Effect of pre-transplant dialysis modality on outcomes in the first two years after kidney transplantation

Kidney transplantation (KT) is the treatment of choice for patients with end-stage renal disease (ESRD), off ering superior survival and quality of life compared with dialysis. Several observational studies have investigated the infl uence of hemodialysis (HD) and peritoneal dialysis (PD) on post-transplant outcomes.

Objective: to assess the effect of dialysis modality prior to KT on outcomes during the fi rst two years after transplantation.

Materials and methods. The study included 95 KT recipients, divided into two groups: (1) patients previously treated with PD (n = 45) and (2) patients previously treated with HD (n = 50). The groups were comparable in age, dialysis duration, and immunosuppressive therapy regimens. The mean follow-up period was 19.4 ± 6.4 months.

Results. Delayed graft function (DGF) occurred less frequently in the PD group (17.8%) compared with the HD group (34%), although the diff erence did not reach statistical signifi cance (p = 0.08). Patients in the HD group required signifi cantly more rehospitalizations, with a median of 2.24 [1–3] compared to 1.9 [0–2.5] in the PD group (p = 0.01). Infectious complications were also more common among HD patients (62% vs 42%, p = 0.005). In particular, bacterial infections occurred signifi cantly more often in the HD group (63% vs 43%, p = 0.0001), whereas viral and fungal infections were detected at similar frequencies in both groups (p > 0.2). The incidence of graft rejection was comparable between groups. Two-year graft survival (91% in PD vs 94% in HD, p = 0.8) and patient survival (94% in PD vs 96% in HD, p = 0.9) did not diff er signifi cantly. Likewise, serum creatinine and daily proteinuria at the end of follow-up showed no statistically signifi cant diff erences (p = 0.7 and p = 0.3, respectively).

Conclusion. In this study, patients who received PD prior to transplantation showed more favorable post-transplant outcomes, including a signifi cantly lower frequency of rehospitalizations and infectious complications, as well as a trend toward reduced DGF. However, two-year graft and patient survival were similar between the PD and HD groups.

1. Thurlow JS, Joshi M, Yan G, Norris KC, Agodoa LY, Yuan CM, Nee R. Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy. Am J Nephrol. 2021; 52 (2): 98–107. doi: 10.1159/000514550.

2. Amaral S, Sayed BA, Kutner N, Patzer RE. Preemptive kidney transplantation is associated with survival benefits among pediatric patients with end-stage renal disease. Kidney Int. 2016 Nov; 90 (5): 1100–1108. doi: 10.1016/j.kint.2016.07.028.

3. Molnar MZ, Mehrotra R, Duong U, Bunnapradist S, Lukowsky LR, Krishnan M et al. Dialysis modality and outcomes in kidney transplant recipients. Clin J Am Soc Nephrol. 2012 Feb; 7 (2): 332–341. doi: 10.2215/CJN.07110711.

4. López-Oliva MO, Rivas B, Pérez-Fernández E, Ossorio M, Ros S, Chica C et al. Pretransplant peritoneal dialysis relative to hemodialysis improves long-term survival of kidney transplant patients: a single-center observational study. Int Urol Nephrol. 2014 Apr; 46 (4): 825–832. doi: 10.1007/s11255-013-0521-0.

5. Lin HT, Liu FC, Lin JR, Pang ST, Yu HP. Impact of the pretransplant dialysis modality on kidney transplantation outcomes: a nationwide cohort study. BMJ Open. 2018 Jun 4; 8 (6): e020558. doi: 10.1136/bmjopen-2017-020558.

6. Lenihan CR, Liu S, Airy M, Walther C, Montez-Rath ME, Winkelmayer WC. The association of pre-kidney transplant dialysis modality with de novo posttransplant heart failure. Cardiorenal Med. 2021; 11 (5–6): 209–217. doi: 10.1159/000518535.

7. So S, Au EHK, Lim WH, Lee VWS, Wong G. Factors influencing long-term patient and allograft outcomes in elderly kidney transplant recipients. Kidney Int Rep. 2020 Dec 13; 6 (3): 727–736. doi: 10.1016/j.ekir.2020.11.035.

