Timing of Return to Dialysis in Patients with Failing Kidney Transplants

Miklos Z. Molnar, Hirohito Ichii, James Lineen, Clarence E. Foster, Zoltan Mathe, Jeffrey Schiff, S. Joseph Kim, Madeleine V. Pahl, Alpesh N. Amin, Kamyar Kalantar-Zadeh, Csaba Kovesdy

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

In the last decade, the number of patients starting dialysis after a failed kidney transplant has increased substantially. These patients appear to be different from their transplant-naïve counterparts, and so may be the timing of dialysis therapy initiation. An increasing number of studies suggest that in transplant-naïve patients, later dialysis initiation is associated with better outcomes. Very few data are available on timing of dialysis reinitiation in failed transplant recipients, and they suggest that an earlier return to dialysis therapy tended to be associated with worse survival, especially among healthier and younger patients and women. Failed transplant patients may also have unique issues such as continuation of immunosuppression versus withdrawal or the need for remnant allograft nephrectomy with regard to dialysis reinitiation. These patients may have a different predialysis preparation work-up, worse blood pressure control, higher or lower serum phosphorus levels, lower serum bicarbonate concentration, and worse anemia management. The choice of dialysis modality may also represent an important question for these patients, even though there appears to be no difference in mortality between patients starting peritoneal versus hemodialysis. Finally, failed transplant patients returning to dialysis appear to have a higher mortality rate compared with transplant-naïve incident dialysis patients, especially in the first several months of dialysis therapy. In this review, we will summarize the available data related to the timing of dialysis initiation and outcomes in failed kidney transplant patients after returning to dialysis.

Original languageEnglish (US)
Pages (from-to)667-674
Number of pages8
JournalSeminars in Dialysis
Volume26
Issue number6
DOIs
StatePublished - Dec 1 2013

Fingerprint

Dialysis
Transplants
Kidney
Mortality
Bicarbonates
Nephrectomy
Serum
Immunosuppression
Phosphorus
Allografts
Renal Dialysis
Anemia
Therapeutics
Hypertension
Survival

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Molnar, M. Z., Ichii, H., Lineen, J., Foster, C. E., Mathe, Z., Schiff, J., ... Kovesdy, C. (2013). Timing of Return to Dialysis in Patients with Failing Kidney Transplants. Seminars in Dialysis, 26(6), 667-674. https://doi.org/10.1111/sdi.12129

Timing of Return to Dialysis in Patients with Failing Kidney Transplants. / Molnar, Miklos Z.; Ichii, Hirohito; Lineen, James; Foster, Clarence E.; Mathe, Zoltan; Schiff, Jeffrey; Kim, S. Joseph; Pahl, Madeleine V.; Amin, Alpesh N.; Kalantar-Zadeh, Kamyar; Kovesdy, Csaba.

In: Seminars in Dialysis, Vol. 26, No. 6, 01.12.2013, p. 667-674.

Research output: Contribution to journalArticle

Molnar, MZ, Ichii, H, Lineen, J, Foster, CE, Mathe, Z, Schiff, J, Kim, SJ, Pahl, MV, Amin, AN, Kalantar-Zadeh, K & Kovesdy, C 2013, 'Timing of Return to Dialysis in Patients with Failing Kidney Transplants', Seminars in Dialysis, vol. 26, no. 6, pp. 667-674. https://doi.org/10.1111/sdi.12129
Molnar MZ, Ichii H, Lineen J, Foster CE, Mathe Z, Schiff J et al. Timing of Return to Dialysis in Patients with Failing Kidney Transplants. Seminars in Dialysis. 2013 Dec 1;26(6):667-674. https://doi.org/10.1111/sdi.12129
Molnar, Miklos Z. ; Ichii, Hirohito ; Lineen, James ; Foster, Clarence E. ; Mathe, Zoltan ; Schiff, Jeffrey ; Kim, S. Joseph ; Pahl, Madeleine V. ; Amin, Alpesh N. ; Kalantar-Zadeh, Kamyar ; Kovesdy, Csaba. / Timing of Return to Dialysis in Patients with Failing Kidney Transplants. In: Seminars in Dialysis. 2013 ; Vol. 26, No. 6. pp. 667-674.
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