Nephrology, Dialysis and Transplantation Department, Gabriel Montpied University Hospital, 54 rue Montalembert, BP69, 63003, Clermont-Ferrand Cedex 1, France.
Dialysis Center, Association pour l'Utilisation du Rein artificiel (AURA) Auvergne, Clermont-Ferrand, France.
J Nephrol. 2018 Feb;31(1):147-155. doi: 10.1007/s40620-017-0449-z. Epub 2017 Oct 24.
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.
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.
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.
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.
慢性肾脏病（CKD）并发症的管理在移植肾失功的患者中并不总是充分的。我们旨在评估 CKD 并发症的发生频率，并评估它们是否会导致该患者人群的预后更差。
我们分析了 2000 年至 2010 年间在法国五个透析中心开始透析的 49 例移植肾失功（T+）患者和匹配的未移植（T-）患者。记录了透析开始时、住院和死亡时的 CKD 并发症，并对两组患者进行了比较。
在透析开始时，T+患者更有可能出现碳酸氢盐<22mmol/L（77.6%比 22.0%，p<0.01）、磷酸盐>1.5mmol/L（77.6%比 59.2%，p=0.03）、动脉血压>130/80mmHg（75.5%比 93.9%，p=0.01）、体重指数<23（59.2%比 32.7%，p=0.01）和白蛋白<38g/L（69.4%比 36.7%）。T+患者在透析开始后 1 年内住院更频繁（40.8±7.0比 16.3±5.3%，对数秩检验 p=0.01），5 年生存率也低于 T-患者（82.1±6.2比 64.0±7.4%，对数秩检验 p=0.02）。然而，在校正 CKD 并发症后，住院和死亡风险较低。
尽管由肾病医生进行了定期随访，但 T+患者在开始透析前发生 CKD 并发症的频率高于 T-患者。更好地管理 T+患者的 CKD 并发症可能会改善透析开始后的预后。
