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Peritoneal dialysis and kidney transplant. A two-way ticket in an integrated renal replacement therapy model.
Nefrologia. 2011; 31(4):441-8.N

Abstract

BACKGROUND

Peritoneal dialysis (PD) seems to be a good option to initiate renal replacement therapy (RRT), but patients with graft failure choose PD less frequently than incident patients (de novo).

OBJECTIVE

To describe patient movements between PD and kidney transplantation (TX) and risk factors for failure of the PD technique.

METHOD

Multicentre observational study of patients starting PD between 2003 and 2009 with follow-up up until January 2010. Survival analysis based on switching from PD to HD as an event using Kaplan-Meier (KM) and forward, stepwise Cox proportional hazards models. Hazard ratio and 95% confidence intervals (HR [CI]) are shown. MAIN VARIABLE: Switch from PD to HD. Two-group comparison: PD post transplant (post-TX) patients (76) compared to pure incident PD (de novo-PD) patients (830).

PATIENTS

906 PD patients from 19 public hospitals with a mean age of 54.8 years (64.9% male); main ESRD aetiology: glomerulonephritis (25.4%), diabetes (16.7%), vascular-ischaemic (10.7%), interstitial (13.6%) and polycystic (11.2%). Comorbidity conditions: Charlson Index 5.1 (SD 2.4); 21.6% diabetes mellitus (DM), 24.0% cardiovascular (CV) events.

RESULTS

Mean follow-up period on PD: 1.85 years (95% CI [1.68-2.02 years]). KM estimation for switching to HD due to PD failure was 5.46 years [4.42-6.50 years]. At the end of follow-up, 88 patients had died, 154 had been transferred to HD and 306 had received a graft (annual rate for patients on waiting list: 0.49 TX per year on PD). The best Cox multivariate model for switching from PD to HD includes: post-TX (HR: 1.63 [1.01-2.63]), DM (HR: 1.69 [1.19-2.40]) and age (1.01 [1.00-1.02]) per year. Post-TX patients were younger (43.8 years vs 55.3 years) and with less comorbidity conditions than de novo-PD patients (DM 18.4% vs 21.9%; CV 15.8% vs 24.7%). However post-TX patients had worse clinical evolution with a rapid decline of renal function (∆-3.88 vs -1.8 ml/min per year); a higher admission rate (0.9 vs 0.62 per year) but similar peritonitis rate (0.45 vs 0.53 episodes per year). They also needed to be transferred to HD more frequently (28.9% vs 15.8%; P<.006) and needed more time to TX (4.8 years vs 1.7 years, Kaplan-Meier). Consequently, time spent on PD was higher in the post-TX group (2.8 vs 1.8 year).

LIMITATIONS

Observational study with absence of a standard protocol to switch PD-HD.

CONCLUSION

PD seems to be a good first choice technique due to low mortality and high TX ratio in our area. A previous graft failure is associated with a higher rate of PD-failure but time spent on PD is enough to consider this technique as a good option.

Authors+Show Affiliations

Servicio de Nefrología. H. U. Fundación Alcorcón (REDINREN), C/Budapest s/n, Alcorcón, Madrid, Spain jmportoles@fhalcorcon.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng spa

