BACKGROUND: The effect of pretransplantation renal replacement therapy (RRT) modality on allograft and recipient survival outcome is not well understood. METHODS: We studied allograft and recipient survival by using US Renal Data System records from January 1, 1990, to December 31, 1999, with a follow-up period through December 31, 2000 (n = 92,844; 60% males; 70% white; 23% black). Pretransplantation and predominant RRT modality during the end-stage renal disease (ESRD) period and number and specific combinations of RRT modalities were evaluated. RESULTS: Compared with hemodialysis (HD), a Cox model showed that peritoneal dialysis (PD) immediately before transplantation predicts a 3% lower risk for graft failure (P < 0.05) and 6% lower risk for recipient death (P < 0.001). When predominant RRT modality was analyzed (modality used for > 50% of the ESRD time), PD (hazard ratio [HR], 0.97; P < 0.05) had a protective effect for graft survival compared with HD. Better recipient survival also was associated with PD (HR, 0.96; P < 0.05). Increased number of RRT modalities during the ESRD course was associated with increased risk for graft failure (HR, 1.04 per additional modality used; P < 0.005) and recipient death (HR, 1.11 per additional modality used; P < 0.001). Any combination or any single modality (except for PD + HD for graft survival and PD + HD and PD + HD + transplantation for recipient survival) had protective effects on graft and recipient survival compared with HD. CONCLUSION: Our results suggest that compared with PD, HD as an RRT modality immediately before transplantation or as a predominant RRT modality during the ESRD course, used alone or in combination with other RRT modalities, is associated with increased risks for graft failure and recipient death. Increased number of RRT modalities used during the ESRD course is associated with worsening of graft and recipient survival.
BACKGROUND: The effect of pretransplantation renal replacement therapy (RRT) modality on allograft and recipient survival outcome is not well understood. METHODS: We studied allograft and recipient survival by using US Renal Data System records from January 1, 1990, to December 31, 1999, with a follow-up period through December 31, 2000 (n = 92,844; 60% males; 70% white; 23% black). Pretransplantation and predominant RRT modality during the end-stage renal disease (ESRD) period and number and specific combinations of RRT modalities were evaluated. RESULTS: Compared with hemodialysis (HD), a Cox model showed that peritoneal dialysis (PD) immediately before transplantation predicts a 3% lower risk for graft failure (P < 0.05) and 6% lower risk for recipient death (P < 0.001). When predominant RRT modality was analyzed (modality used for > 50% of the ESRD time), PD (hazard ratio [HR], 0.97; P < 0.05) had a protective effect for graft survival compared with HD. Better recipient survival also was associated with PD (HR, 0.96; P < 0.05). Increased number of RRT modalities during the ESRD course was associated with increased risk for graft failure (HR, 1.04 per additional modality used; P < 0.005) and recipient death (HR, 1.11 per additional modality used; P < 0.001). Any combination or any single modality (except for PD + HD for graft survival and PD + HD and PD + HD + transplantation for recipient survival) had protective effects on graft and recipient survival compared with HD. CONCLUSION: Our results suggest that compared with PD, HD as an RRT modality immediately before transplantation or as a predominant RRT modality during the ESRD course, used alone or in combination with other RRT modalities, is associated with increased risks for graft failure and recipient death. Increased number of RRT modalities used during the ESRD course is associated with worsening of graft and recipient survival.
Authors: María O López-Oliva; Begoña Rivas; Elia Pérez-Fernández; Marta Ossorio; Silvia Ros; Carlos Chica; Ana Aguilar; María-Auxiliadora Bajo; Fernando Escuin; Luis Hidalgo; Rafael Selgas; Carlos Jiménez Journal: Int Urol Nephrol Date: 2013-09-08 Impact factor: 2.370
Authors: Javier Padillo-Ruiz; Alvaro Arjona-Sánchez; Cristobal Muñoz-Casares; Juan Ruiz-Rabelo; Maria Dolores Navarro; Juan C Regueiro Journal: World J Surg Date: 2010-07 Impact factor: 3.352
Authors: Asher A Mendelson; Qiunong Guan; Irina Chafeeva; Gerald A da Roza; Jayachandran N Kizhakkedathu; Caigan Du Journal: Perit Dial Int Date: 2013 Jan-Feb Impact factor: 1.756
Authors: Alessandro Domenici; Maria Cristina Comunian; Loredana Fazzari; Francesca Sivo; Angela Dinnella; Barbara Della Grotta; Giorgio Punzo; Paolo Menè Journal: Int J Nephrol Date: 2011-09-15