Dialysis Modality and Outcomes in Kidney Transplant Recipients

Molnar, Miklos Z.; Mehrotra, Rajnish; Duong, Uyen; Bunnapradist, Suphamai; Lukowsky, Lilia R.; Krishnan, Mahesh; Kövesdy, Csaba P.; Kalantar-Zadeh, Kamyar

doi:10.2215/cjn.07110711

Cited by 56 publications

(84 citation statements)

References 33 publications

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“…Table 1 depicts the baseline characteristics of the 12 included retrospective cohort studies; they were single-center studies, 2 were multicenter studies and 2 were databasebased studies. Six studies of 187,886 ESRD patients were included in the analysis of patient survival [6][7][8][9][10]17] …”

Section: Discussionmentioning

confidence: 99%

“…However, other studies have indicated an increased survival for patients and grafts treated by peritoneal dialysis (PD) or, on the contrary, increased graft survival by hemodialysis (HD) [5][6][7][8] , despite the fact that the 2 largest studies using national datasets in the 21st century have yielded conflicting results [8,9] . From previous studies, it has been found that short-term posttransplant complications such as acute rejection (AR) and delayed graft function (DGF) have also made differences [1,5,6,[9][10][11][12] . In such situations, a meta-analysis can be helpful to assess whether a true difference exists; the purpose of this systematic review and meta-analysis was to explore which pretransplant dialysis modality yielded better results.…”

Section: Introductionmentioning

confidence: 99%

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A Comparison of Transplant Outcomes in Peritoneal and Hemodialysis Patients: A Meta-Analysis

Tang

Liu

2016

Blood Purif

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Background: Peritoneal dialysis (PD) and hemodialysis (HD) have been considered the 2 standard pre-transplant dialysis modalities in patients awaiting kidney transplantation. However, the impact of pretransplant dialysis on the short- and long-term post-transplant outcomes remains controversial. Methods: We searched PubMed, EMBASE and the Cochrane central register of controlled trials for this review. Twelve studies were identified by strict screening for the meta-analysis. Results: We found that pretransplant PD patients had a significantly lower incidence of delayed graft function than HD patients, with an OR 0.67 (95% CI 0.62-0.72, p < 0.05). In contrast, there was no significant difference in the incidence of acute rejection, OR 0.96 (95% CI 0.75-1.16). Pretransplant PD had a better 5-year patient survival rate than HD, with a hazard ratio 0.86 (95% CI 0.79-0.95, p < 0.05); however, there were no significant differences in the graft survival rate (p = 0.08). Conclusions: We found that PD was a better choice of pretransplant dialysis modality than HD. Video Journal Club ‘Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=446272.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Comparison of Transplant Outcomes in Peritoneal and Hemodialysis Patients: A Meta-Analysis

Tang

Liu

2016

Blood Purif

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“…The creation of the national DaVita dialysis patient cohort has been described previously (19)(20)(21)(22)(23). We collected demographic data (such as age, sex, race, type of insurance, marital status, presence of diabetes, and dialysis vintage) and details of medical history data.…”

Section: Clinical and Demographic Measuresmentioning

confidence: 99%

“…Blood samples methods were described previously (19)(20)(21)(22)(23). Most blood samples were collected predialysis with the exception of postdialysis serum urea nitrogen to calculate urea kinetics.…”

Section: Laboratory Measuresmentioning

confidence: 99%

Association of Pre–Kidney Transplant Markers of Mineral and Bone Disorder with Post-Transplant Outcomes

Molnar¹,

Kövesdy²,

Mucsi³

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Mineral and bone disorders (MBDs) are common in long-term dialysis patients and are risk factors for unfavorable outcomes. The associations between pretransplant levels of MBD surrogates and outcomes after kidney transplantation are not clear. States. All dialysis patients who received a kidney transplant during this period were identified and divided into groups according to increments of pretransplant MBD markers. Unadjusted and multivariate adjusted predictors of transplant outcomes were examined.Results The 11,776 patients were aged 47614 years and 39% were women. Compared with recipients with pretransplant time-averaged serum alkaline phosphatase of 80-120 U/L, recipients with pretransplant serum alkaline phosphatase of 120-160 and $160 U/L had 49% and 64% higher graft failure censored all-cause mortality in multivariable adjusted models. There was no significant association between time-averaged serum alkaline phosphatase categories and risk of death censored graft failure, delayed graft function (DGF), or acute rejection (AR). Compared with recipients with pretransplant time-averaged serum parathyroid hormone (PTH) levels of 150-300 pg/ml, there was no significant association with graft censored death among recipients with pretransplant serum PTH $800 pg/ml. In addition, the risk of graft failure, DGF, and AR did not show any association with time-averaged serum intact PTH level. There was no significant association between timeaveraged serum calcium categories and risk of graft failure censored death, DGF, and AR.Conclusions In this cohort, hemodialysis patients with pretransplant serum alkaline phosphatase .120 U/L have unfavorable post-transplant mortality, whereas there was no association between serum PTH and serum calcium levels and post-transplant outcomes.

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“…There are conflicting reports about the correlation between pre-transplant dialysis modality and post-transplant outcomes [1, 2]; therefore, the association between peritoneal dialysis (PD)/haemodialysis (HD) and post-transplant outcomes remains debatable [3]. In a large survey conducted in the United States involving 14,508 renal transplant recipients during the period from 2001 to 2006, it was found that pre-transplant PD was associated with lower all-cause and cardiovascular mortality; but there was no association between pre-transplant dialysis modality and graft failure risk or delayed graft function in multivariate adjusted models [4]. DGF and AKI after renal transplantation negatively influence short- and long-term graft outcome.…”

mentioning

confidence: 99%