Journal Article

Reduced survival and quality of life following return to dialysis after transplant failure: the Dialysis Outcomes and Practice Patterns Study

Jeffrey Perl, Jinyao Zhang, Brenda Gillespie, Bjorn Wikström, Joan Fort, Takeshi Hasegawa, Douglas S. Fuller, Ronald L. Pisoni, Bruce M. Robinson and Francesca Tentori

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 27, issue 12, pages 4464-4472
Published in print December 2012 | ISSN: 0931-0509
Published online September 2012 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfs386
Reduced survival and quality of life following return to dialysis after transplant failure: the Dialysis Outcomes and Practice Patterns Study

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Background

Although dialysis after kidney transplant failure (TF) is common, the outcomes of these patients remain unclear. We compared outcomes of TF patients with transplant-naïve (TN) patients wait-listed for kidney transplantation.

Methods

We used data from the Dialysis Outcomes and Practice Patterns Study (DOPPS), including laboratory markers and health-related quality of life (HR-QOL). Mortality and hospitalization of participants with one prior TF versus TN patients were compared using the Cox regression analysis. HR-QOL physical and mental component summary scores (PCS and MCS) were examined using linear mixed models, and clinical practices were compared using logistic regression.

Results

Compared with TN patients (n = 2806), TF patients (n = 1856) were younger (48 versus 51 years, P = 0.003), less likely to be diabetic (18 versus 27%, P < 0.0001) and to use a permanent surgical vascular access {adjusted odds ratio (AOR): 0.85 [95% confidence interval (CI): 0.70–1.03], P = 0.10}, particularly within the first 3 months after TF [AOR 0.45 (0.32–0.62), P < 0.0001]. TF patients also had lower PCS [mean difference −2.56 (−3.36, −1.75), P < 0.0001] but not MCS [−0.42 (−1.34, 0.50), P = 0.37]. All-cause mortality [adjusted hazard ratio (AHR): 1.32 (95% CI: 1.05–1.66), P = 0.02], especially infection-related [AHR 2.45 (95% CI: 1.36–4.41), P = 0.01], was higher among TF patients.

Conclusions

TF patients have reduced QOL and higher mortality, particularly due to infections, than TN patients. Interventions to optimize care before and after starting dialysis remain to be identified and applied in clinical practice.

Keywords: health-related quality of life; hemodialysis; kidney allograft loss; kidney transplantation; survival

Journal Article.  4826 words.  Illustrated.

Subjects: Nephrology

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