Fernandez Fresnedo G
Nephrology Service, University Hospital Marqués de Valdecilla, Santander, Spain.
Transplant Proc. 2009 Jul-Aug;41(6):2092-4. doi: 10.1016/j.transproceed.2009.06.135.
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.
尽管长期预后有所改善，但慢性移植肾肾病导致的移植肾丢失仍然是一个重要障碍。这种情况，再加上肾移植患者数量的不断增加，意味着重新进入透析项目的移植患者数量将逐渐增多。移植肾丢失后开始透析的患者中，其死亡率一直高于移植肾功能正常或接受透析治疗的患者。然而，移植环境中慢性肾脏病患者的管理方式与肾功能障碍程度相似的原发性肾脏病患者的管理方式有何不同尚不清楚。许多4T-5T期患者患有与慢性肾脏病相关的并发症，这些并发症低于为非移植慢性肾脏病患者设定的目标。少数研究评估了移植失败后重新接受透析的患者。移植领域的不同指南尚未分析这一重要方面。基于这一前提，西班牙肾脏病学会专门从事肾移植和透析领域的一个工作组审查了肾移植肾衰竭患者重新接受透析的护理的各个临床方面，形成了这份共识文件以优化管理。
