A registry-based retrospective study comparing pre-dialysis care and early outcomes in native vs. transplant kidney failure

Background and hypothesis
Starting dialysis is associated with morbidity and mortality. Outcomes for people with failed transplants can be poorer than for people with native kidney failure. We aimed to determine if dialysis modality, place of initiation, and mortality outcomes differed in the first 90 days between people starting dialysis for transplant and native kidney failure.

Methods
Retrospective cohort using linked UK Renal Registry (UKRR) data and Hospital Episode Statistics. Modality, place of initiation, and outcomes compared to day 90 for 16,417 adults starting dialysis in England between January 2018 and December 2019.

Results
Relative to those with native kidney failure (90.6%), those with transplant failure (9.4%) were younger (median 55.2 vs 66.3 years) and commenced more in-centre haemodialysis (86.8% vs 82.2%, adjusted-OR 1.72 (95% CI 1.47-2.01), p <0.0001).

Compared with individuals reported to have native chronic kidney disease, and accounting for age, sex, diabetes and ethnicity, those with transplant failure had increased odds of starting dialysis in hospital (adjusted-OR 2.26 (95% CI 1.84-2.76), p<0.0001), at higher eGFRs (8.9 vs 7.9 ml/min/1.73 m², p=0.0001); and death (adjusted-OR 1.95 (95% CI 1.31-2.90), p=0.001).

Discussion
UK patients starting dialysis for transplant failure do so at higher eGFRs than those receiving specialist chronic kidney disease care. Those with transplant failure appear disproportionately likely to start as inpatients, receive haemodialysis, or die within 90 days. These findings are likely to reflect differences between both patient groups and care pathways. Deeper understanding may inform improvements in care.