Pretransplant Dialysis Modality Research Articles

Impact of Pretransplant Dialysis Modality on Posttransplant Outcomes: A Single-Center Experience.

It remains unclear whether posttransplant outcomes differ according to the pretransplant dialysis modality (peritoneal dialysis vs hemodialysis). Our aim was to assess posttransplant outcomes in patients with different predialysis modalities. Two thousand two hundred fifty-eight kidney recipients following up in Hamed Alessa Organ transplant center in Kuwait were included and divided into two groups according to pre-transplant dialysis modality: Group 1: those who received hemodialysis (HD) and group 2: those with peritoneal dialysis (PD). Demographics, pretransplant and posttransplant comorbidities, and patient and graft outcomes were studied. There were 1956 patients on hemodialysis, and 302 patients were on peritoneal dialysis. Most were male patients (1456 vs 802 female patients), with comparable mean age (P = .34). Chronic glomerulonephritis and diabetic nephropathy represented the most common original kidney disease before transplant (27.6% and 21.4%, respectively), with higher prevalence of glomerulonephritis in group 1 and diabetic nephropathy in group 2 (P = .001). The 2 groups were comparable with regard to immunosuppression (induction and maintenance) (P > .05). Posttransplant diabetes and hypertension were significantly higher in the hemodialysis group (P = .004 and P = 003, respectively). There was no significant difference between the 2 groups with regard to the graft outcome (P = .86). However, patient survival was significantly higher in the hemodialysis group (81.2% vs 64.4%). Compared with peritoneal dialysis, pretransplant hemodialysis is associated with better posttransplant patient survival despite no difference in the graft outcome. Diabetes-related complications could be attributed to such outcomes.

Association Between Pretransplant Dialysis Modality and Long-Term Graft Outcomes

Association Between Pretransplant Dialysis Modality and Long-Term Graft Outcomes

Dialysis Modality, Transplant Characteristics, and Incident Atrial Fibrillation After Kidney Transplant: An Observational Study Using USRDS Data

Atrial fibrillation is the most common arrhythmia and is increasing in prevalence. The prevalence of atrial fibrillation is high among patients receiving dialysis, affecting ∼21.3% of the patients receiving hemodialysis and 15.5% of those receiving peritoneal dialysis. The association of previous dialysis modality with incident atrial fibrillation in patients after receiving their first kidney transplant has not been studied. We used the United States Renal Data System to retrospectively identify adult, Medicare-insured patients who received their first kidney transplant between January 1, 2005, and September 30, 2012 and who had not previously been diagnosed with atrial fibrillation. The study included 43,621 patients who were aged 18 years older when receiving a first kidney transplant between January 1, 2005, and September 30, 2012 and whose primary payer was Medicare (parts A and B) at the time of transplantation and the 6 months preceding it. Dialysis modality used before transplant. Time to incidence of atrial fibrillation up to 3 years posttransplant. Multivariable Cox regression was used to estimate HRs. Of 43,621 patients, 84.9% received hemodialysis and 15.1% received peritoneal dialysis before transplant. The mean±SD age was 51±13.6 years; 60.8% were male, 55.6% White, and 35.8% Black race. The mean dialysis vintage was 4.3±2.8 years. Newly diagnosed atrial fibrillation after kidney transplant occurred in 286 patients (during 15,363 person-years) who had received peritoneal dialysis and in 2,315 patients (during 83,536 person-years) who had received hemodialysis.After multivariable adjustment, atrial fibrillation was 20% (95% CI, 4%-38%) more likely in those who had been receiving hemodialysis versus peritoneal dialysis, regardless of whether death was considered a competing risk or a censoring event. Each year of pretransplant dialysis vintage increased the risk of posttransplant atrial fibrillation by 6% (95% CI, 3%-9%). Residual confounding; data from billing claims does not specify the duration of atrial fibrillation or whether it is valvular. Pretransplant hemodialysis, as compared with peritoneal dialysis, was associated with higher risk of newly diagnosed atrial fibrillation after a first kidney transplant. New-onset atrial fibrillation (AF) occurs in 7% of kidney transplant recipients in the first 3 years posttransplantation. We conducted this study to determine whether pretransplant dialysis modality was associated with posttransplant AF. We identified 43,621 patients; 84.9% used hemodialysis and 15.1% used peritoneal dialysis pretransplant. Multivariable Cox regression was used to estimate hazard ratios. We found that patients receiving hemodialysis pretransplant were at 20% increased risk of developing posttransplant AF as compared with patients receiving peritoneal dialysis. As our understanding of transplant-specific risk factors for AF increases, we may be able to better risk-stratify transplant patients and develop monitoring and management strategies that can improve outcomes.

