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Dialysis modality and outcomes in kidney transplant recipients.
Clin J Am Soc Nephrol. 2012 Feb; 7(2):332-41.CJ

Abstract

BACKGROUND AND OBJECTIVES

The influence of pretransplant dialysis modality on post-transplant outcomes is not clear. This study examined associations of pretransplant dialysis modality with post-transplant outcomes in a large national cohort of kidney transplant recipients.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Linking the 5-year patient data of a large dialysis organization to the Scientific Registry of Transplant Recipients, 12,416 hemodialysis and 2092 peritoneal dialysis patients who underwent first kidney transplantation were identified. Mortality or graft failure and delayed graft function risks were estimated by Cox regression (hazard ratio) and logistic regression (odds ratio), respectively.

RESULTS

Recipients treated with peritoneal dialysis pretransplantation had lower (21.9/1000 patient-years [95% confidence interval: 18.1-26.5]) crude all-cause mortality rate than those recipients treated with hemodialysis (32.8/1000 patient-years [30.8-35.0]). Pretransplant peritoneal dialysis use was associated with 43% lower adjusted all-cause and 66% lower cardiovascular death. Furthermore, pretransplant peritoneal dialysis use was associated with 17% and 36% lower unadjusted death-censored graft failure and delayed graft function risk, respectively. However, after additional adjustment for relevant covariates, pretransplant peritoneal dialysis modality was not a significant predictor of death-censored graft failure delayed graft function, respectively. Similar trends were noted on analyses using a propensity score matched cohort of 2092 pairs of patients.

CONCLUSIONS

Compared with hemodialysis, patients treated with peritoneal dialysis before transplantation had lower mortality but similar graft loss or delayed graft function. Confounding by residual selection bias cannot be ruled out.

Authors+Show Affiliations

Harold Simmons Center for Chronic Disease Research and Epidemiology, Harbor-University of California at Los Angeles Medical Center, Torrance, CA 90509-2910, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22156753

Citation

Molnar, Miklos Z., et al. "Dialysis Modality and Outcomes in Kidney Transplant Recipients." Clinical Journal of the American Society of Nephrology : CJASN, vol. 7, no. 2, 2012, pp. 332-41.
Molnar MZ, Mehrotra R, Duong U, et al. Dialysis modality and outcomes in kidney transplant recipients. Clin J Am Soc Nephrol. 2012;7(2):332-41.
Molnar, M. Z., Mehrotra, R., Duong, U., Bunnapradist, S., Lukowsky, L. R., Krishnan, M., Kovesdy, C. P., & Kalantar-Zadeh, K. (2012). Dialysis modality and outcomes in kidney transplant recipients. Clinical Journal of the American Society of Nephrology : CJASN, 7(2), 332-41. https://doi.org/10.2215/CJN.07110711
Molnar MZ, et al. Dialysis Modality and Outcomes in Kidney Transplant Recipients. Clin J Am Soc Nephrol. 2012;7(2):332-41. PubMed PMID: 22156753.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dialysis modality and outcomes in kidney transplant recipients. AU - Molnar,Miklos Z, AU - Mehrotra,Rajnish, AU - Duong,Uyen, AU - Bunnapradist,Suphamai, AU - Lukowsky,Lilia R, AU - Krishnan,Mahesh, AU - Kovesdy,Csaba P, AU - Kalantar-Zadeh,Kamyar, Y1 - 2011/12/08/ PY - 2011/12/14/entrez PY - 2011/12/14/pubmed PY - 2012/6/13/medline SP - 332 EP - 41 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 7 IS - 2 N2 - BACKGROUND AND OBJECTIVES: The influence of pretransplant dialysis modality on post-transplant outcomes is not clear. This study examined associations of pretransplant dialysis modality with post-transplant outcomes in a large national cohort of kidney transplant recipients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Linking the 5-year patient data of a large dialysis organization to the Scientific Registry of Transplant Recipients, 12,416 hemodialysis and 2092 peritoneal dialysis patients who underwent first kidney transplantation were identified. Mortality or graft failure and delayed graft function risks were estimated by Cox regression (hazard ratio) and logistic regression (odds ratio), respectively. RESULTS: Recipients treated with peritoneal dialysis pretransplantation had lower (21.9/1000 patient-years [95% confidence interval: 18.1-26.5]) crude all-cause mortality rate than those recipients treated with hemodialysis (32.8/1000 patient-years [30.8-35.0]). Pretransplant peritoneal dialysis use was associated with 43% lower adjusted all-cause and 66% lower cardiovascular death. Furthermore, pretransplant peritoneal dialysis use was associated with 17% and 36% lower unadjusted death-censored graft failure and delayed graft function risk, respectively. However, after additional adjustment for relevant covariates, pretransplant peritoneal dialysis modality was not a significant predictor of death-censored graft failure delayed graft function, respectively. Similar trends were noted on analyses using a propensity score matched cohort of 2092 pairs of patients. CONCLUSIONS: Compared with hemodialysis, patients treated with peritoneal dialysis before transplantation had lower mortality but similar graft loss or delayed graft function. Confounding by residual selection bias cannot be ruled out. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/22156753/Dialysis_modality_and_outcomes_in_kidney_transplant_recipients_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=22156753 DB - PRIME DP - Unbound Medicine ER -