ASSOCIATION BETWEEN ESTIMATED GLOMERULAR FILTRATION RATES AT INITIATION OF DIALYSIS AND ALL-CAUSE MORTALITY IN KIDNEY TRANSPLANT RECIPIENTS WITH A FAILING KIDNEY ALLOGRAFT
Dr Dharshana Sabanayagam1,2,3, Dr Farzaneh Boroumand1,2, Dr Katrina Chau4,5, Dr Eric Au6,7,8, Dr Shuvo Baker1, Dr Ryan Gately9,10, Dr Pedro Lopez11,12,13, Professor Wai Lim11,14, Professor Armando Teixeira-Pinto1,2, Professor Germaine Wong1,2,3
1Sydney School of Public Health, University Of Sydney, Sydney, Australia, 2Centre for Kidney Research, The Children’s Hospital, Westmead, Australia, 3Department of Renal and Transplantation Medicine, Westmead Hospital, Westmead, Australia, 4School of Medicine, Western Sydney University, Campbelltown, Australia, 5Department of Renal Medicine, Blacktown Hospital, Blacktown, Australia, 6Australia & New Zealand Dialysis & Transplant Registry, South Australian Health & Medical Research Institute, Adelaide, Australia, 7School of Population and Global Health, University of Melbourne, Melbourne, Australia, 8The Alfred Hospital, Melbourne, Australia, 9Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Australia, 10School of Medicine, The University of Queensland, Brisbane, Australia, 11Medical School, Faculty of Health & Medical Sciences, University of Western Australia, Perth, Australia, 12Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia, 13Grupo de Pesquisa em Exercício para Populações Clínicas (GPCLIN), Universidade de Caxias do Sul, Caxias do Sul, Brazil, 14Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
Introduction: The effects of estimated glomerular filtration rate (eGFR) thresholds at the time of dialysis initiation in incident dialysis patients on all-cause death have been examined in clinical trials, but not in patients with failing grafts. This study aimed to determine whether eGFR trajectories post-transplantation and eGFRs at the time of dialysis initiation were associated with survival outcomes post-allograft loss.
Method: We used data from the ANZDATA registry to identify patients who experienced first kidney allograft loss and commenced dialysis between 2018-2022. Latent class mixed models (LCMM) were used to determine eGFR trajectory subclasses post-transplantation until dialysis initiation and adjusted Cox proportional hazards models to estimate the effects of eGFR at the time of dialysis initiation and eGFR trajectory subclasses on all-cause mortality on dialysis.
Results: Within the cohort of 1131 eligible transplant recipients, three distinct classes of eGFR trajectories were identified post-transplantation: class 1 – slow decline (75.5%), class 2 – accelerated decline (6.4%), class 3 – progressive decline (18%). The adjusted Cox model (HR 95%CI) found no significant differences in the risk of death post-dialysis initiation between the three classes of eGFR trajectory (Class 1 [reference], Class 2 [0.83, 0.44-1.54, p = 0.552], Class 3 [1.02, 0.71-1.44, p = 0.929]) or between different levels of eGFR, with HR (95%CI) of 1.02 (0.99-1.05, p= 0.198) per mL/min/1.73m2 increase in eGFR.
Conclusion: Our study did not find any significant differences in survival outcomes post-allograft loss between varying levels of eGFR at dialysis initiation, and between different eGFR trajectories post-transplantation. Therefore, the patterns of eGFR decline and eGFR at the time of dialysis initiation have no effects on the risk of death after return to dialysis.
Biography:
Dharshana Sabanayagam is an adult nephrologist, working as a Post-Graduate Fellow at Westmead Hospital. She is also enrolled in a Doctorate of Philosophy with the University of Sydney, with a focus on optimisation of dialysis initiation in people with kidney failure.