A new study published in Hemodialysis International first described the syndrome of rapid onset end stage renal disease SORO ESRD acute yet irreversible renal failure. The objective was to study the impact of SORO ESRD renal allograft survival. This was a retrospective analysis of individual adult patient level serum creatinine trajectories of ESRD patients on maintenance hemodialysis for 90 days. Among 1461 ESRD patients assessed 149 patients including 13 renal transplant recipients RTRs fulfilled the diagnosis of SORO ESRD of which 4 were males 9 were females 12 Caucasians one other with a mean age of 45 years. The findings showed that serum creatinine was 1.4 mg dL in the last year before hemodialysis initiation. Initial hemodialysis access was a dialysis catheter in all 13 patients. Acute kidney injury AKI precipitating SORO ESRD followed acute rejection in 4 postoperative in 2 tubulo interstitial nephritis in 2 unknown in 2 infection sepsis in 1 contrast nephropathy in 1 BK virus nephropathy in 1 and cardio renal syndrome in 1. Renal allograft survival ranged from 277 4939 days a mean of approx. 4 years . Renal allograft biopsies were available in 9 out of 14 renal transplant recipients RTRs 4 showed acute rejection 2had interruption of immunosuppression 3were detected with acute tubular necrosis and 4 others showed chronic transplant glomerulopathy. Time on hemodialysis ranged from129 1630 days a mean of approx. 2.4 years . However 5 out of 13 RTRs with SORO ESRD died 3 following cardiac arrest and 2 after the discontinuation of hemodialysis. On the other hand 4 out of 13 patients were re transplanted in the period of this study. Hence it was inferred that SORO ESRD contributed significantly to late renal allograft loss and return to hemodialysis with 100 initial dialysis catheter rate. This study identified the potentially preventable causes of AKI leading to SORO ESRD. It was stated that the application of experience gained from such studies would help reduce late renal allograft loss and the need for re transplantation.