8. Gardezi AI, Aziz F, Parajuli S. The Role of Peritoneal Dialysis in Different Phases of Kidney Transplantation. Kidney360. 2022 Feb 28; 3 (4): 779–787. doi: 10.34067/KID.0000482022.

9. Morozov YuA, Marchenko TV, Goncharova AV, Doletskaya LG. Function of the kidney transplant at children in the early and late postoperative periods. Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016; 6 (1): 8–15.

10. Bahl D, Haddad Z, Datoo A, Qazi YA. Delayed graft function in kidney transplantation. Curr Opin Organ Transplant. 2019 Feb; 24 (1): 82–86. https://doi.org/10.1097/MOT.0000000000000604.

11. Tapiawala SN, Tinckam KJ, Cardella CJ, Schiff J, Cattran DC, Cole EH, Kim SJ. Delayed graft function and the risk for death with a functioning graft. J Am Soc Nephrol. 2010 Jan; 21 (1): 153–161. https://doi.org/10.1681/ASN.2009040412.

12. Freitas C, Fructuoso M, Martins LS, Almeida M, Pedroso S, Dias L et al. Posttransplant outcomes of peritoneal dialysis versus hemodialysis patients. Transplant Proc. 2011 Jan-Feb; 43 (1): 113–116. https://doi.org/10.1016/j.transproceed.2010.12.008.

13. Sezer S, Karakan S, Özdemir Acar FN, Haberal M. Dialysis as a bridge therapy to renal transplantation: Comparison of graft outcomes according to mode of dialysis treatment. Transplant Proc. 2011 Mar; 43 (2): 485–487. https://doi.org/10.1016/j.transproceed.2011.01.027.

14. Sharma A, Teigeler TL, Behnke M, Cotterell A, Fisher R, King A et al. The mode of pretransplant dialysis does not affect postrenal transplant outcomes in African Americans. J Transplant. 2012; 2012: 303596. https://doi.org/10.1155/2012/303596.

15. Song SH, Lee JG, Lee J, Huh KH, Kim MS, Kim SI, Kim YS. Outcomes of kidney recipients according to mode of pretransplantation renal replacement therapy. Transplant Proc. 2016 Sep; 48 (7): 2461–2463. https://doi.org/10.1016/j.transproceed. 2016.02.096.

16. Yang Q, Zhao S, Chen W, Mao H, Huang F, Zheng Z et al. Influence of dialysis modality on renal transplant complications and outcomes. Clin Nephrol. 2009 Jul; 72 (1): 62–68. https://doi.org/10.5414/CNP72062.

17. Caliskan Y, Yazici H, Gorgulu N, Yelken B, Emre T, Turkmen A et al. Effect of pretransplant dialysis modality on kidney transplantation outcome. Perit Dial Int. 2009 Feb; 29 Suppl 2: S117–S122. https://doi.org/10.1177/089686080902902S23.

18. Dipalma T, Fernandez-Ruiz M, Praga M, Polanco N, Gonzalez E, Gutierrez-Solis E et al. Pretransplant dialysis modality does not influence shortor longterm outcome in kidney transplant recipients: Analysis of paired kidneys from the same deceased donor. Clin Transplant. 2016 Sep; 30 (9): 1097–1107. https://doi.org/10.1111/ctr.12793.

19. Snyder JJ, Kasiske BL, Gilbertson DT, Collins AJ. A comparison of transplant outcomes in peritoneal and hemodialysis patients. Kidney Int. 2002 Oct; 62 (4): 1423–1430. https://doi.org/10.1111/j.1523-1755.2002. kid563.x.

20. Moist LM, Port FK, Orzol SM, Young EW, Ostbye T, Wolfe RA. Predictors of loss of residual renal function among new dialysis patients. J Am Soc Nephrol. 2000 Mar; 11 (3): 556–564. https://doi.org/10.1681/ASN.V113556.

21. Jansen MA, Hart AA, Korevaar JC, Dekker FW, Boeschoten EW, Krediet RT. NECOSAD Study Group. Predictors of the rate of decline of residual renal function in incident dialysis patients. Kidney Int. 2002 Sep; 62 (3): 1046–1053. https://doi.org/10.1046/j.15231755.2002.00505.x.

22. Jain D, Haddad DB, Goel N. Choice of dialysis modality prior to kidney transplantation: Does it matter? World J Nephrol. 2019 Jan 21; 8 (1): 1–10. https://doi.org/10.5527/wjn.v8.i1.0000.