Association Between Pretransplant Dialysis Modality and Kidney Transplant Outcomes

The benefits and disadvantages of different pretransplant dialysis modalities and their posttransplant outcomes remain unclear in contemporary kidney transplant care. To summarize the available evidence of the association of different pretransplant dialysis modalities, including hemodialysis and peritoneal dialysis (PD), with posttransplant outcomes. MEDLINE, Embase, PubMed, Cochrane Library, Scopus, CINAHL, and gray literature were searched from inception to March 18, 2022 (updated to April 1, 2022), for relevant studies and with no language restrictions. Randomized clinical trials and nonrandomized observational (case-control and cohort) studies that investigated the association between pretransplant dialysis modality and posttransplant outcomes regardless of age or donor sources (living or deceased) were abstracted independently by 2 reviewers. Following Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology reporting guidelines, 2 reviewers independently extracted relevant information using a standardized approach. Random-effects meta-analysis was used to estimate pooled adjusted hazard ratio (HR) or odds ratio and 95% CI. Primary outcomes included all-cause mortality, overall graft failure, death-censored graft failure, and delayed graft function. Secondary outcomes included acute rejection, graft vessel thrombosis, oliguria, de novo heart failure, and new-onset diabetes after transplant. The study analyzed 26 nonrandomized studies (1 case-control and 25 cohort), including 269 715 patients (mean recipient age range, 14.5-67.0 years; reported proportions of female individuals, 29.4%-66.9%) whose outcomes associated with pretransplant hemodialysis vs pretransplant PD were compared. No significant difference, with very low certainty of evidence, was observed between pretransplant PD and all-cause mortality (13 studies; n = 221 815; HR, 0.92 [95% CI, 0.84-1.01]; P = .08) as well as death-censored graft failure (5 studies; n = 96 439; HR, 0.98 [95% CI, 0.85-1.14]; P = .81). However, pretransplant PD was associated with a lower risk for overall graft failure (10 studies; n = 209 287; HR, 0.96 [95% CI, 0.92-0.99]; P = .02; very low certainty of evidence) and delayed graft function (6 studies; n = 47 118; odds ratio, 0.73 [95% CI, 0.70-0.76]; P < .001; low certainty of evidence). Secondary outcomes were inconclusive due to few studies with available data. Results of the study suggest that pretransplant PD is a preferred dialysis modality option during the transition to kidney transplant. Future studies are warranted to address shared decision-making between health care professionals, patients, and caregivers as well as patient preferences.

P8.059: Kidney Transplant Outcome According to Pre-transplant Dialysis Modality

P8.059: Kidney Transplant Outcome According to Pre-transplant Dialysis Modality

Impact of pre-transplant dialysis modality on kidney transplant outcomes: a systematic review and meta-analysis.

