Improvement in the care of patients with kidney transplant failure: recommendations of the Spanish Society of Nephrology.

Although long-term outcomes have 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 variable mortality rates among patients starting dialysis after graft loss are consistently higher than those observed among patients with functioning grafts or on dialysis treatment. However, the manner in which the management of chronic kidney disease patients in the transplant setting differs from that of patients with native kidney disease who display a similar degree of renal dysfunction is not known. Many patients in stages 4T-5T have chronic kidney disease-related complications that fall below the targets established for nontransplant chronic kidney disease subjects. A limited number of studies have evaluated patients returning to dialysis after graft failure. The distinct guidelines in the setting of transplantation have not analyzed this important aspect. From this premise, a working group of the Spanish Society of Nephrology specializing in the field of kidney transplantation and dialysis reviewed each clinical aspect of care of kidney transplant patients with renal failure returning to dialysis, yielding this consensus document to optimize management.