerto por nefropatía crónica representa un problema importante. Esta situación hace que el número de pacientes que son readmitidos de nuevo a programas de diálisis vaya aumentando progresivamente. La mortalidad de los pacientes que vuelven a diálisis es variable, pero en general más alta que la de aquellos pacientes que empiezan diálisis por primera vez. Además, el manejo de la enfermedad renal crónica de estos pacientes difiere de la de los sujetos no trasplantados, no alcanzándose en los estadios 4-5 los targets objetivos de población no trasplantada. Los estudios que analizan este aspecto de la vuelta a diálisis del paciente trasplantado son limitados. A pesar de la relevancia de este tipo de pacientes, tanto por su progresivo incremento en número como por ser una etapa de elevada mortalidad, las guías europeas y americanas no mencionan datos relevantes sobre el cuidado de este tipo de pacientes que han perdido el injerto. Teniendo en cuenta este estado de cosas, en este grupo de trabajo de la S.E.N. se decidió abordar los puntos más debatidos en el manejo de estos pacientes.

Although long-term outcomes also improved, graft loss caused by chronic allograft nephropathy remains an important obstacle. This situation, together with the progressive increase in the number of renal transplant patients, means that the population of transplant patients readmitted to a dialysis program will be progressively greater. The mortality rate in patients starting dialysis after graft loss has been reported as variable, though higher than that observed in patients with a functioning graft and that observed in patients on dialysis treatment. However, it is not known how the management of chronic kidney disease patients in the transplant setting differs from that of patients with native kidney disease with a similar degree of renal dysfunction. Many patients in stages 4T–5T have chronic kidney disease related complications that fall below targets established for nontransplant chronic kidney disease patients. A limited number of studies have evaluated patients returning to dialysis after graft failure and the different guidelines in the setting of transplantation have not analyzed this crucial aspect so important. Parting from this premise, a working group of the Spanish Society of Nephrology in the field of kidney transplantation and dialysis has reviewed in-depth each of the clinical aspects of care of patients with kidney transplant failure coming back to dialysis and drawn up a consensus document in order to optimize the management of this condition.

Bibliography

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[2]

Suthanthiran, M, Strom TB. Renal Transplantation. N Engl J Med 1994;331(6):365-76. [Pubmed]

[3]

Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of the first cadaveric transplant. N Engl J Med 1999;341:1725-30. [Pubmed]

[4]

Laupacis A, Keown P, Pus N, Krueger H, Ferguson B, Wong C, et al. A study of the quality of life a cost-utility or renal transplantation. Kidney Int 1996;50:235-42. [Pubmed]

[5]

Cecka JM. The OPTN/UNOS renal transplant registry. En: Cecka JM, Terasaki PI, editors. Clinical transplants. Los Angeles (Calif): UCLA tissue typing laboratory; 2005;1-16.

[6]

Collaborative Transplant Study. www.cts.org.

[7]

Amend WCJ, Vincenti F, Tomlanovich SJ. The first three postransplant months. En: Danovitch, editor. Handbook of kidney transplantation. 4.ª ed. Philadelphia: Lippincott Williams and Wilkins; 2005;212-23.

[8]

Prommool S, Jhangri GS, Cockfield SM, Halloran PF. Time dependency of factors affecting renal allograf survival. J Am Soc Nephrol 2000;11:565-73. [Pubmed]

[9]

Canadian Institute for Health Information: Annual report 1996. Organ donation and transplantation. Volumen 2. Otawa, Ontario, Canadian Organ Replacement Register; 1996.

[10]

National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. Am J Kidney Dis 2002;39(1):S1-266. [Pubmed]

[11]

Abbud-Filho M, Adams PL, Alberú J, Cardella C, Chapman J, Cochat P, et al. A report of the Lisbon conference on the care of the kidney transplant recipient. Transplantation 2007;83:S1-22. [Pubmed]

[12]

Ansell D, Udayaraj UP, Steenkamp R, Dudley CR. Chronic renal failure in kidney transplant recipients. Do they receive optimum care? data from the UK renal registry. Am J Transplant 2007;7(5):1167-76. [Pubmed]

[13]

12.Marcén, R, Teruel, JL. Patient outcomes after kidney allograft loss. Transplantation Reviews 2008;62-72.

[14]

Cattran DC, Fenton SSA. Contemporary management of renal failure: Outcome of the failed allograft recipient. Kidney Int 1993;43(41):S36-S39.

[15]

Kaplan B, Meier-Kriesche H-U. Death after graft loss: an important late study endpoint in kidney transplantation. Am J Transplant 2002;2:970-4. [Pubmed]

[16]

Knoll G, Muirhead N, Trpeski L, Badovinac K. Patient survival following or transplant failure in Canada. Am J Transplant 2002;13:2560-9.

[17]

Gill JS, Abichandani R, Kausz AT, Pererira, BJG. Mortality after kidney transplant failure: the impact of non immunologic factors. Kidney Int 2002;62:1875-83. [Pubmed]

[18]

López-Gómez JM, Pérez-Flores I, Jofré R, Carretero D, Rodríguez-Benítez P, Villaverde M, et al. Presence of a failed kidney transplant in patients who are on haemodialysis is associated with chronic inflammatory state and erytropoietin resistance. J Am Soc Nephrol 2004;15:2494-501. [Pubmed]

[19]

Djamali A, Kendziorski C, Brazy PC, Becker BN. Disease progression and outcomes in chronic kidney disease and renal transplantation. Kidney Int 2003;64(5):1800-7. [Pubmed]

[20]

Arias M, Escallada R, de Francisco AL, Rodrigo E, Fernández- Fresnedo G, Setién MA, et al. Return to dialysis after renal transplantation. Which would be the best way? Kidney Int Suppl 2002;80:85-8.

[21]

Fernández Fresnedo G, Ruiz JC, Gómez Alamillo C, de Francisco ALM, Arias M. Survival after dialysis initiation: a comparison of transplant patients after graft loss versus non transplant patients. Transplant Proc 2008;40(9):2889-90. [Pubmed]

[22]

Kasiske BL, Vázquez MA, Harmon ME, et al. Recommendations for outpatients surveillance of renal transplant recipients. J Am Soc Nephrol 2000;11:S1-86. [Pubmed]

[23]

The EBPG expert group on renal transplantation. European best practice guidelines for renal transplantation (Part 1). 2000;15(7):1-85.

[24]

The EBPG expert group on renal transplantation. European best practice guidelines for renal transplantation (Part 2); 2002;17(4):1-67. [Pubmed]

[25]

Karthikeyan V, Karpinski J, Nair RC, Knoll G. The burden of chronic kidney disease in renal transplant recipients. Am J Transplant 2004;4(2):262-9. [Pubmed]

[26]

25.Marcén R, Pascual J, Tenorio M, Ocaña EJ, Teruel JL, Villafruela JJ, et al. Chronic kidney disease in renal transplant recipients. Transplant Proc 2005;37(9):3718-20. [Pubmed]

[27]

Fernández-Fresnedo G, de Francisco A, Ruiz JC, Cotorruelo JG, Alamillo CG, Valero R, et al. Relevance of chronic kidney disease classification (K/DOQI) in renal transplant patients. Transplant Proc 2006;38(8):2402-3. [Pubmed]

[28]

27.Marcén R, Castillo D, Capdevila L, Fernández-Fresnedo G, Rodrigo E, Cantarell C, et al. Achieving chronic kidney disease treatment targets in renal transplant recipients: results from a cross-sectional study in Spain. Transplantation 2009;87(9):1340-6. [Pubmed]

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