Mortality High in UK Patients With Transplant Kidney Failure

TOPLINE: 

Patients with transplant kidney failure who started dialysis had higher estimated glomerular filtration rates (eGFRs) at initiation, were nearly twice as likely to receive in-centre haemodialysis (ICHD), and had almost twice the risk for 90-day mortality compared with those with native chronic kidney disease (CKD).

METHODOLOGY:

• Researchers conducted a cohort study using linked data from the UK Renal Registry and Hospital Episode Statistics to examine dialysis modality, the place of dialysis initiation, and 90-day mortality outcomes among patients starting dialysis due to either transplant kidney failure or failure of their own kidneys.
• They included 16,417 adults (median age, 65.2 years; 36.1% women) who initiated dialysis between January 2018 and December 2019, of whom 14,880 had no prior transplant and 1537 had transplant failure.
• Among the included patients, 5359 initiated dialysis at 14 centres with reliable CKD data submission, allowing for a comparison between those with transplant failure and those with native CKD known to nephrology services. In this cohort, 2999 had native CKD before dialysis initiation, whereas 518 started dialysis after transplant failure.

TAKEAWAY:

• Compared with patients with native CKD, those with transplant failure started dialysis at higher eGFRs (7.9 vs 8.9 mL/min/1.73 m²) and had higher odds of starting dialysis as inpatients (adjusted odds ratio [aOR], 2.26; 95% CI, 1.84-2.76).
• Patients with transplant failure also had increased odds of receiving ICHD vs home therapy at dialysis initiation (aOR, 3.04; 95% CI, 2.30-4.01) and at day 90 (aOR, 2.09; 95% CI, 1.65-2.65).
• At 90 days after the initiation of dialysis, patients with transplant failure had about a twofold higher risk for mortality than those with native CKD (aOR, 1.95; 95% CI, 1.31-2.90).

IN PRACTICE:

“Our findings highlight disproportionately higher mortality; lower access to planned, home-based dialysis initiation; and initiation at higher eGFRs for those under specialist care with transplant failure compared to individuals with native CKD,” the authors wrote.

SOURCE:

This study was led by Matthew Beresford, Bristol Medical School, Bristol, England. It was published online on May 22, 2025, in Clinical Kidney Journal.

LIMITATIONS: 

This study did not include individuals who underwent pre-emptive transplantation or re-transplantation or those who opted for conservative management, which could have affected comparisons between groups. The restricted cohort was formed from a convenience sample of centres, potentially limiting the generalizability of the findings. Additionally, limited data prevented differentiation between patients who withdrew from dialysis without recovery and those who regained kidney function at 90 days.

DISCLOSURES:

One author reported receiving support from Southmead Hospital Charity, and three authors reported being employees of the UK Renal Registry.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.