Changes in clinical indicators related to the transition from dialysis to kidney transplantation:data from the ERA-EDTA Registry

Background: Kidney transplantation should improve abnormalities that are common during dialysis treatment, like anaemia and mineral bone disease. However, its impact is incompletely understood. We therefore aimed to assess changes in clinical indicators after the transition from chronic dialysis to kidney transplantation. Methods: We used ERA-EDTA Registry data and included adult dialysis patients for whom data on clinical indicators before and after transplantation (2005-2015) were available. Linear mixed models were used to quantify the effect of transplantation and of time after transplantation for each indicator. Results: In total, 16,312 patients were included. Mean (SD) age at transplantation was 50.1 (14.2) years, 62.9% were male and 70.2% were on haemodialysis before transplantation. Total-, LDL-, and HDL cholesterol and triglycerides increased right after transplantation, but decreased thereafter. All other indicators normalized or approached the target range soon after transplantation and these improvements sustained for the first four years of follow-up. In patients with higher eGFR levels (30-60 and >60 ml/min/1.73 m2) the improvement of haemoglobin, ferritin, ionized calcium, phosphate, PTH, HDL cholesterol, triglycerides, albumin and CRP levels was more pronounced than in patients with a lower eGFR (<30 ml/min/1.73m2). Conclusions: Except for total cholesterol, LDL cholesterol and triglycerides, all clinical indicators improved after transplantation. These improvements were related to eGFR. Nevertheless, values remained out of range in a considerable proportion of patients and anaemia and hyperparathyroidism were still common problems. Further research is needed to understand the complex relationship between eGFR and the different clinical indicators.