A kidney transplant recipient 10 years post-transplant has a chronically declining eGFR (now 25 mL/min/1.73m2). He has chronic allograft nephropathy

Question

A kidney transplant recipient 10 years post-transplant has a chronically declining eGFR (now 25 mL/min/1.73m2). He has chronic allograft nephropathy with IFTA. He is on Tacrolimus 2 mg BD, Mycophenolate 500 mg BD, Prednisolone 5 mg. His transplant team is planning for return to dialysis. At what point should a new AV fistula be created?

Accepted Answer

At least 6 months before anticipated dialysis need, as for any CKD patient approaching ESKD

Answer

Tunnelled line is always used for re-starting dialysis as the preferred next step

Answer

Fistula creation is not possible in transplant patients as the preferred next step

Answer

When eGFR falls below 5 as the preferred next management strategy in this patient

Answer

Only when dialysis is definitely needed as the preferred next management strategy

Failing Graft Dialysis Access Planning — ESENeph MCQ