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Changes in clinical indicators related to the transition from dialysis to kidney transplantation-data from the ERA-EDTA Registry.

ABSTRACT: Background:Kidney transplantation should improve abnormalities that are common during dialysis treatment, like anaemia and mineral and bone disorder. However, its impact is incompletely understood. We therefore aimed to assess changes in clinical indicators after the transition from chronic dialysis to kidney transplantation. Methods:We used European Renal Association-European Dialysis and Transplant Association Registry data and included adult dialysis patients for whom data on clinical indicators before and after transplantation (2005-15) were available. Linear mixed models were used to quantify the effect of transplantation and of time after transplantation for each indicator. Results:In total, 16?312 patients were included. The mean age at transplantation was 50.1 (standard deviation 14.2) years, 62.9% were male and 70.2% were on haemodialysis before transplantation. Total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol and triglycerides increased right after transplantation but decreased thereafter. All other indicators normalized or approached the target range soon after transplantation and these improvements were sustained for the first 4 years of follow-up. In patients with higher estimated glomerular filtration rate (eGFR) levels (30-60 and >60?mL/min/1.73 m2), the improvement of haemoglobin, ferritin, ionized calcium, phosphate, parathyroid hormone, HDL cholesterol, triglycerides, albumin and C-reactive protein levels was more pronounced than in patients with a lower eGFR (<30?mL/min/1.73 m2). Conclusions:Except for total cholesterol, LDL cholesterol and triglycerides, all clinical indicators improved after transplantation. These improvements were related to eGFR. Nevertheless, values remained out of range in a considerable proportion of patients and anaemia and hyperparathyroidism were still common problems. Further research is needed to understand the complex relationship between eGFR and the different clinical indicators.

SUBMITTER: Tantiyavarong P

PROVIDER: S-EPMC7147310 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Changes in clinical indicators related to the transition from dialysis to kidney transplantation-data from the ERA-EDTA Registry.

Tantiyavarong Pichaya P Kramer Anneke A Heaf James G JG Finne Patrik P Åsberg Anders A Cases Aleix A Caskey Fergus J FJ Massy Ziad A ZA Jager Kitty J KJ Noordzij Marlies M

Clinical kidney journal 20190701 2

<h4>Background</h4>Kidney transplantation should improve abnormalities that are common during dialysis treatment, like anaemia and mineral and bone disorder. However, its impact is incompletely understood. We therefore aimed to assess changes in clinical indicators after the transition from chronic dialysis to kidney transplantation.<h4>Methods</h4>We used European Renal Association-European Dialysis and Transplant Association Registry data and included adult dialysis patients for whom data on c ...[more]

PMID: 32296524

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Project description:Dialysis facility performance measures to improve access to kidney transplantation are being considered. Referral of patients for kidney transplantation evaluation by the dialysis facility is one potential indicator, but limited data exist to evaluate whether referral is associated with existing dialysis facility quality indicators.Cross-sectional study.12,926 incident (July 2005 to September 2011) adult (aged 18-69 years) patients treated at 241 dialysis facilities with complete quality indicator information from US national registry data linked to transplantation referral data from all 3 Georgia kidney transplantation centers.Facility performance on dialysis quality indicators (high, intermediate, and low tertiles).Percentages of patients referred within 1 year of dialysis therapy initiation at dialysis facility.Overall, a median of 25.4% of patients were referred for kidney transplantation within 1 year of dialysis therapy initiation. Higher facility-level referral was associated with better performance with respect to standardized transplantation ratio (high, 28.6%; intermediate, 25.1%; and low, 22.9%; P=0.001) and percentage waitlisted (high, 30.7%; intermediate, 26.8%; and low, 19.2%; P<0.001). Facility-level referral was not associated with indicators of quality of care associated with dialysis therapy initiation, including percentage of incident patients being informed of transplantation options. For most non-transplantation-related indicators of high-quality care, including those capturing mortality, morbidity, and anemia management, better performance was not associated with higher facility-level transplantation referral.Potential ecologic fallacy and residual confounding.Transplantation referral among patients at dialysis facilities does not appear to be associated with overall quality of dialysis care at the facility. Quality indicators related to kidney transplantation were positively associated with, but not entirely correspondent with, higher percentages of patients referred for kidney transplantation evaluation from dialysis facilities. These results suggest that facility-level referral, which is within the control of the dialysis facility, may provide information about the quality of dialysis care beyond current indicators.

Dataset Information

Changes in clinical indicators related to the transition from dialysis to kidney transplantation-data from the ERA-EDTA Registry.

Publications

Changes in clinical indicators related to the transition from dialysis to kidney transplantation-data from the ERA-EDTA Registry.

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