Emily J See1,2, Carmel M Hawley1,2,3,4,5, Yeoungjee Cho1,2,3,5, Nigel D Toussaint1,6, John Wm Agar1,7, Elaine M Pascoe1,3,5, Wai H Lim1,8, Ross S Francis1,2, Michael G Collins1,9, David W Johnson1,2,4,5. 1. Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia. 2. Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia. 3. School of Medicine, University of Queensland, Brisbane, Queensland, Australia. 4. Translational Research Institute, Brisbane, Queensland, Australia. 5. Australasian Kidney Trials Network, Brisbane, Queensland, Australia. 6. Department of Nephrology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia. 7. Department of Nephrology, University Hospital Geelong, Geelong, Victoria, Australia. 8. Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia. 9. Department of Nephrology, Auckland City Hospital, Auckland, New Zealand.
Abstract
AIM: Differences in early graft function between kidney transplant recipients previously managed with either haemodialysis (HD) or peritoneal dialysis are well described. However, only two single-centre studies have compared graft and patient outcomes between extended hour and conventional HD patients, with conflicting results. METHODS: This study compared the outcomes of all extended hour (≥24 h/week) and conventional HD patients transplanted in Australia and New Zealand between 2000 and 2014. The primary outcome was delayed graft function (DGF), defined in an ordinal manner as either a spontaneous fall in serum creatinine of less than 10% within 24 h, or the need for dialysis within 72 h following transplantation. Secondary outcomes included the requirement for dialysis within 72 h post-transplant, acute rejection, estimated glomerular filtration rate at 12 months, death-censored graft failure, all-cause and cardiovascular mortality, and a composite of graft failure and mortality. RESULTS: A total of 4935 HD patients (378 extended hour HD, 4557 conventional HD) received a kidney transplant during the study period. Extended hour HD was associated with an increased likelihood of DGF compared with conventional HD (adjusted proportional odds ratio 1.33; 95% confidence interval 1.06-1.67). There was no significant difference between extended hour and conventional HD in terms of any of the secondary outcomes. CONCLUSION: Compared to conventional HD, extended hour HD was associated with DGF, although long-term graft and patient outcomes were not different.
AIM: Differences in early graft function between kidney transplant recipients previously managed with either haemodialysis (HD) or peritoneal dialysis are well described. However, only two single-centre studies have compared graft and patient outcomes between extended hour and conventional HDpatients, with conflicting results. METHODS: This study compared the outcomes of all extended hour (≥24 h/week) and conventional HDpatients transplanted in Australia and New Zealand between 2000 and 2014. The primary outcome was delayed graft function (DGF), defined in an ordinal manner as either a spontaneous fall in serum creatinine of less than 10% within 24 h, or the need for dialysis within 72 h following transplantation. Secondary outcomes included the requirement for dialysis within 72 h post-transplant, acute rejection, estimated glomerular filtration rate at 12 months, death-censored graft failure, all-cause and cardiovascular mortality, and a composite of graft failure and mortality. RESULTS: A total of 4935 HDpatients (378 extended hour HD, 4557 conventional HD) received a kidney transplant during the study period. Extended hour HD was associated with an increased likelihood of DGF compared with conventional HD (adjusted proportional odds ratio 1.33; 95% confidence interval 1.06-1.67). There was no significant difference between extended hour and conventional HD in terms of any of the secondary outcomes. CONCLUSION: Compared to conventional HD, extended hour HD was associated with DGF, although long-term graft and patient outcomes were not different.