Document Detail

Opportunities to improve the care of patients with kidney transplant failure.
MedLine Citation:
PMID:  12028460     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Patients initiating dialysis after a failed kidney transplant are a subgroup of chronic kidney disease (CKD) patients who have not been characterized. Exposure to immunosuppressive medications differentiates these patients from the general incident end-stage renal disease (ESRD) population. METHODS: Data from the Health Care Financing Administration 2728 form were used to determine the hematocrit, erythropoietin use, serum albumin and glomerular filtration rate (GFR) among 4643 patients with failed kidney transplants who initiated dialysis between April 1995 and December 1998. RESULTS: At dialysis initiation, the mean hematocrit, serum albumin and GFR were 27.5%, 3.3 g/dL, and 8.4 mL/min/1.73 m2, respectively, and only 35% of patients had received erythropoietin. In a multivariate analysis, patients <45 years, females, patients of non-White race, non-diabetic patients, hemodialysis patients and patients with a lower serum albumin had a higher odds for hematocrit <30%. Erythropoietin use was associated with female gender, White race, increased time since transplantation, being employed, peritoneal dialysis, and higher serum albumin. Patients >/=45 years and patients with diabetes or congestive heart failure had higher odds for hypoalbuminemia, while employed patients, peritoneal dialysis patients, patients with higher hematocrit and patients who had received erythropoietin had lower odds of hypoalbuminemia. CONCLUSIONS: Despite being known to specialty physicians, patients with failed kidney transplants initiate dialysis at levels of hematocrit, serum albumin, and GFR that may be suboptimal and similar to those in the general incident ESRD population. Socioeconomic factors remain important barriers to the provision of CKD care even among these patients with established specialty physician contact. Improved CKD care could improve the outcomes of this unique subgroup of CKD patients.
John S Gill; Rekha Abichandani; Samina Khan; Annamaria T Kausz; Brian J G Pereira
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Kidney international     Volume:  61     ISSN:  0085-2538     ISO Abbreviation:  Kidney Int.     Publication Date:  2002 Jun 
Date Detail:
Created Date:  2002-05-24     Completed Date:  2002-10-21     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0323470     Medline TA:  Kidney Int     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2193-200     Citation Subset:  IM    
Division of Nephrology, New England Medical Center, Boston, Massachusetts 02111, USA.
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MeSH Terms
Erythropoietin / therapeutic use
Glomerular Filtration Rate
Kidney Transplantation*
Middle Aged
Quality of Health Care*
Renal Dialysis
Serum Albumin / analysis
Treatment Failure
Grant Support
Reg. No./Substance:
0/Serum Albumin; 11096-26-7/Erythropoietin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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