Peritoneal Dialysis for Potential Kidney Transplant Recipients: Pride or Prejudice?

Abstract

Kidney transplantation (KT) is recognized as the gold-standard of treatment for patients with end-stage renal disease. Additionally, it has been demonstrated that receiving a pre-emptive KT ensures the best recipient and graft survivals. However, due to an overwhelming discrepancy between the organs available and the patients on the transplant waiting list, the vast majority of transplant candidates require prolonged periods of dialysis before being transplanted. For many years, peritoneal dialysis (PD) and hemodialysis (HD) have been considered competitive renal replacement therapies (RRT). This dualistic vision has recently been questioned by evidence suggesting that an individualized and flexible approach may be more appropriate. In fact, tailored and cleverly planned changes between different RRT modalities, according to the patient’s needs and characteristics, are often needed in order to achieve the best results. While home HD is still under scrutiny in this particular setting, current data seems to favor the use of PD over in-center HD in patients awaiting a KT. In this specific population, the demonstrated advantages of PD are superior quality of life, longer preservation of residual renal function, lower incidence of delayed graft function, better recipient survival, and reduced cost.

Evaluation and comparison of depression, anxiety, self-esteem, and social adaptation in hemodialysis and peritoneal dialysis patients

“…18,19 However, due to the rapid increase in ESRD incidence and the chances of transplantation is low, the vast majority of these patients living with PD or HD throughout their lives. [20][21][22] Studies comparing the patient groups on psychiatric morbidity, which is frequently seen in CKD, can provide a valuable idea about which dialysis method can be preferred at first. Depression is a common psychiatric disorder in dialysis patients.…”

Peritoneal dialysis after shared decision-making: the disparity between reality and patient expectations

“…The advantage of PD over ICHD is that PD can be performed at home by patients, without the need to travel to a hemodialysis center, with increased flexibility and freedom. Accumulating evidence demonstrated that PD has been a cost-saving treatment compared to ICHD in most developed countries and some developing countries [ 4 , 6 ]. The current policy in Taiwan tends to be “PD-Favored”, which means the government’s dialysis policy encourages the use of PD as the treatment option while removing any existing disincentives [ 4 ].…”

“…A study has found that HCPs may offer PD as an option more often to patients with higher health literacy or better self-care abilities [ 7 ]. Although PD emphasizes flexibility and freedom as its advantages, renal replacement therapy must be tailored to the specific needs and preferences of the patient [ 6 , 16 ]; thus, PD is not always the most appropriate treatment modality for the patient. Inadequate patient education might result from the candidacy bias of physicians and nurses [ 17 ].…”

Clinical and Surgical Challenges in Kidney Transplantation: Toward a Personalized Approach?

“…Consolidated knowledge and evidence-based care constantly mutate to adapt new scientific advances to old and emerging clinical or surgical challenges. Necessarily, the progressive changes in our praxis contribute to addressing the issues we face every day, from the well-established [ 1 , 2 , 3 ] to the uncommon ones [ 4 ], as well as to the unprecedented crisis caused by the ongoing SARS-CoV-2 pandemic [ 5 ].…”

“…Once recognized as poor transplant candidates, this complex group of recipients is now routinely transplanted with encouraging long-term recipient and allograft survivals [ 4 ]. In a provocative manuscript, Nardelli and coworkers questioned the preferential use of hemodialysis over peritoneal dialysis in patients awaiting a KT, promoting a more flexible (and perhaps less biased) vision of the two renal replacement modalities [ 3 ]. Lastly, the systematic review performed by the group of researchers from Tor Vergata University summarized current trends in the management of immunosuppression in KT recipients with SARS-CoV-2 infection [ 5 ].…”