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Association of Pre-Transplant Dialysis Modality and Post-Transplant Outcomes: A Meta-Analysis.
Perit Dial Int. 2017 May-Jun; 37(3):259-265.PD

Abstract

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.

Authors+Show Affiliations

Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States mr.chan@hosp.wisc.edu.Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States. Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.

Pub Type(s)

Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

28007762

Citation

Joachim, Emily, et al. "Association of Pre-Transplant Dialysis Modality and Post-Transplant Outcomes: a Meta-Analysis." Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis, vol. 37, no. 3, 2017, pp. 259-265.
Joachim E, Gardezi AI, Chan MR, et al. Association of Pre-Transplant Dialysis Modality and Post-Transplant Outcomes: A Meta-Analysis. Perit Dial Int. 2017;37(3):259-265.
Joachim, E., Gardezi, A. I., Chan, M. R., Shin, J. I., Astor, B. C., & Waheed, S. (2017). Association of Pre-Transplant Dialysis Modality and Post-Transplant Outcomes: A Meta-Analysis. Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis, 37(3), 259-265. https://doi.org/10.3747/pdi.2016.00011
Joachim E, et al. Association of Pre-Transplant Dialysis Modality and Post-Transplant Outcomes: a Meta-Analysis. Perit Dial Int. 2017 May-Jun;37(3):259-265. PubMed PMID: 28007762.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Pre-Transplant Dialysis Modality and Post-Transplant Outcomes: A Meta-Analysis. AU - Joachim,Emily, AU - Gardezi,Ali I, AU - Chan,Micah R, AU - Shin,Jung-Im, AU - Astor,Brad C, AU - Waheed,Sana, Y1 - 2016/12/22/ PY - 2016/01/11/received PY - 2016/09/02/accepted PY - 2016/12/23/pubmed PY - 2018/4/5/medline PY - 2016/12/24/entrez KW - Dialysis KW - hemodialysis KW - peritoneal KW - transplant SP - 259 EP - 265 JF - Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis JO - Perit Dial Int VL - 37 IS - 3 N2 - ♦ 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. SN - 1718-4304 UR - https://www.unboundmedicine.com/medline/citation/28007762/full_citation L2 - https://journals.sagepub.com/doi/10.3747/pdi.2016.00011?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -