Peritoneal dialysis in patients with failed kidney transplant: Single centre experience

Chaudhri, Saurabh; Thomas, Alison; Samad, Nasreen; Fan, Stanley

doi:10.1111/nep.12951

Cited by 8 publications

(14 citation statements)

References 15 publications

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“…Animal studies have indicated that long-term exposure to immunosuppressant therapy (calcineurin inhibition) can lead to fibrosis of the peritoneal membrane [34]. However, in one of the studies included in our review, Chaudhri et al [23] demonstrated similar baseline dialysate-toplasma ratios of creatinine and net ultrafiltration between the two study groups indicating a limited role for long term calcineurin inhibitors on the peritoneal membrane function in patients with kidney transplant.…”

Section: Discussionmentioning

confidence: 80%

“…A separate group of two studies reported higher mortality in the Tx group than in the nTx group. Chen et al [21] found a borderline higher incidence of peritonitis in the Tx group than in the nTx group, while Chaudhri et al [23] found a lower risk of peritonitis in the Tx group. Five studies reported the time-to-first peritonitis episode with four of them finding no differences between the two groups, while Badve et al [18] found significantly longer times in the Tx group than in the nTx group.…”

Section: Resultsmentioning

confidence: 97%

“…Figure 1 presents the study flow-chart. We identified 20 studies for full text analysis of which 12 fulfilled the inclusion criteria [10,11,[14][15][16][17][18][19][20][21][22][23]. Table 1 lists the details of all the studies included (all retrospective in nature and reporting data from different world regions).…”

Section: Resultsmentioning

confidence: 99%

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Comparison of outcomes of peritoneal dialysis between patients after failed kidney transplant and transplant-naïve patients: a meta-analysis of observational studies

Meng

et al. 2021

Renal Failure

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Purpose: The influence of prior failed kidney transplants on outcomes of peritoneal dialysis (PD) is unclear. Thus, we conducted a systematic review and meta-analysis to compare the outcomes of patients initiating PD after a failed kidney transplant with those initiating PD without a prior history of kidney transplantation. Methods: We searched PubMed, Embase, CENTRAL, and Google Scholar databases from inception until 25 November 2020. Our meta-analysis considered the absolute number of events of mortality, technical failures, and patients with peritonitis, and we also pooled multi-variable adjusted hazard ratios (HR). Results: We included 12 retrospective studies. For absolute number of events, our analysis indicated no statistically significant difference in technique failure [RR, 1.14; 95% CI, 0.80-1.61; I 2 ¼52%; p ¼ 0.48], number of patients with peritonitis [RR, 1.13; 95% CI, 0.97-1.32; I 2 ¼5%; p ¼ 0.11] and mortality [RR, 1.00; 95% CI, 0.67-1.50; I 2 ¼63%; p ¼ 0.99] between the study groups. The pooled analysis of adjusted HRs indicated no statistically significant difference in the risk of technique failure [HR, 1.25; 95% CI, 0.88-1.78; I 2 ¼79%; p ¼ 0.22], peritonitis [HR, 1.04; 95% CI, 0.72-1.50; I 2 ¼76%; p ¼ 0.85] and mortality [HR, 1.24; 95% CI, 0.77-2.00; I 2 ¼66%; p ¼ 0.38] between the study groups. Conclusion: Patients with kidney transplant failure initiating PD do not have an increased risk of mortality, technique failure, or peritonitis as compared to transplant-naïve patients initiating PD. Further studies are needed to evaluate the impact of prior and ongoing immunosuppression on PD outcomes.

