Returning to Dialysis after Kidney Transplant Failure. Does the Dialysis Treatment Modality Influence the Survival Prognosis?
Antonio Moreno Salazar1, Cristhian Orellana Chávez1, Teresa García Álvarez1, Carmen Minguez Mañanes1, Julie Wu1, Ana Delgado Ureña1, Javier Naranjo Muñoz1, Juan Manuel Cazorla López1, Florentino Villanego Fernández1, Auxiliadora Mazuecos Blanca1.
1Nefrología, HU PUERTA DEL MAR, CÁDIZ, Spain
Background: Haemodialysis (HD) and peritoneal dialysis (PD) survival results are similar, but there are just a few survival studies about the return to renal replacementent therapy (RRT) after renal transplantation (RT), additionally, these studies are quite uncertain.
Methods: Retrospective cohort study including patients who returned to dialysis (HD or PD) after first kidney transplantation from 01/01/2006 to 31/01/2017. Deceased <90 days after restarting dialysis were excluded. Demographic characteristics, time in RRT, modality of therapy before and after transplantation, Charlson comorbidity index (CCI) and cause of death were analyzed. Survival was calculated till: the end of the study, death, new transplantation or change in dialysis treatment modality.
Results: 165 patients were included. 149 of them return to HD (HD-group) and 16 return to PD (PD-group). Before transplantation, 93.8% of PD-Group used peritoneal dialysis as RRT while only 84.6% used haemodialysis in HD-group (p<0,001). Average age at allograft failure was 54.1±6.2 in PD-group and 59.5±12.5 in HD-Group (p=0,032) with a CCI of 4,4±2,1 in PD-group vs. 5,9±2,5 in HD-group (p=0,027).
A RRT modality change was necessary in 5 (31%) at PD-group vs 4 (2%) at HD-Group (p<0,001). The average time to the change of modality was similar in both cases (921 vs. 914 days, ns). Low dialysis doses (1), catheter problems and late peritonitis episodes (3, time to first episode of peritonitis: 1338 days) were the causes of change at PD-group, however all patients who changed RRT modality in HD-group suffered vascular access problems.
Survival prognosis, even adjusted by CCI, death causes and re-transplantation rate had no statistically significant difference.
Discussion: After allograft failure, haemodialysis is the RRT chosen by most patients. Those who chose peritoneal dialysis used the same therapy before transplantation in the majority of cases. Despite of the fact that patients that chose peritoneal dialysis were younger and had less comorbidities, survival prognosis and re-transplantation rate were similar to haemodialysis patients.
