Kidney Week

Abstract: FR-PO421

Dialysis after Graft Loss: Preliminary Findings of a Large Multinational Database

Session Information

• Hemodialysis Epidemiology and Outcomes
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Shivakumar, Oshini, Imperial College London Institute of Global Health Innovation, London, London, United Kingdom

Oshini Shivakumar, MA, MBBS

• Ye, Xiaoling, Renal Research Institute, New York, New York, United States

Xiaoling Ye, PhD, MPH

• Larkin, John W., Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States

John W. Larkin, PhD

• Kotanko, Peter, Renal Research Institute, New York, New York, United States

Peter Kotanko, MD, FASN

• Hippen, Benjamin E., Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States

Benjamin E. Hippen, MD, FASN

• Guinsburg, Adrian M., Fresenius Medical Care Argentina SA, Buenos Aires, Argentina

Adrian M. Guinsburg, MD

• Raimann, Jochen G., Renal Research Institute, New York, New York, United States

Jochen G. Raimann, MD, PhD, MPH

• Ashby, Damien, Imperial College Healthcare NHS Trust, London, United Kingdom

Damien Ashby, PhD

• Tam, Frederick W.K., Imperial College Healthcare NHS Trust, London, United Kingdom

Frederick W.K. Tam, MBBS, PhD, FASN

• Ashrafian, Hutan, Imperial College London Institute of Global Health Innovation, London, London, United Kingdom

Hutan Ashrafian, MD, PhD, MBA

Background

Dialysis after graft loss(DAGL) make a significant proportion of new dialysis starters; historically reported to have increased mortality compared to transplant-naive(T-N) starters(Figure1).
This study examines the mortality risk of DAGL compared to T-Ndialysis starters, to ascertain if the former warrant dedicated care.

Methods

A retrospective observational study.
All adult patients who started haemodialysis in Fresenius Medical Care from 1^stJanuary 2018 to 31^stMarch 2021 were identified in the Apollo DialDB dataset. DAGL identified using ICD10 codes ‘Kidney transplant failure’,‘Unspecified complication of kidney transplant’ and ‘Other complication of kidney transplant’.
The T-N control group had never received a kidney transplant and had not received immunosuppressants in the first six months of dialysis start.

Results

A total of 360,469 haemodialysis patients from 40countries included in the analysis. 10,010 patients on DAGL, and 350,459 in T-N control group. In univariate analysis, DAGL patients were significantly younger in all age categories and had a higher proportion of male sex. Serum creatinine, ferritin, phosphate and neutrophil-to-lymphocyte ratio were higher in the DAGL group. Haemoglobin was lower in the DAGL group(Table 1).
In the Cox proportional model adjusted for age, gender, and laboratory markers, patients with DAGL had an equivalent survival probability compared to T-N dialysis starters(HR:0.93,95%CI:0.86,1.02)(Table 2).

Conclusion

This preliminary analysis is in line with recent publications of a more equivalent survival in the two groups.
Our results are congruous with younger patients receiving kidney transplant early in their renal replacement therapy journey. We posit that DAGL patients may start dialysis at a lower level of renal function, and higher levels of inflammation. We aim to adjust for confounding factors, to present further refined mortality risk comparison by Autumn2024.