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Abstract: SA-PO1043

Survival in Patients Who Return to Dialysis with Kidney Allograft Failure: The Argentinian Dialysis Registry Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Laham, Gustavo, Centro de Educación Medica e Investigaciones Clínicas(CEMIC), Buenos Aires, Argentina
  • Giordani, Maria Cora, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
  • Bisigniano, Liliana, INCUCAI, CABA, Argentina
  • Tagliafichi, Viviana, INCUCAI, CABA, Argentina
  • Rosa diez, Guillermo Javier, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Background

The number of patients (Pts) who return to dialysis (Dx) after Kidney allograft failure (KAF) is increasing. The outcome of these Pts remain unclear. Some studies showed lower survival rates in KAF Pts than transplant naïve incidents dialysis (TNID) Pts. Our aim was to compare outcome of KAF versus Pts on waiting list (WL) and those with a kidney transplant contraindication (KTC)

Methods

We performed a retrospective observational study using data from the Argentinian Dialysis Registry between 2005 and 2016. We recorded demographics, laboratory markers and vascular access at entry. To compare mortality between the 3 groups Kaplan Meier, log rank test and Cox regression were used

Results

This study included 75722 Pts of which 2734 (3.6 %) were KAF Pts. The TNID (n=72988) Pts were significantly older, included higher percentages of males, diabetic and hypertensive when compared with Pts who started Dx after KAF. Regarding Dx modality, 5.8 % of Pts initiated PD in KAF group vs 3.9 % in TNID group (p<0.0001). There was a high percentage of Pts starting HD with transient catheters, being 66.1% and 65.5 % in KAF and TNID group respectively. Overall mortality was 54.6 % during follow up. Death probability between the 3 cohorts (KAF(n=2734) vs WL (n=14630) vs KTC(n=58358) revealed a significant difference (log-rank test: 10734.5; P< 0.0001) indicating worse survival for KTC incident Dx Pts cohort and best survival for WL. We also performed a survival curve adjusting for covariates that were statistically significant for mortality in Cox multivariate analysis. We found that KAF Pts had as poor outcome as KTC Pts. Multivariate Cox analysis showed that age >65 years: HR: 1.845 (1.79-1.89) P < 0.0001, transient catheter: HR: 1.303 (1.26-1.34) P < 0.0001, male sex: HR: 1.043 (1.01-1.07) P < 0.0002, diabetic: HR: 1.273 (1.22-1.31) P < 0.0001, hemodialysis modality: HR: 1.168 (1.07-1.27) P < 0.0004, hepatitis C: HR: 1.303 (1.26-1.34) P < 0.0001 and Albumin: HR: 1.247 (1.21-1.28) P < 0.0001 were strongly associated with mortality, while being on waiting list: HR: 0.285 (0.23-0.35) P < 0.0001 was found to be protective

Conclusion

Patients who return to Dx after KAF have higher mortality than WL patients and similar to KTC patients