Paula M. Buchanan, Mark A. Schnitzler, David Axelrod, Paolo R. Salvalaggio and Krista L. Lentine
Background: The economic implications of dialysis-requiring allograft dysfunction early after kidney transplantation are not well-described. Methods: Data for Medicare-insured adult kidney transplant recipients in 1995-2004 who did not develop permanent graft failure in the first 90 days were drawn from the United States Renal Data System. We identified dialysis treatmentrecords from Medicare claims and categorized patients according to frequency and duration of posttransplant dialysis as: first week (delayed graft function, DGF), second week, weeks 3 or 4, second month, or third month.Associations of dialysis requirements withMedicare payments for the transplant hospitalization and over the next three years were estimated with multivariable linear regression. Graft and patient survival according to early dialysis requirements were examined with multivariable survival analysis. Results: Among 37,533 recipients, 15,314 (41%) experienced DGF and 3,184 (21% of those with DGF) received dialysis beyond the first week. Compared with no dialysis in the first 3 months, adjusted marginal first-yearcosts associated with early post-transplant dialysis ranged from $6,467 for dialysis requirement limited to first week to $27,606 for dialysis in multiple periods (p<0.0001). Patients who experienced DGF and received dialysis in >2 early periods were more than twice as likely to lose their grafts within 3 years as those without early dialysis requirements. Conclusions: While dialysis in the first week post-transplant is an adverse risk marker, early dialysis in weeks 2 to 12 is associated with similarly adverse, if not worse, costs and clinical consequences. This observation supports a need for broader definition of DGF.
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