P48
WHEN TO START HAEMODIALYSIS IN NATIVE VERSUS TRANSPLANT RENAL FAILURE; AN
OBSERVATIONAL SINGLE CENTRE, RETROSPECTIVE STUDY
Imran, M, Brown, N, Shah, M, Bell, G, Howse, M
Royal Liverpool University Hospital NHS Trust
BACKGROUND: Many factors influence the decision to start renal replacement therapy (RRT) when native or
transplant kidneys fail.UK renal registry report (2007) have shown that with time the clinicians are starting their
patients on dialysis at a higher eGFR when their native kidneys fail. On the other hand, the data from European
registry have shown increasing mortality in native CKD patients when they were started on dialysis at a higher eGFR.
It is important to pre-empt uremic symptoms in the light of biochemical parameters as the patients presenting with
these symptoms needing emergency dialysis have poor outcome. GFR seems to be a better guide than creat.clearance
to plan RRT in end stage native renal failure. In transplant patients, the role of eGFR and creat clearance as a guide
to RRT is not well defined. We conducted an observational retrospective study to analyse our data to understand the
similarities and differences in biochemical parameters to start haemodialysis after native versus transplant renal
failure.
METHODS AND RESULTS: We analysed the biochemical data of two patient’s groups (native versus transplant
renal failure) who recently started haemodialysis in our centre. In native renal failure group, during 11 months (JanNov 2009), 62 patients commenced HD (mean age 63, range 32-88 years, 32% were diabetic.) In transplant failure
group, 41 patients (mean age 53, range 22-77 years, 8% diabetics) commenced HD in 34 months (from Jan 2007-Oct
2009).The important biochemical parameters measured within the last 6 months prior to the start of HD are
summarised in the table.
The parameter (the latest value was measured
Native renal failure
Transplant failure (T)
prior to start HD)
K+ (mmol/L)
n (%)
60 (97%)
41 (100%)
Mean (range)
5.2 (3-7)
5.4 (4-7.9)
Urea (mmol/L)
n (%)
60 (97%)
41 (100%)
Mean (range)
36 (18-60)
28 (10-33)
eGFR (ml/min)
n (%)
60 (97%)
14 (23%)
Mean (range)
6.7 (3-13)
12 (6-16)
Albumin (g/L)
n (%)
58 (95%)
39 (95%)
Mean (range)
35 (14-47)
36 (21-49)
Urinary vol (L/24 hour)
n (%)
16 (26%)
14 (34%)
Mean (range)
1.8 (1-2.8)
1.7 (1.1-2.5)
Creat. Clearance (ml/min)
n (%)
26 (43%)
14 (23%)
Mean (range)
10 (1-26)
11 (6-19)
Table: The biochemical parameters in native and transplant renal failure the latest value measured within 6 months
prior to start of HD; n is the number of patients who had the parameter measured within last 6 months (shown also as
%age of total population in the group)
CONCLUSIONS: This observational study highlights many similarities in the biochemical parameters which were
used to help in decision making to commence HD in native and transplant failure. The study also highlights the
clinical practice, where in case of native renal failure eGFR is commonly assessed prior to consider RRT rather than
creat Clearance. However it was interesting that in many transplant renal failure cases neither eGFR nor creat
clearance were measured. We can assume that clinical symptoms were given priority in decision making to commence
HD in transplant group. The important limitations of the study are; selection bias, small number of patients, lack of
clinical information and the non availability of biochemical parameters in many patients. This and similar studies will
continue to highlight the need of guidelines to start RRT, particularly when the transplant kidney fails.