Abstract: SA-PO314
Survival After Transplant Allograft Failure (TAF) and Return to Dialysis in Latin America
Session Information
- Hemodialysis and Frequent Dialysis: Potpourri
November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Guinsburg, Adrian M., Fresenius Medical Care Global Medical Office, Waltham, Massachusetts, United States
- Diaz Bessone, Maria Ines, Fresenius Medical Care Global Medical Office, Waltham, Massachusetts, United States
- Berbessi, Juan Carlos, Fresenius Medical Care Global Medical Office, Waltham, Massachusetts, United States
- Hippen, Benjamin E., Fresenius Medical Care Global Medical Office, Waltham, Massachusetts, United States
Background
Dialysis initiation with a permanent access and in-target clinical parameters for patients (pts) returning to dialysis after TAF are less frequently achieved than in incident dialysis population, even though transplanted pts usually enjoy specialist care. We aimed to compare rates of hospitalization (hosp) and survival between pts incident to dialysis after TAF or native kidney failure (NKF) in Fresenius Medical Care clinics in Latin America
Methods
We selected all incident dialysis pts between Jan 2017 and Dec 2021. Pts were classified as TAF or NKF according to ESRD cause reported. Baseline parameters were collected within first 30 days after dialysis initiation and Hosp were observed during 6 months. Pts were tracked until death, lost-to-follow-up, or end of study. Three models were fitted: Model 1 (KM): univariate, Model 2 (Cox): case-mix adjusted (age, gender, diabetes) and Model 3 (Cox): fully adjusted (model 2 + vascular access + baseline labs)
Results
34,630 incident pts to dialysis were selected: 630 (1.8%) TAF and 34,000 (98.2%) NKF. Hosp (6 months) showed no significant difference in model 1. However, TAF showed Hosp HR 1.35, p<0.005 and HR 1.45, p<0.005 in model 2 and 3 respectively. Mortality risk was lower for TAF in model 1 (fig 1A, left), invert to TAF HR 1.23, p 0.03 in model 2, and no difference was found in model 3 (fig 1B, right)
Conclusion
In the first 6 months after dialysis initiation, risk of hosp for pts with ESRD after TAF was not significantly different from ESRD after NKF in univariate analysis, but after full multivariate adjustment, HR for hosp for TAF increased to 1.45. TAF pts showed higher survival in univariate analysis, with no significant mortality differences after full multivariate adjustment. Observed survival differences may be ameliorated by attention to CVC prevalence, Ca, P, Hb, and albumin for pts with ESRD after TAF
Fig1A: Mortality risk for patients with ESRD after TAF and NKF, univariate analysis. Fig2A: Hazard ratio for death in patients with ESRD after TAF, full multivariate adjustment