Fallo precoz de trasplante renal y vuelta a diálisis peritoneal: Estudio preliminar de permeabilidad y eficacia de diálisis

The return to dialysis after a kidney transplant failure (KTF) is more frequent each time. The clinical situation of these patients used to be worst than that of new dialysis patients starting hemodialysis or peritoneal dialysis (PD). There is a lot of studies about the clinical situation of patients with KTF after a long period of functioning KT, but there is a lack of information about the evolution of a small group of patients with an early KTF (days or weeks after transplantation). Aim: Our aim is to study the effect of an early KTF (at risk of acute treatments and agresive measures to maintain the function of a suboptimal graft) on peritoneal membrane permeability, clinical outcomes and PD efficacy. Patients and Methods: We included 9 patients from the last 5 years previosly treated with PD and with early KTF (age 53.5±15.4 Y/O) (gender 5 male, 4 female) that returned to PD after 25±23 (10-64) days of KT. We studied inflammation, nutrition, kidney function, membrane permeability and dialysis efficacy, previous to KT, inmediately after PD return (PD0), at one month (PD1) and after 3 months (PD3); membrane permeability and efficay were measured preKT and after 3 months of PD return. Results: No significative differences were found in nutrition or inflammation parameters. Diuresis decreased from PreKT to PD0 and to PD1 (p=.032), with a non-significant decrease of creatinine clearance. Ultrafiltration decreased from 1407 a 951ml/day (p=.022) and from 314 a 260ml/4h (p=.018) in the peritoneal equilibrium test at the third month on PD, without changes in peritoneal protein losses and creatinine dialysate/plasma ratio. Weekly Kt/V and weekly ClCr decreased slightly but maintaining appropiate levels of efficacy. Conclusions: In this small group of patients that return to PD after early KTF and short period of follow-up does not seem that the management of a kidney graft at risk cause important damage to clinical parameters, dialysis efficacy and peritoneal permeability.