For end-stage renal disease (ESRD), patients receiving kidney transplantation, peritoneal dialysis (PD) and hemodialysis (HD) are both appropriate modes of pre-transplant dialysis. The aim of this review is to assess the impact of pre-transplant PD compared to HD on kidney transplant outcomes in ESRD patients. A comprehensive search in digital databases, like PubMed, SCOPUS and EMBASE and a manual search were conducted to identify cohort studies comparing the kidney transplant outcomes of both pre-transplant dialysis modalities. The data were subjected to both qualitative and quantitative analysis. A meta-analysis was carried out to calculate the effect estimate for patient survival, graft survival and delayed graft function, death-censored graft survival, acute rejection-free graft survival, graft vessel thrombosis, urological complications, surgical complications, any infections, and onset of diabetes after transplantation. The qualities of the included studies were judged by the New-castle Ottawa scale. The overall patient survival is shown to be better with patients who underwent pre-transplant PD compared to HD with OR 1.34 95% CI [1.11, 1.61], p = 0.002. Delayed graft function was found to be highly associated with HD compared to PD with OR 0.60 [0.52, 0.70], p<0.0001 with moderate heterogeneity (i2 = 48%). However, no difference was observed in terms of graft survival, complications, infections, and new onset of diabetes mellitus compared to patients undergoing pre-transplant HD. Within the limitations of the review, it can be concluded that ESRD patients undergoing pre-transplant PD were found to have better patient survival and lower incidence of delayed graft function.

The Association of Pre-Kidney Transplant Dialysis Modality with de novo Posttransplant Heart Failure

Background: Heart failure (HF) after kidney transplantation is a significant but understudied problem. Pretransplant dialysis modality could influence incident HF risk through differing cardiac stressors. However, whether pretransplant dialysis modality is associated with the development of posttransplant HF is unknown. Methods: We used the US Renal Data System to assemble a cohort of 27,701 patients who underwent their first kidney transplant in the USA between the years 2005 and 2012 and who had Medicare fee-for-service coverage for >6 months preceding their transplant date. Patients with any HF diagnosis prior to transplant were excluded. Detailed baseline patient characteristics and comorbidities were abstracted. The outcome of interest was de novo posttransplant HF. Pretransplant dialysis modality was defined as the dialysis modality used at the time of transplant. We conducted time-to-event analyses using Cox regression. Death was treated as a competing risk in the study’s primary analysis. Graft failure was included as a time-varying covariate. Results: Among eligible patients, 81% were treated with hemodialysis prior to transplant, and hemodialysis patients were more likely to be male, had a shorter dialysis vintage, and had more diabetes and vascular disease diagnoses. When adjusted for all available demographic and clinical data, pretransplant treatment with hemodialysis (vs. peritoneal dialysis) was associated with a 19% increased risk in de novo posttransplant HF, with sub-distribution HR 1.19 (95% CI: 1.09–1.29). Conclusions: Our results suggest that choice of pretransplant dialysis modality may impact the development of posttransplant HF.

Impact of pre-transplant dialysis modality on the outcome and health-related quality of life of patients after simultaneous pancreas-kidney transplantation

BackgroundSimultaneous pancreas-kidney transplantation (SPKT) profoundly improves the health-related quality of life (HRQoL) of recipients. However, the influence of the pre-transplant dialysis modality on the success of the SPKT and post-transplant HRQoL remains unknown.MethodsWe analyzed the surgical outcome, long-term survival, as well as HRQoL of 83 SPKTs that were performed in our hospital between 2000 and 2016. Prior to transplant, 64 patients received hemodialysis (HD) and nineteen patients received peritoneal dialysis (PD). Physical and mental quality of life results from eight basic scales and the physical and mental component summaries (PCS and MCS) were measured using the Short Form 36 (SF-36) survey.ResultsPeri- and postoperative complications, as well as patient and graft survival were similar between the two groups. Both groups showed an improvement of HRQoL in all SF-36 domains after transplantation. Compared with patients who received HD before transplantation, PD patients showed significantly better results in four of the eight SF-36 domains: physical functioning (mean difference HD - PD: − 12.4 ± 4.9, P = < 0.01), bodily pain (− 14.2 ± 6.3, P < 0.01), general health (− 6.3 ± 2.8, P = 0.04), vitality (− 6.8 ± 2.6, P = 0.04), and PCS (− 5.2 ± 1.5, P < 0.01) after SPKT. In the overall study population, graft loss was associated with significant worsening of the HRQoL in all physical components (each P < 0.01).ConclusionsThe results of this analysis show that pre-transplant dialysis modality has no influence on the outcome and survival rate after SPKT. Regarding HRQoL, patients receiving PD prior to SPKT seem to have a slight advantage compared with patients with HD before transplantation.

