CKD complications in kidney-transplanted patients going back to dialysis: impact on patients outcomes

Aims The management of chronic kidney disease (CKD) complications is not always adequate in patients with a failed kidney transplant. We aimed to evaluate the frequency of CKD complications and assess whether they may lead to worse outcomes in this patient population. Method We analyzed 49 kidney transplant recipients with a failed transplant (T+) and matched non-transplanted patients (T-) starting dialysis between 2000 and 2010 in five dialysis centers in France. CKD complications at dialysis initiation, hospitalizations and death were recorded and compared between the two groups. Results At dialysis initiation, T+ patients were more likely to have bicarbonate < 22 mmol/l (77.6 vs. 22.0%, p < 0.01), phosphate > 1.5 mmol/l (77.6 vs. 59.2%, p = 0.03), arterial blood pressure > 130/80 mmHg (75.5 vs. 93.9%, p = 0.01), body mass index < 23 (59.2 vs. 32.7%, p = 0.01) and albumin < 38 g/l (69.4 vs. 36.7%) than T-patients. T+ patients were hospitalized more frequently in the year following dialysis initiation (40.8 +/- 7.0 vs. 16.3 +/- 5.3%, log rank p = 0.01) and 5-year survival rate was lower than in T-patients (82.1 +/- 6.2 vs. 64.0 +/- 7.4%, log rank p = 0.02). However risk of hospitalization and mortality was lesser after adjustments for CKD complications. Conclusion Despite regular follow-up by nephrologists, CKD complications before initiation of dialysis are more frequent in T+ patients than in T-patients. A better management of CKD complications in T+ patients could improve outcomes after dialysis initiation.