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Section: Discussionmentioning

confidence: 80%

Section: Resultsmentioning

confidence: 97%

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Comparison of outcomes of peritoneal dialysis between patients after failed kidney transplant and transplant-naïve patients: a meta-analysis of observational studies

Meng

et al. 2021

Renal Failure

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“…Regarding the technique survival, in accordance with others [10,29], no difference was found between the groups in the present study. In contrast, Chaudhri et al found a higher rate of technique failure in patients coming from Tx compared to never-transplanted patients [12]. Yet Benomar et al have reported similar results, and pointed out that poor dialysis adequacy was the main cause of technique failure [7].…”

Section: Discussionmentioning

confidence: 95%

“…Considering peritonitis, Chen et al found a trend toward a lower event-free time in pediatric patients who started PD after Tx failure compared to those who were transplanted naïve [30]. However, studies on the adult population showed no difference regarding peritonitis between groups [7,9,12]. Notably, in those studies, different immunosuppressive protocols were performed after PD initiation, making a comparison between them difficult to analyze.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of incident peritoneal dialysis patients coming from kidney transplantation program: A case-control study

et al. 2020

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Introduction Brazil ranks second in the absolute number of transplantations in the world. Despite improvements in graft survival, many patients will progress to graft loss and return to dialysis. Concerns exist regarding adverse clinical outcomes in this population when undergone peritoneal dialysis (PD). Objective To compare the occurrence of mortality, technique failure, and peritonitis among incident patients in PD coming from either Tx or pre-dialysis treatment. Methodology A retrospective study in which 47 adult patients with Tx failure (Tx group) were matched for age, gender, diabetes mellitus (DM), modality and start year of PD, with 1:1 predialysis patient (nTx group). The Fine-Gray competing risk model was used to analyze mortality and technique failure. Results Compared to nTx, the Tx group had a lower body mass index, serum potassium, and albumin concentrations. A higher ferritin level, transferrin saturation and the number of patients with positive serology for viral hepatitis were also observed in the Tx group. In the multivariate analysis, patients of the Tx group had 4.4-times higher risk of death (p = 0.007), with infection as the main cause. Technique failure and peritonitis were similar in both groups. Conclusion Previous Tx is a risk factor for mortality but not for technique failure or peritonitis in incident patients on a PD program.

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Peritoneal dialysis patient selection from a comorbidity perspective

Heimbürger

Lindholm

2020

Seminars in Dialysis

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Chronic kidney disease (CKD) affects a large part of the population and represents a global public health problem as it is-especially in advanced stages of CKD-associated with major medical, societal, and economic burdens. 1 Despite preventive and therapeutic measures, CKD is often a progressive illness that may lead to end-stage renal disease (ESRD), 2,3 necessitating initiation of renal replacement therapy (RRT) by kidney transplantation, hemodialysis (HD), or peritoneal dialysis (PD). Although the best option for RRT is kidney transplantation, due to its advantages in terms of quality of life and survival, many patients cannot undergo transplantation because of lack of donors, older age, various comorbidities, or specific contraindications, and for these patients, choosing the best dialysis modality, PD or HD, according to their individual need and ability is an important task. 4 While clinical outcomes and life quality with PD are at least as good as with in-center HD, the latter is the dominating dialysis modality in almost all countries. This may be due to absolute contraindications to PD (which are few) or because of patient's preferences; however, many potentially eligible patients may not be considered to be suitable for PD or not even offered the option of PD because of conditions including comorbidities-some of which are the focus of this review-that rightly or wrongly are thought to represent a risk for complications. In addition, financial issues, in particular reimbursement policy, 5-7 has a strong impact on the use of PD, but lies outside the scope of this review.Compared to in-center HD, most studies indicate that PD associates with equivalent or during the first years of dialysis even better survival, 8 several specific medical advantages such as better preservation of residual renal function, 9 and, being a home-based dialysis therapy, socioeconomic advantages such as increased patient autonomy and reduced cost of therapy. 10 Nevertheless, even though as many as 70%-80% of patients may be eligible for PD at the time of dialysis initiation, [11][12][13] and there are no guidelines

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Peritoneal dialysis in patients with failed kidney transplant: Single centre experience

Cited by 8 publications

References 15 publications

Comparison of outcomes of peritoneal dialysis between patients after failed kidney transplant and transplant-naïve patients: a meta-analysis of observational studies

Comparison of outcomes of peritoneal dialysis between patients after failed kidney transplant and transplant-naïve patients: a meta-analysis of observational studies

Clinical outcomes of incident peritoneal dialysis patients coming from kidney transplantation program: A case-control study

Peritoneal dialysis patient selection from a comorbidity perspective

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