P1157IMPACT OF MODE OF DIALYSIS ON COMPLICATIONS AFTER SIMULTANEOUS PANCREAS- KIDNEY TRANSPLANTATION

Abstract Background and Aims Simultaneous pancreas-Kidney transplantation (SPKT) has established its position in treating patients with type 1diabetes and end-stage renal disease. Infections in the early post-transplantation period are one of the most significant causes of the high morbidity and mortality rates associated with SPKT. Pre-transplant dialysis modality may affect evolution and it has suspected that peritoneal dialysis (PD) is associated whit more surgical complications, especially intra-abdominal infections. The aim: evaluate whether pretransplant dialysis modality affects the risk for postoperative complications in SPKT transplant recipients Method retrospective and descriptive study of a series of patients who underwent SPKT from 2000 to 2018 in our hospital. We studied complication occurring during the first 3 months after transplantation Results From 2000 to 2019 we performed 38 SPKT in 22 men and 16 women. The mean age of the patients was 35.3(28-44) years. Of the 38 SPKT patients, 44.7% on hemodialysis before transplantation, 26.3% were on peritoneal dialysis and 28.9% had not received any substitutive renal therapy. Were similar regarding baseline characteristics. The complications of the post-transplant period are shown in graph 1. The most frequent complications were infectious in almost 2/3 of the patients and within them the intra-abdominal infections affected almost half, 18, of the patients. Were 3 thrombosis of the pancreas that caused the loss of the graft but none of the kidney. All early postoperative complications are compared in table 1.Whit no significant difference between groups of intraabdominal infection (p. 0.5) and graft thrombosis (p 0.7). There were also no differences in relaparotomy, acute rejection and delayed graft function During the follow-up 4 patients died, one case due to a heart attack while the other 3 in relation to intraabdominal infectious processes and need for reintervention Conclusion: Despite improvements in the outcomes of STKP infectious complications remain a significant cause of morbidity and mortality Peritoneal dialysis is not a risk factor postoperative complication after STPK

P1656THE IMPACT OF PRE-TRANSPLANT DIALYSIS MODALITY ON EARLY POST-TRANSPLANT PERIOD ADVERSE EVENTS : A PROSPECTIVE COHORT STUDY WITH PROPENSITY SCORE MATCHING

Abstract Background and Aims Among peritoneal dialysis (PD) or hemodialysis (HD) while waiting for a kidney transplant (KT), which is better in terms of KT outcomes has long been of interest. Nowadays it is difficult to agree on which modality is better. The primary objective of this study was to compare the incidence of composite outcomes (delayed graft function, primary non-function, biopsy-proven acute rejection) within 1 year after primary adult KT between recipients taken PD and HD before KT (PD group vs. HD group, respectively). Method This study was a prospective, multi-sites cohort study. We used a propensity score matching to control for patients characteristics. Results Total 1040 patients were enrolled consecutively. Among them, 1030 patients (248, PD group; 782, HD group) were included in the final analysis. The HD group was older and had higher prevalence of diabetes, higher Charlson comorbidity index score, higher prevalence of positive PRA and more prescription of rituximab than the PD group significantly. After propensity score matching (246, PD group; 476, HD group), there were no differences in baseline characteristics between the two groups. In the whole population, there was no difference in the risk of the composite outcomes between the PD and HD groups (19% vs. 17%, hazard ratio [HR] 1.25, 95% confidence interval [CI] 0.88 ∼ 1.77, p = 0.21). There were also no differences in the risk of each component in the composite outcomes between the two groups. Primary non-function, a component of the composite outcomes did not occur in the both groups. There were no differences in the risks of death, frequency and total duration of re-hospitalization after KT for 1 year, and the changes of eGFR for 1 year between the two groups. The results from the propensity score matched population were consistent with those from the whole population. There was no difference in the risk of the composite outcomes between the PD and HD groups (19% vs. 17%, HR 1.17, 95% CI 0.80 ∼ 1.74, p = 0.43). Conclusion The pre-transplant dialysis modality does not affect the incidences of delayed graft function and acute rejection in early period of KT. (NCT01513707) This study was supported by Baxter Incorporated.

