Opportunities to improve the care of patients with kidney transplant failure

• Published in: Kidney international Vol. 61; no. 6; pp. 2193 - 2200
• Main Authors: Gill, John S., Abichandani, Rekha, Khan, Samina, Kausz, Annamaria T., Pereira, Brian J.G.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2002; Nature Publishing; Elsevier Limited
• Subjects: Adult; anemia; Biological and medical sciences; chronic kidney disease; erythropoietin; Erythropoietin - therapeutic use; Female; Glomerular Filtration Rate; Hematocrit; Humans; hypoalbuminemia; kidney transplant; Kidney Transplantation; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Quality of Health Care; Renal Dialysis; Renal failure; Retreatment; Serum Albumin - analysis; Treatment Failure; kidney transplant; chronic kidney disease; glomerular filtration rate; hypoalbuminemia; anemia; erythropoietin; Kidney disease; Human; Postoperative; Urinary system disease; Hemodialysis; Transplantation; Homotransplantation; Kidney; Quality of life; Extrarenal dialysis; Treatment; Surgery; Renal failure; Complication
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1046/j.1523-1755.2002.00373.x

Opportunities to improve the care of patients with kidney transplant failure. Patients initiating dialysis after a failed kidney transplant are a subgroup of chronic kidney disease (CKD) patients who have not been characterized. Exposure to immunosuppressive medications differentiates these patients from the general incident end-stage renal disease (ESRD) population. Data from the Health Care Financing Administration 2728 form were used to determine the hematocrit, erythropoietin use, serum albumin and glomerular filtration rate (GFR) among 4643 patients with failed kidney transplants who initiated dialysis between April 1995 and December 1998. At dialysis initiation, the mean hematocrit, serum albumin and GFR were 27.5%, 3.3 g/dL, and 8.4 mL/min/1.73m2, respectively, and only 35% of patients had received erythropoietin. In a multivariate analysis, patients <45 years, females, patients of non-White race, non-diabetic patients, hemodialysis patients and patients with a lower serum albumin had a higher odds for hematocrit <30%. Erythropoietin use was associated with female gender, White race, increased time since transplantation, being employed, peritoneal dialysis, and higher serum albumin. Patients ≥45 years and patients with diabetes or congestive heart failure had higher odds for hypoalbuminemia, while employed patients, peritoneal dialysis patients, patients with higher hematocrit and patients who had received erythropoietin had lower odds of hypoalbuminemia. Despite being known to specialty physicians, patients with failed kidney transplants initiate dialysis at levels of hematocrit, serum albumin, and GFR that may be suboptimal and similar to those in the general incident ESRD population. Socioeconomic factors remain important barriers to the provision of CKD care even among these patients with established specialty physician contact. Improved CKD care could improve the outcomes of this unique subgroup of CKD patients.