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A comparison of transplant outcomes in peritoneal and hemodialysis patients.
Kidney Int. 2002 Oct; 62(4):1423-30.KI

Abstract

BACKGROUND

Studies examining the effect of pre-transplant dialysis modality on graft and patient survival after kidney transplantation have produced conflicting results. Therefore, we studied the effects of pre-transplant dialysis modality on outcomes in a large United States cohort.

METHODS

We compared rates of transplantation between peritoneal dialysis and hemodialysis patients from the years 1995 to 1998 in the United States (N = 252,402) and outcomes after transplantation (N = 22,776), using data from the Centers for Medicare and Medicaid Services.

RESULTS

In a Cox proportional hazards analysis that was adjusted for multiple patient characteristics, kidney transplantation was 1.39 (95% CI = 1.35 to 1.43) times more likely in peritoneal dialysis vs. hemodialysis patients (P < 0.0001). Over the entire follow-up period, the adjusted risk for death-censored graft failure was 1.15 (1.04 to 1.26) times higher in peritoneal dialysis vs. hemodialysis (P < 0.05), but mortality and overall graft failure rates were not different. Pre-transplant dialysis modality did not affect outcomes for patients who survived with a functioning kidney for at least 3 months. However, in adjusted Cox analyses restricted to the first 3 months, peritoneal dialysis was associated with a 1.23 (1.09 to 1.39) times higher risk for early graft failure (P < 0.001) and a 1.33 (1.16 to 1.53) times higher risk for death-censored graft failure (P < 0.001). Peritoneal dialysis patients, however, were seen to have a lower incidence of delayed graft function. In a smaller sample of patients with data on causes of early graft failure, graft thrombosis was more commonly listed as a cause of graft failure among peritoneal dialysis patients, 41% (64/156), compared to hemodialysis patients, 30% (106/349), P < 0.05.

CONCLUSIONS

Kidney transplantation is more frequent in peritoneal dialysis than in hemodialysis patients, and transplantation in peritoneal dialysis patients is more frequently associated with early, but not late, graft failure. Delayed graft function was less common in peritoneal dialysis patients but this potential benefit appears to be offset by other factors which are associated with early graft loss. Additional studies are needed to determine what factors may help understand this early risk of graft failure.

Authors+Show Affiliations

Minneapolis Medical Research Foundation, 914 S. 8th Street, Suite D-253, Minneapolis, MN 55404, USA. jsnyder@nephrology.orgNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12234315

Citation

Snyder, Jon J., et al. "A Comparison of Transplant Outcomes in Peritoneal and Hemodialysis Patients." Kidney International, vol. 62, no. 4, 2002, pp. 1423-30.
Snyder JJ, Kasiske BL, Gilbertson DT, et al. A comparison of transplant outcomes in peritoneal and hemodialysis patients. Kidney Int. 2002;62(4):1423-30.
Snyder, J. J., Kasiske, B. L., Gilbertson, D. T., & Collins, A. J. (2002). A comparison of transplant outcomes in peritoneal and hemodialysis patients. Kidney International, 62(4), 1423-30.
Snyder JJ, et al. A Comparison of Transplant Outcomes in Peritoneal and Hemodialysis Patients. Kidney Int. 2002;62(4):1423-30. PubMed PMID: 12234315.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparison of transplant outcomes in peritoneal and hemodialysis patients. AU - Snyder,Jon J, AU - Kasiske,Bertram L, AU - Gilbertson,David T, AU - Collins,Allan J, PY - 2002/9/18/pubmed PY - 2003/2/26/medline PY - 2002/9/18/entrez SP - 1423 EP - 30 JF - Kidney international JO - Kidney Int VL - 62 IS - 4 N2 - BACKGROUND: Studies examining the effect of pre-transplant dialysis modality on graft and patient survival after kidney transplantation have produced conflicting results. Therefore, we studied the effects of pre-transplant dialysis modality on outcomes in a large United States cohort. METHODS: We compared rates of transplantation between peritoneal dialysis and hemodialysis patients from the years 1995 to 1998 in the United States (N = 252,402) and outcomes after transplantation (N = 22,776), using data from the Centers for Medicare and Medicaid Services. RESULTS: In a Cox proportional hazards analysis that was adjusted for multiple patient characteristics, kidney transplantation was 1.39 (95% CI = 1.35 to 1.43) times more likely in peritoneal dialysis vs. hemodialysis patients (P < 0.0001). Over the entire follow-up period, the adjusted risk for death-censored graft failure was 1.15 (1.04 to 1.26) times higher in peritoneal dialysis vs. hemodialysis (P < 0.05), but mortality and overall graft failure rates were not different. Pre-transplant dialysis modality did not affect outcomes for patients who survived with a functioning kidney for at least 3 months. However, in adjusted Cox analyses restricted to the first 3 months, peritoneal dialysis was associated with a 1.23 (1.09 to 1.39) times higher risk for early graft failure (P < 0.001) and a 1.33 (1.16 to 1.53) times higher risk for death-censored graft failure (P < 0.001). Peritoneal dialysis patients, however, were seen to have a lower incidence of delayed graft function. In a smaller sample of patients with data on causes of early graft failure, graft thrombosis was more commonly listed as a cause of graft failure among peritoneal dialysis patients, 41% (64/156), compared to hemodialysis patients, 30% (106/349), P < 0.05. CONCLUSIONS: Kidney transplantation is more frequent in peritoneal dialysis than in hemodialysis patients, and transplantation in peritoneal dialysis patients is more frequently associated with early, but not late, graft failure. Delayed graft function was less common in peritoneal dialysis patients but this potential benefit appears to be offset by other factors which are associated with early graft loss. Additional studies are needed to determine what factors may help understand this early risk of graft failure. SN - 0085-2538 UR - https://www.unboundmedicine.com/medline/citation/12234315/A_comparison_of_transplant_outcomes_in_peritoneal_and_hemodialysis_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0085-2538(15)48687-9 DB - PRIME DP - Unbound Medicine ER -