Pretransplant dialysis modality and long-term patient and kidney allograft outcome: a 15-year retrospective single-centre cohort study.

Among factors determining long-term kidney allograft outcome, pretransplant renal replacement therapy (RRT) is the most easily modifiable. Previous studies analysing RRT modality impact on patient and graft survival are conflicting. Studies on allograft function are scarce, lack sufficient size and follow-up. We retrospectively studied patient and allograft survival together with allograft function and its decline in 2277 allograft recipients during 2000-2014. Pretransplant RRT modality ≥60days as grouped into "no RRT" (n=136), "haemodialysis (HD)" (n=1847), "peritoneal dialysis (PD)" (n=159), and "HD+PD" (n=135) was evaluated. Kaplan-Meier analysis demonstrated superior 5-/10-/15-year patient (93.0/81.8/73.1% vs. 86.2/71.6/49.8%), death-censored graft (90.8/85.4/71.5% vs. 84.4/75.2/63.2%), and 1-year rejection-free graft survival (73.8% vs. 63.8%) in PD versus HD patients. Adjusted Cox regression revealed 34.5% [1.5-56.5%] lower hazards of death, whereas death-censored graft loss was similar [HR=0.707 (0.469-1.064)], and rejection was less frequent [HR=0.700 (0.508-0.965)]. Allografts showed higher 1-/3-/5-year estimated glomerular filtration rate (eGFR) in "PD" versus "HD" groups. Living donation benefit for allograft function was most pronounced in groups "no RRT" and "PD". Functional allograft decline (eGFR slope) was lowest for "PD". Allograft recipients on pretransplant PD versus HD demonstrated superior all-cause patient and rejection-free graft survival along with better allograft function (eGFR).

Effect of Pretransplant Dialysis Modality on Outcomes After Simultaneous Pancreas-Kidney Transplantation.

BackgroundPretransplant dialysis modality may affect outcome after simultaneous pancreas-kidney transplantation (SPKT), and it has been suspected that peritoneal dialysis (PD) is associated with more postoperative complications compared to hemodialysis (HD). The aim of this study was to evaluate whether pretransplant dialysis modality affects the risk for postoperative complications in SPKT recipients.Material/MethodsThis was a retrospective longitudinal cohort study of all patients undergoing SPKT from 2010 to 2017, during which 99 simultaneous pancreas-kidney transplantations were performed. Three pre-emptive transplantations were excluded. Patient groups receiving PD (n=59) or HD (n=37) were similar regarding baseline characteristics. All complications occurring during the first 3 months after transplantation, as well as patient and graft survival, were analyzed.ResultsThere were no significant differences in postoperative complications between groups, with similar rates of intra-abdominal infections (8% in HD vs. 10% in PD), pancreatitis (16% in HD vs. 17% in PD), gastrointestinal bleedings (22% in HD vs. 10% in PD), and relaparotomies (27% in HD vs. 24% in PD). None of the patients had venous graft thrombosis. Past peritonitis was not associated with increased risk for postoperative complications in PD patients. Patient and graft survival were similar between PD and HD groups.ConclusionsPeritoneal dialysis is not a risk factor for postoperative complications after SPKT.

PUK4 COMPARISON OF POSTTRANSPLANT NEW-ONSET DIABETES AND CANCER BETWEEN PERITONEAL AND HEMODIALYSIS RECIPIENTS: RESULTS OF A PROPENSITY-MATCHED COHORT STUDY

