Grant: Operating Grant

Increased rates of kidney transplant involving more medically complex donors and recipients and limited improvement of long-term kidney transplant survival have resulted in an increasing number of people with kidney transplant failure. These people have poor outcomes when they start dialysis. In addition, information on outcomes prior to dialysis is lacking and people who survive until dialysis initiation may represent a selected population of more robust or healthier people. There are insufficient data to inform optimal management of the failing transplant, complications of kidney disease and preparation for dialysis or repeat transplantation in these people. We will study kidney transplant recipients whose transplant is failing using the databases of the Alberta Kidney Disease Network (www.akdn.info) and chart review. We will study the risk of death and hospitalization from the date of an irreversible decline of the kidney transplant function below approximately 20% -- when the risk of adverse events starts to be considerable and when we do not know how best to provide care. We will study how quickly kidney disease progresses and whether those who reach kidney failure start dialysis in a planned manner. We will compare these outcomes between people with a transplant and people without a transplant and the same degree of kidney dysfunction. Canadian nephrologists ranked the management of people with kidney transplant failure as a top priority for the new national clinical practice guidelines, according to a recent survey (www.csnscn.ca). This will be the first large study describing the risk of mortality during transition from transplant to end-stage kidney failure. Knowledge about how mortality varies as kidney function declines is important to understand when and which interventions are more likely to be beneficial.