Dialysis modality and outcomes in kidney transplant recipients

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

Research output: Contribution to journalArticle

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Abstract

Background and objectives the influence of pretransplant dialysis modality on post-transplant outcomes is not clear. This study examined associations of pretransplant dialysis modality with post-transplant outcomes in a large national cohort of kidney transplant recipients. Design, setting, participants, & measurements Linking the 5-year patient data of a large dialysis organization to the Scientific Registry of Transplant Recipients, 12,416 hemodialysis and 2092 peritoneal dialysis patients who underwent first kidney transplantation were identified. Mortality or graft failure and delayed graft function risks were estimated by Cox regression (hazard ratio) and logistic regression (odds ratio), respectively. Results Recipients treated with peritoneal dialysis pretransplantation had lower (21.9/1000 patient-years [95% confidence interval: 18.1-26.5]) crude all-cause mortality rate than those recipients treated with hemodialysis (32.8/1000 patient-years [30.8-35.0]). Pretransplant peritoneal dialysis use was associated with 43% lower adjusted all-cause and 66% lower cardiovascular death. Furthermore, pretransplant peritoneal dialysis use was associated with 17% and 36% lower unadjusted death-censored graft failure and delayed graft function risk, respectively. However, after additional adjustment for relevant covariates, pretransplant peritoneal dialysis modality was not a significant predictor of death-censored graft failure delayed graft function, respectively. Similar trends were noted on analyses using a propensity score matched cohort of 2092 pairs of patients. Conclusions Compared with hemodialysis, patients treated with peritoneal dialysis before transplantation had lower mortality but similar graft loss or delayed graft function. Confounding by residual selection bias cannot be ruled out.

Original languageEnglish (US)
Pages (from-to)332-341
Number of pages10
JournalClinical Journal of the American Society of Nephrology
Volume7
Issue number2
DOIs
StatePublished - Feb 1 2012

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Peritoneal Dialysis
Delayed Graft Function
Dialysis
Transplants
Kidney
Renal Dialysis
Mortality
Propensity Score
Selection Bias
Kidney Transplantation
Registries
Transplant Recipients
Transplantation
Logistic Models
Odds Ratio
Organizations
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Molnar, M. Z., Mehrotra, R., Duong, U., Bunnapradist, S., Lukowsky, L. R., Krishnan, M., ... Kalantar-Zadeh, K. (2012). Dialysis modality and outcomes in kidney transplant recipients. Clinical Journal of the American Society of Nephrology, 7(2), 332-341. https://doi.org/10.2215/CJN.07110711

Dialysis modality and outcomes in kidney transplant recipients. / Molnar, Miklos Z.; Mehrotra, Rajnish; Duong, Uyen; Bunnapradist, Suphamai; Lukowsky, Lilia R.; Krishnan, Mahesh; Kovesdy, Csaba; Kalantar-Zadeh, Kamyar.

In: Clinical Journal of the American Society of Nephrology, Vol. 7, No. 2, 01.02.2012, p. 332-341.

Research output: Contribution to journalArticle

Molnar, MZ, Mehrotra, R, Duong, U, Bunnapradist, S, Lukowsky, LR, Krishnan, M, Kovesdy, C & Kalantar-Zadeh, K 2012, 'Dialysis modality and outcomes in kidney transplant recipients', Clinical Journal of the American Society of Nephrology, vol. 7, no. 2, pp. 332-341. https://doi.org/10.2215/CJN.07110711
Molnar MZ, Mehrotra R, Duong U, Bunnapradist S, Lukowsky LR, Krishnan M et al. Dialysis modality and outcomes in kidney transplant recipients. Clinical Journal of the American Society of Nephrology. 2012 Feb 1;7(2):332-341. https://doi.org/10.2215/CJN.07110711
Molnar, Miklos Z. ; Mehrotra, Rajnish ; Duong, Uyen ; Bunnapradist, Suphamai ; Lukowsky, Lilia R. ; Krishnan, Mahesh ; Kovesdy, Csaba ; Kalantar-Zadeh, Kamyar. / Dialysis modality and outcomes in kidney transplant recipients. In: Clinical Journal of the American Society of Nephrology. 2012 ; Vol. 7, No. 2. pp. 332-341.
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abstract = "Background and objectives the influence of pretransplant dialysis modality on post-transplant outcomes is not clear. This study examined associations of pretransplant dialysis modality with post-transplant outcomes in a large national cohort of kidney transplant recipients. Design, setting, participants, & measurements Linking the 5-year patient data of a large dialysis organization to the Scientific Registry of Transplant Recipients, 12,416 hemodialysis and 2092 peritoneal dialysis patients who underwent first kidney transplantation were identified. Mortality or graft failure and delayed graft function risks were estimated by Cox regression (hazard ratio) and logistic regression (odds ratio), respectively. Results Recipients treated with peritoneal dialysis pretransplantation had lower (21.9/1000 patient-years [95{\%} confidence interval: 18.1-26.5]) crude all-cause mortality rate than those recipients treated with hemodialysis (32.8/1000 patient-years [30.8-35.0]). Pretransplant peritoneal dialysis use was associated with 43{\%} lower adjusted all-cause and 66{\%} lower cardiovascular death. Furthermore, pretransplant peritoneal dialysis use was associated with 17{\%} and 36{\%} lower unadjusted death-censored graft failure and delayed graft function risk, respectively. However, after additional adjustment for relevant covariates, pretransplant peritoneal dialysis modality was not a significant predictor of death-censored graft failure delayed graft function, respectively. Similar trends were noted on analyses using a propensity score matched cohort of 2092 pairs of patients. Conclusions Compared with hemodialysis, patients treated with peritoneal dialysis before transplantation had lower mortality but similar graft loss or delayed graft function. Confounding by residual selection bias cannot be ruled out.",
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