most renal transplant recipients are vulnerable to new-onset diabetes and newly-developed cancer as a complication of their procedure and aggressive immunosuppressant therapy. Currently, an increasing effort to determine the underlying factors and effective prevention for such complications. However, type of pretransplant dialysis modality as a predictor was hardly evaluated. To compare post-TX new-onset diabetes and cancer between pretransplant HD and PD for adults with ESRD in the US. A propensity-matched retrospective study of renal recipients between January 2007 and December 2011, following ≥60 days of maintenance dialysis. All the data were obtained from the USRDS for the period 2006 to 2012. Adults who received either kidney or kidney/pancreas, with ≥6 months of pre-TX history were included. Patients with other organ transplants, two or more prior renal TXs, and missing data were excluded. Incidence density rates (IDR) and rate differences (R-Diff.) along with Cox proportional hazard analyses were used. Our p-value was adjusted using Bonferroni correction for multiple comparisons. A total of 19,612 renal recipients (9,806 pairs) were included. No difference in follow-up (HD=36.51 vs PD=36.08 months, p-value =0.0807). Nearly, 50% of recipients had 2-18 months of pretransplant dialysis. PD recipients showed significantly more IDR of new-onset diabetes (R-Diff. =5.84/1000 person-year) and cancer (R-Diff. =6.18/1000 person-year). Adjusted Cox analyses indicated a nonsignificant hazard of new-onset diabetes (p-value =0.4140) and a significant hazard of cancer among PD recipients (p-value =0.0357). Renal recipients who were ≥ 50 years old, hypertensive, publicly insured, received a cadaveric organ, and those administered steroids as initial immunosuppressant showed significantly higher hazards for developing post-TX diabetes and cancer. Over the 6-year period, PD patients exhibited higher incidence rates of diabetes and cancer. Upon adjusting for other factors, PD had a significant hazard of developing cancer but not diabetes compared to hemodialysis patients.

Choice of dialysis modality prior to kidney transplantation: Does it matter?

The population of patients with end stage renal disease (ESRD) is increasing, lengthening waiting lists for kidney transplantation. Majority of the patients are not able to receive a kidney transplant in timely manner even though it is well established that patient survival and quality of life after kidney transplantation is far better when compared to being on dialysis. A large number of patients who desire a kidney transplant ultimately end up needing some form of dialysis therapy. Most of incident ESRD patients choose hemodialysis (HD) over peritoneal dialysis (PD) as the modality of choice in the United States, even though studies have favored PD as a better choice of pre-transplant dialysis modality than HD. PD is largely underutilized in the United States due to variety of reasons. As a part of the decision making process, patients are often educated how the choice regarding modality of dialysis would fit into their life but it is not clear and not usually discussed, how it can affect eventual kidney transplantation in the future. In this article we would like to discuss ESRD demographics and outcomes, modality of dialysis and kidney transplant related events. We have summarized the data comparing PD and HD as the modality of dialysis and its impact on allograft and recipient outcomes after kidney transplantation.

The Pretransplant Dialysis Modality is not Associated with Short-Term Surgical Complications after Kidney-Pancreas Transplantation

The Pretransplant Dialysis Modality is not Associated with Short-Term Surgical Complications after Kidney-Pancreas Transplantation

Effects of pretransplant peritoneal vs hemodialysis modality on outcome of first kidney transplantation from donors after cardiac death

BackgroundThe effect of pretransplant peritoneal dialysis (PD) or hemodialysis (HD) modality on outcomes of kidney transplantation (KT) for end-stage renal disease (ESRD) is debatable. We evaluated the outcomes these modalities in KT from donor after cardiac death (DCD).MethodsA cohort of 251 patients on HD, PD or pre-emptive who underwent first KT from DCD between January 2014 and December 2016 were prospectively analyzed to compare for outcomes on recovery of renal function, complications as well as patient and graft survival. The patients were followed till August 2017. Data on 104 HD and 98 PD were available for final comparative outcome analysis, 5 pre-emptive were analyzed as the control group.ResultsBoth HD and PD group patients were well matched for demographic and baseline characteristics. The follow-up period was 12.5 (3.0, 22.0) months in HD and 12.0 (6.0, 20.0) months in PD patients. Post-transplant renal functions between the two groups showed no differences. Among PD patients, 16 (16.3%) suffered delayed graft function, versus 19 (18.3%) in HD, with no statistical differences (p = 0.715). Complications of acute rejection, infections were comparable between the groups. The patient survival, graft survival and death-censored graft survival were similar for HD and PD after adjusting for other multiple risk factors.ConclusionsOur results indicate that outcome of first KT from DCD is not affected by pretransplant dialysis modality of PD or HD in aspects of recovery of renal function, complications as well as patient and graft survival.

