[Impact of advanced kidney disease on transplanted patients and their return to dialysis]

Although long-term outcomes also improved, graft loss caused by chronic allograft nephropathy remains an important obstacle. This situation, together with the progressive increase in the number of renal transplant patients, means that the population of transplant patients readmitted to a dialysis program will be progressively greater. The mortality rate in patients starting dialysis after graft loss has been reported as variable, though higher than that observed in patients with a functioning graft and that observed in patients on dialysis treatment. However, it is not known how the management of chronic kidney disease patients in the transplant setting differs from that of patients with native kidney disease with a similar degree of renal dysfunction. Many patients in stages 4T-5T have chronic kidney disease related complications that fall below targets established for nontransplant chronic kidney disease patients. A limited number of studies have evaluated patients returning to dialysis after graft failure and the different guidelines in the setting of transplantation have not analyzed this crucial aspect so important. Parting from this premise, a working group of the Spanish Society of Nephrology in the field of kidney transplantation and dialysis has reviewed in-depth each of the clinical aspects of care of patients with kidney transplant failure coming back to dialysis and drawn up a consensus document in order to optimize the management of this condition.