Hemodialysis or Peritoneal Dialysis, Which Is Better for Patients with Delayed Graft Function?

Abstract

Background/Aims: Hemodialysis (HD) or peritoneal dialysis (PD) is an important renal replacement method in patients with delayed graft function (DGF) after kidney transplantation; however, it is not clear which dialysis modality is superior. This study determined the impact of different dialysis modalities on patients with DGF. Methods: It was a single-center, retrospective and descriptive study. We performed 673 kidney transplants from donors after cardiac death (DCD) between January 2010 and December 2016 at our center and 138 (20.5%) recipients developed DGF after transplantation. We classified the recipients into two groups according to post-transplant dialysis: DGF-HD (n=96) and DGF-PD (n=42). We analyzed the outcomes of the different dialysis modalities 30 days and 1 year post-transplantation. Results: There were no differences in baseline factors between patients with post-transplant HD (n = 96) or PD (n = 42). There were 10 patients with conversion from PD to HD during DGF. The DGF-PD patients had a higher rate of treatment failure than the DGF-HD patients (23.8% vs. 0%, p < 0.001), peritonitis (7.1% vs. 0%, p = 0.027), and longer duration of dialysis dependence (10.5 vs. 9 days, p = 0.003). There was no statistically significant difference between both groups with respect to acute rejection, hemorrhage, and patient and graft survival at 1 year. Conclusion: In renal transplant recipients with DGF, post-transplant PD led to increased treatment failure. PD did not result in rapid recovery of transplanted renal function, and had a high probability of peritonitis.

Continuation of Peritoneal Dialysis in Adult Kidney Transplant Recipients With Delayed Graft Function

“…Our peritonitis rate of 6.25% during DGF was much lower compared to some of the earlier studies reporting these outcomes. [19][20][21] These were comparable to the study by Yan et al 30 Contrary to the above-mentioned studies, our study did not find any case of wound infection or leakage in patients who underwent PD for DGF. One reason for the observed lower rate of complications could be a strict patient selection, as any patient with a potential breach in the peritoneal membrane was excluded.…”

“…37,38 All of these factors may contribute to a speedy recovery of graft function in PD patients. Similar to the two studies mentioned above from Thomson et al 29 and Yan et al, 30 we did not notice any significant difference in long-term graft survival or graft function at the time of last follow-up, indicating that the choice of modality at the time of DGF may not impact long-term outcomes. Rejection within first year and the presence of postsurgery complications were the only factors associated with a higher risk of DCGF.…”

“…Five of 16 patients in our study had to be switched to HD. Our failure rate of 31.3% was slightly higher than what was observed by Yan et al 30 However, three of five patients were switched due to poor clearance. In retrospect, this could have been managed by increasing the number of exchanges as none except one of these patients had inadequate clearance before transplantation.…”

“…There was no difference in rates of acute rejections and glomerular filtration rate at 6 and 12 months between the two groups. Yan et al 30 compared 42 PD patients with 96 HD patients undergoing dialysis for DGF at a single center in China. The PD failure rate was 23.8% and the peritonitis rate was 7.1% in this study.…”

Peritoneal Dialysis for Delayed Graft Function After Kidney Transplantation: To Do or Not to Do?

“…The authors 5 found that the risk factors for peritonitis were more than 2 acute rejection episodes, previous history of peritonitis, and PD catheter exit site infections, technical issues during transplantation including accidental visceral injury or urinary leak, and primary renal allograft nonfunction. On the other hand, Andreetta et al 6 and Yan et al 7 reported a relatively low risk of peritonitis with performing PD posttransplantation. However, the current study by Gardezi et al 1 is somehow at odds with those previously published studies reporting a lower rate of peritonitis of 6.25% during DGF.…”