Impact of the pretransplant dialysis modality on kidney transplantation outcomes: a nationwide cohort study

ObjectiveMost patients with uraemia must undergo chronic dialysis while awaiting kidney transplantation; however, the role of the pretransplant dialysis modality on the outcomes of kidney transplantation remains obscure. The objective...

Association of Pre-Transplant Dialysis Modality and Post-Transplant Outcomes: A Meta-Analysis.

♦ BACKGROUND: It remains unclear whether post-transplant outcomes differ according to the pre-transplant dialysis modality (peritoneal dialysis [PD] versus hemodialysis [HD]). We performed a meta-analysis of studies that assessed either post-transplant mortality, graft survival, or delayed graft function (DGF) in both PD and HD patients. ♦ METHODS: Two independent authors searched English-language literature from January 1, 1980, through August 31, 2014, national conference proceedings, and reference lists. We used combinations of terms related to dialysis (hemodialysis, peritoneal dialysis, or renal replacement therapy), kidney transplant, and outcomes. Studies were included if they measured any of the 3 post-transplant study outcomes in both pre-transplant HD and PD. ♦ RESULTS: A total of 16 studies were included in the final analysis. Of these, 6 studies reported adjusted hazard ratio for mortality, pooled adjusted risk ratio: 0.89 (95% confidence interval [CI] 0.82 - 0.97) in favor of PD (p = 0.006). The same 6 studies reported adjusted hazard ratio for graft survival, pooled adjusted risk ratio: 0.97 (95% CI 0.92 - 1.01, p = 0.16). A total of 13 studies reported unadjusted DGF. Pooled odds ratio: 0.5 (95% CI 0.41 - 0.63) in favor of PD (p < 0.005). Significant heterogeneity observed for all outcomes: I2 = 72.7%, I2 = 59.9%, and I2 = 66.8%, respectively. ♦ CONCLUSIONS: Based on these results, pre-transplant PD is associated with better post-transplant survival than HD. Pre-transplant PD was also associated with decreased risk for DGF compared with HD, although these results were unadjusted. There was no significant difference in graft survival between pre-transplant HD and PD. These results suggest that PD may be the preferred dialysis modality for patients expected to receive a transplant.

A Comparison of Transplant Outcomes in Peritoneal and Hemodialysis Patients: A Meta-Analysis

Background: Peritoneal dialysis (PD) and hemodialysis (HD) have been considered the 2 standard pre-transplant dialysis modalities in patients awaiting kidney transplantation. However, the impact of pretransplant dialysis on the short- and long-term post-transplant outcomes remains controversial. Methods: We searched PubMed, EMBASE and the Cochrane central register of controlled trials for this review. Twelve studies were identified by strict screening for the meta-analysis. Results: We found that pretransplant PD patients had a significantly lower incidence of delayed graft function than HD patients, with an OR 0.67 (95% CI 0.62-0.72, p < 0.05). In contrast, there was no significant difference in the incidence of acute rejection, OR 0.96 (95% CI 0.75-1.16). Pretransplant PD had a better 5-year patient survival rate than HD, with a hazard ratio 0.86 (95% CI 0.79-0.95, p < 0.05); however, there were no significant differences in the graft survival rate (p = 0.08). Conclusions: We found that PD was a better choice of pretransplant dialysis modality than HD. Video Journal Club ‘Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=446272.

Impact of Dialysis Modality on Kidney Transplantation Outcomes

Survival benefits of renal transplantation over dialysis therapy are well established for patients with end-stage renal disease (ESRD). Transition from one treatment modality to another is common. Understanding the differences in outcomes with the various renal replacement therapies will help nephrologists to provide best advice for dialysis patients. The influence of pretransplant dialysis modality on post-transplant outcomes is not clear. An overview of the various issues related to dialysis modality on kidney transplantation outcomes is discussed in this topic review. These include allograft and recipient survival, the impact of dialysis vintage and choice of dialysis modality on transplant outcomes.