PubMed ID

21738247

Citation

Portolés, J, et al. "Peritoneal Dialysis and Kidney Transplant. a Two-way Ticket in an Integrated Renal Replacement Therapy Model." Nefrologia : Publicacion Oficial De La Sociedad Espanola Nefrologia, vol. 31, no. 4, 2011, pp. 441-8.
Portolés J, Moreno F, López-Sánchez P, et al. Peritoneal dialysis and kidney transplant. A two-way ticket in an integrated renal replacement therapy model. Nefrologia. 2011;31(4):441-8.
Portolés, J., Moreno, F., López-Sánchez, P., Mancha, J., Gómez, M., Corchete, E., Del Peso, G., Bajo, M. A., Llópez-Carratalá, R., & Fernández-Perpén, A. (2011). Peritoneal dialysis and kidney transplant. A two-way ticket in an integrated renal replacement therapy model. Nefrologia : Publicacion Oficial De La Sociedad Espanola Nefrologia, 31(4), 441-8. https://doi.org/10.3265/Nefrologia.pre2011.May.10898
Portolés J, et al. Peritoneal Dialysis and Kidney Transplant. a Two-way Ticket in an Integrated Renal Replacement Therapy Model. Nefrologia. 2011;31(4):441-8. PubMed PMID: 21738247.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Peritoneal dialysis and kidney transplant. A two-way ticket in an integrated renal replacement therapy model. AU - Portolés,J, AU - Moreno,F, AU - López-Sánchez,P, AU - Mancha,J, AU - Gómez,M, AU - Corchete,E, AU - Del Peso,G, AU - Bajo,M A, AU - Llópez-Carratalá,R, AU - Fernández-Perpén,A, AU - ,, PY - 2011/05/23/accepted PY - 2011/7/9/entrez PY - 2011/7/9/pubmed PY - 2011/12/13/medline SP - 441 EP - 8 JF - Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia JO - Nefrologia VL - 31 IS - 4 N2 - BACKGROUND: Peritoneal dialysis (PD) seems to be a good option to initiate renal replacement therapy (RRT), but patients with graft failure choose PD less frequently than incident patients (de novo). OBJECTIVE: To describe patient movements between PD and kidney transplantation (TX) and risk factors for failure of the PD technique. METHOD: Multicentre observational study of patients starting PD between 2003 and 2009 with follow-up up until January 2010. Survival analysis based on switching from PD to HD as an event using Kaplan-Meier (KM) and forward, stepwise Cox proportional hazards models. Hazard ratio and 95% confidence intervals (HR [CI]) are shown. MAIN VARIABLE: Switch from PD to HD. Two-group comparison: PD post transplant (post-TX) patients (76) compared to pure incident PD (de novo-PD) patients (830). PATIENTS: 906 PD patients from 19 public hospitals with a mean age of 54.8 years (64.9% male); main ESRD aetiology: glomerulonephritis (25.4%), diabetes (16.7%), vascular-ischaemic (10.7%), interstitial (13.6%) and polycystic (11.2%). Comorbidity conditions: Charlson Index 5.1 (SD 2.4); 21.6% diabetes mellitus (DM), 24.0% cardiovascular (CV) events. RESULTS: Mean follow-up period on PD: 1.85 years (95% CI [1.68-2.02 years]). KM estimation for switching to HD due to PD failure was 5.46 years [4.42-6.50 years]. At the end of follow-up, 88 patients had died, 154 had been transferred to HD and 306 had received a graft (annual rate for patients on waiting list: 0.49 TX per year on PD). The best Cox multivariate model for switching from PD to HD includes: post-TX (HR: 1.63 [1.01-2.63]), DM (HR: 1.69 [1.19-2.40]) and age (1.01 [1.00-1.02]) per year. Post-TX patients were younger (43.8 years vs 55.3 years) and with less comorbidity conditions than de novo-PD patients (DM 18.4% vs 21.9%; CV 15.8% vs 24.7%). However post-TX patients had worse clinical evolution with a rapid decline of renal function (∆-3.88 vs -1.8 ml/min per year); a higher admission rate (0.9 vs 0.62 per year) but similar peritonitis rate (0.45 vs 0.53 episodes per year). They also needed to be transferred to HD more frequently (28.9% vs 15.8%; P<.006) and needed more time to TX (4.8 years vs 1.7 years, Kaplan-Meier). Consequently, time spent on PD was higher in the post-TX group (2.8 vs 1.8 year). LIMITATIONS: Observational study with absence of a standard protocol to switch PD-HD. CONCLUSION: PD seems to be a good first choice technique due to low mortality and high TX ratio in our area. A previous graft failure is associated with a higher rate of PD-failure but time spent on PD is enough to consider this technique as a good option. SN - 1989-2284 UR - https://www.unboundmedicine.com/medline/citation/21738247/Peritoneal_dialysis_and_kidney_transplant__A_two_way_ticket_in_an_integrated_renal_replacement_therapy_model_ L2 - http://www.revistanefrologia.com/es/linksolver/ft/ivp/0211-6995/31/441 DB - PRIME DP - Unbound Medicine ER -