Abstract: SA-PO951
CKD Management and Hemodialysis Planning in Stage 5 Transplant vs. Native CKD Patients
Session Information
- Transplantation: Clinical - 3
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Macau, Ricardo A., Unidade Local de Saude Santa Maria, Lisboa, Portugal
- Ferreira, Afonso Valério, Centro Academico de Medicina de Lisboa, Lisboa, Lisboa, Portugal
- Gameiro, Joana, Unidade Local de Saude Santa Maria, Lisboa, Portugal
- Marques, Filipe, Unidade Local de Saude Santa Maria, Lisboa, Portugal
- Abreu, Fernando, Unidade Local de Saude Santa Maria, Lisboa, Portugal
- Santana, Alice, Unidade Local de Saude Santa Maria, Lisboa, Portugal
- Lopes, Jose António, Centro Academico de Medicina de Lisboa, Lisboa, Portugal
Background
CKD management and renal replacement therapy (RRT) planning is challenging, especially in patients with graft failure and transitioning to dialysis (dialysis after graft loss), whose complications may not be properly managed, comparing to native CKD patients initiating dialysis.
Methods
We compared patients with native CKD (NKD) and those with graft loss (Tx) initiating hemodialysis (HD) at a Portuguese University Hospital between 2021 and 2023 at a ratio of 3:1. We considered: Age, sex, transplant or native kidney failure, cause of CKD, comorbidities, laboratory at HD start (T0) and three months prior (T3), type of vascular access at HD start and planned start of RRT. We considered as outcomes: type of HD start [outpatient / elective (vs hospitalisation / urgent) and Catheter as vascular access] as well as the patients’ status regarding therapeutic levels of haemoglobin and bicarbonate.
Results
The study comprised 112 participants, including 78 (69.6%) NKD and 34 (30.4%) Tx recipients. Participants ranged from 25 to 90 years, (average 65.8 years). Among them, 66 (58.9%) were male. NKD patients demonstrated a higher prevalence of planned RRT initiation (88.5% vs. 47.1%, p < 0.001) and elective RRT start (91.0% vs. 32.4%, p < 0.001). They were notably younger at RRT initiation than Tx patients (52.1 years vs. 70.2 years, p < 0.001). At RRT start, significant differences were observed in bicarbonate levels (21.39 mmol/L in NKD vs. 19.26 mmol/L in Tx, p = 0.011) and patients achieving haemoglobin targets (65.4% in NKD vs. 41.2% in Tx, p = 0.017). At T3, consistent trends were observed, with differences in bicarbonate and haemoglobin targets.
Conclusion
This retrospective analysis may reveal disparities in CKD management between transplant and native kidney disease patients, notably at the initiation of dialysis. Transplant recipients seem to exhibit a less programmed start, often requiring emergent interventions, while native CKD patients demonstrate better anaemia and metabolic acidosis control. These findings emphasize the impact of transplantation status on CKD management trajectories and highlight the need for further research to understand these differences comprehensively and develop tailored interventions.