UK Renal Registry

ILD113

Kidney transplantation is the treatment of choice for most people with kidney failure. However, kidney transplants do not work forever: a kidney transplant is described as failing if the function is declining and the person will require alternative treatment (dialysis/new transplant or conservative care) within 6-12 months. Predicting when a kidney transplant will fail can often be very difficult and is compounded by the fact that in some cases doctor, patient, or both, are not ready to face the possibility of kidney transplant failure. However, it is important that preparation for the next steps after kidney transplant failure is undertaken early, both to increase the chances of early re transplantation and to ensure smooth transition to the patients preferred subsequent treatment. Research has shown that patients who are inadequately prepared for the eventuality of kidney or kidney transplant failure are more likely to suffer adverse consequences and have a higher risk of dying. Between 2004 to 2018 there were approximately 6175 patients with transplants that were at least 2 years old and an eGFR less than 30 but greater than or equal to 15 who were not on dialysis. Not all these patients will experience transplant failure within 12 months and require planning for dialysis or subsequent re transplantation. Unfortunately, eGFR trends on their own are not sufficient to predict those who will experience transplant failure and when it will occur. This study will explore whether the Kidney Failure Risk Equation (KFRE) can be used as a tool to help triage patients with high risk of transplant failure so they can receive timely low clearance care and onwards planning for subsequent re-transplantation or preferred subsequent treatment. It will look at whether historical episodes of acute kidney injury give a higher risk of transplant failure. The kidney failure risk equation can be calculated from routinely collected data which includes patient age, sex, eGFR, urine albumin/creatinie ratio or converted urine protein/creatinine ratio. The other version of the equation that uses 8 different pieces of data and also includes adjusted calcium, phosphate, albumin and bicarbonate levels.