Comparison of outcomes of peritoneal dialysis between patients after failed kidney transplant and transplant-naïve patients: a meta-analysis of observational studies

Abstract

Purpose: The influence of prior failed kidney transplants on outcomes of peritoneal dialysis (PD) is unclear. Thus, we conducted a systematic review and meta-analysis to compare the outcomes of patients initiating PD after a failed kidney transplant with those initiating PD without a prior history of kidney transplantation. Methods: We searched PubMed, Embase, CENTRAL, and Google Scholar databases from inception until 25 November 2020. Our meta-analysis considered the absolute number of events of mortality, technical failures, and patients with peritonitis, and we also pooled multi-variable adjusted hazard ratios (HR). Results: We included 12 retrospective studies. For absolute number of events, our analysis indicated no statistically significant difference in technique failure [RR, 1.14; 95% CI, 0.80-1.61; I 2 ¼52%; p ¼ 0.48], number of patients with peritonitis [RR, 1.13; 95% CI, 0.97-1.32; I 2 ¼5%; p ¼ 0.11] and mortality [RR, 1.00; 95% CI, 0.67-1.50; I 2 ¼63%; p ¼ 0.99] between the study groups. The pooled analysis of adjusted HRs indicated no statistically significant difference in the risk of technique failure [HR, 1.25; 95% CI, 0.88-1.78; I 2 ¼79%; p ¼ 0.22], peritonitis [HR, 1.04; 95% CI, 0.72-1.50; I 2 ¼76%; p ¼ 0.85] and mortality [HR, 1.24; 95% CI, 0.77-2.00; I 2 ¼66%; p ¼ 0.38] between the study groups. Conclusion: Patients with kidney transplant failure initiating PD do not have an increased risk of mortality, technique failure, or peritonitis as compared to transplant-naïve patients initiating PD. Further studies are needed to evaluate the impact of prior and ongoing immunosuppression on PD outcomes.

Peritoneal dialysis after failed kidney allograft: Comparing patients with and without pd before transplant

“…Peritonitis rate was also similar between the groups in all studies except one [13]. In a meta-analysis, Meng et al [31] concluded that new PD patients with a history of failed…”

“…Peritonitis rate was also similar between the groups in all studies except one [ 13 ]. In a meta-analysis, Meng et al [ 31 ] concluded that new PD patients with a history of failed transplant had similar mortality risks as transplant-naïve ones. It is important to note that many previous studies in this area did not match their control group for age and comorbidity load, which may contribute to a better survival in the failed-transplant group [ 10 , 14 , 16 , 17 ].…”

The Role of Peritoneal Dialysis in Different Phases of Kidney Transplantation

“…Multiple studies have compared the outcomes of patients initiating PD after failed kidney transplant with incident ESRD patients receiving PD. Although some small studies have shown poor outcomes in failed transplant patients (84,85), larger studies and a meta-analysis have demonstrated similar outcomes, including peritonitis rates, technique, and patient survival (81,(86)(87)(88). One study compared the outcomes of patients who initiated PD after allograft failure with those who initiated HD (89).…”

Transição para diálise peritoneal: não importa de onde

“…Não existe uma modalidade preferida ao iniciar a diálise após uma falha no enxerto renal, uma vez que tanto a DP quanto a HD parecem ser opções adequadas [7][8][9] . O manejo ideal da imunossupressão em pacientes que iniciam a diálise com um TR malsucedido ainda é incerto, pois os dados nesse campo são escassos.…”