23. Lobbedez T, Lecouf A, Abbadie O, Ficheux M, de Ligny BH, Ryckelynck JP. Peritoneal dialysis and renal transplantation. Contrib Nephrol. 2009; 163: 250–256. https://doi.org/10.1159/000223806.

24. Joachim E, Gardezi AI, Chan MR, Shin JI, Astor BC, Waheed S. Association of pre-transplant dialysis modality and posttransplant outcomes: A meta-analysis. Perit Dial Int. 2017 May-Jun; 37 (3): 259–265. https://doi.org/10.3747/pdi.2016.00011.

25. Tang M, Li T, Liu H. A comparison of transplant outcomes in peritoneal and hemodialysis patients: A metaanalysis. Blood Purif. 2016; 42 (2): 170–176. https://doi.org/10.1159/000446272.

26. Hou YF, Wang XX, Yang HJ, Zhong S. Impact of pretransplant dialysis modality on kidney transplant outcomes: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci. 2022 Apr; 26 (7): 2292–2304. doi: 10.26355/eurrev_202204_28459.

27. Liakopoulos V, Roumeliotis S, Gorny X, Dounousi E, Mertens PR. Oxidative Stress in Hemodialysis Patients: A Review of the Literature. Oxid Med Cell Longev. 2017; 2017: 3081856.

28. Poppelaars F, Faria B, Gaya da Costa M, Franssen CFM, van Son WJ, Berger SP et al. The Complement System in Dialysis: A Forgotten Story? Front Immunol. 2018 Jan 25; 9: 71. doi: 10.3389/fimmu.2018.00071.

29. Vanholder R, Heering P, Loo AV, Biesen WV, Lambert MC, Hesse U et al. Reduced incidence of acute renal graft failure in patients treated with peritoneal dialysis compared with hemodialysis. Am J Kidney Dis. 1999 May; 33 (5): 934–940. https://doi.org/10.1016/S02726386(99)70429-4.

30. Schwenger V, Dohler B, Morath C, Zeier M, Opelz G. The role of pretransplant dialysis modality on renal allograft outcome. Nephrol Dial Transplant. 2011 Nov; 26 (11): 3761–3766. https://doi.org/10.1093/ndt/gfr132.

31. Kramer A, Jager KJ, Fogarty DG, Ravani P, Finne P, Pérez-Panadés J et al. Association between pre-transplant dialysis modality and patient and graft survival after kidney transplantation. Nephrol Dial Transplant. 2012 Dec; 27 (12): 4473–4480. https://doi.org/10.1093/ndt/gfs450.

32. Che X, Yang X, Yan J, Yuan Y, Ma Q, Ying L et al. Effects of pretransplant peritoneal vs hemodialysis modality on outcome of first kidney transplantation from donors after cardiac death. BMC Nephrol. 2018 Sep 17; 19 (1): 235. https://doi.org/10.1186/s12882-018-1013-3.

33. Van Biesen W, Vanholder R, Verbeke F, Lameire N. Is peritoneal dialysis associated with increased cardiovascular morbidity and mortality? Perit Dial Int. 2006 Jul-Aug; 26 (4): 429–434. https://doi.org/10.1177/089686080602600405.

34. Albakr RB, Bargman JM. A comparison of hemodialysis and peritoneal dialysis in patients with cardiovascular disease. Cardiol Clin. 2021 Aug; 39 (3): 447–453. https://doi.org/10.1016/j.ccl.2021.04.013.

35. Awan AA, Niu J, Pan JS, Erickson KF, Mandayam S, Winkelmayer WC et al. Trends in the Causes of Death among Kidney Transplant Recipients in the United States (1996–2014). Am J Nephrol. 2018; 48 (6): 472–481. doi: 10.1159/000495081. Epub 2018 Nov 23. PMID: 30472701; PMCID: PMC6347016.

36. Ying T, Shi B, Kelly PJ, Pilmore H, Clayton PA, Chadban SJ. Death after Kidney Transplantation: An Analysis by Era and Time Post-Transplant. J Am Soc Nephrol. 2020 Dec; 31 (12): 2887–2899. doi: 10.1681/ASN.2020050566.