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Abstract: PO1308

Returning to Peritoneal Dialysis After Kidney Transplant Failure Is a Valuable Option

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • J. T. Melo, Ana Gabriela, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
  • Ribeiro, Rayra Gomes, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
  • Via Reque Cortes, Daniela del Pilar, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
  • Braga Barbosa, Géssica Sabrine, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
  • Martins, Carolina Steller wagner, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
  • Araujo, Luiza Karla, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
  • Pereira, Benedito J., Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
  • Abensur, Hugo, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
  • Moyses, Rosa M.A., Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
  • Elias, Rosilene M., Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
Background

The prognosis for patients returning to peritoneal dialysis (PD) after a failed transplant is poor and associated with peritonitis and transfer to hemodialysis. PD has an advantage over hemodialysis in preserving residual renal function, which is associated with better outcomes, including survival. Maintaining immunosuppression after starting PD can preserve transplant function but can also increase the risk for infection, and therefore is still arguable.

Methods

We have reviewed electronic charts of patients on PD in the last 8 years in a tertiary academic hospital. We compared survival, residual diuresis and reasons to discontinue PD in 2 groups: patients with graft failure that returned to PD (PD-Ktx, N=17) and other clinical conditions (PD-other, N=153). Reasons for stopping PD therapy included: dialysis inadequacy, kidney transplant, death, transfer to another center, and peritonitis.

Results

The median follow-up was 36 (12,71) months, which was similar between groups [45 (18,96) in PD-Ktx vs. 35 (12,70) months in PD-other, p=0.403]. Patients from PD-Ktx group were lighter than those from PD-other (57.2 ± 14.7 vs. 66.1 ± 16.1kg, p=0.032). Initial and final diuresis volumes were similar among groups (p=0.879 and p=0.698, respectively). Reasons for stopping PD therapy in PD-Ktx and PD-other groups were dialysis inadequacy (17.6% and 20.9%, respectively), kidney transplant (17.6% and 15.7%), death (5.9% and 12.4%), transfer to another center (17.6% and 20.9%), and peritonitis (17.6% and 14.4%). These outcomes were not significantly different between groups (p=0.921). Four out of 17 patients from PD-Ktx maintained immunosuppression and none of those had peritonitis. Kaplan Meier survival comparing PD-Ktx and PD-other showed there is no difference in stopping PD due to peritonitis (log-rank 0.543), which was confirmed in a Cox regression adjusted for weight, diabetes, residual diuresis and age (p=0.493).

Conclusion

Clinicians should leverage the risk of peritonitis versus extend PD technique by preserving residual diuresis in patients with allograft failure returning to PD. We have found similar outcomes in the current study. However, whether withdrawal immunosuppression is needed for these patients requires further investigation.