Should peritoneal dialysis be the preferred therapy pre-kidney transplantation?

The impact of pre-transplant dialysis modality on kidney transplant outcomes has been the impetus for many discrepant reports. Although candidacy for kidney transplantation may not necessarily be the main factor in deciding the choice of pre-transplant dialysis modality, certain complications are thought to be associated with one dialysis modality compared with the other and should be acknowledged. Most of the evidence to date, especially that for lower rates of delayed graft function, indicates an advantage for peritoneal dialysis (PD) over hemodialysis. More importantly, some groups of recipients clearly benefit more from receiving PD pre-transplant, a finding that was recently reported for high-risk adult recipients of expanded-criteria donor organs and pediatric recipients of living-donor organs. On the other hand, PD may be associated with a higher risk of early graft thrombosis. Moreover, the published literature highlights the need for caution in older candidates with a family history of diabetes mellitus because of potential higher risk for new-onset post-transplantation diabetes mellitus in PD patients. Interestingly, prospective studies validating those findings are scarce; most of the published reports have been limited by either small patient numbers or a lack of consideration of other confounding risk factors. In the present review, we examined the available literature related to the influence of pre-transplant dialysis modality on post-transplant allograft and recipient outcomes.