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Abstract: SA-PO803

Use of Peritoneal Dialysis After Kidney Transplant Failure Is Associated With Survival Advantage in a Contemporary National Cohort of ESKD Patients

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Kapoor, Sanjana, Albert Einstein College of Medicine, Bronx, New York, United States
  • Fisher, Molly, Albert Einstein College of Medicine, Bronx, New York, United States
  • Mokrzycki, Michele H., Albert Einstein College of Medicine, Bronx, New York, United States
  • Liriano-Ward, Luz E., Albert Einstein College of Medicine, Bronx, New York, United States
  • Akalin, Enver, Albert Einstein College of Medicine, Bronx, New York, United States
  • Johns, Tanya S., Albert Einstein College of Medicine, Bronx, New York, United States
Background

Kidney allograft failure (KAF) is associated with increased mortality. Prior studies suggest that peritoneal dialysis (PD) may offer short-term survival advantage over hemodialysis (HD) after KAF. We compared patient survival by dialysis modality and HD access type with mortality in patients with KAF

Methods

From 2009-2019, adult (>18 years) incident dialysis patients following KAF were identified using the US Renal Data System. We excluded patients who were missing data on dialysis modality or died within 30 days of initiating dialysis. Dialysis modality was analyzed with an intention-to-treat approach in which mortality was attributed to the initial modality. Patients were censored at re-transplantation or study end. Multivariable Cox Proportional hazards models with multiple imputation for missing data were used to determine the association between dialysis modality and access type and mortality

Results

Of 32,649 KAF patients, 3,201 (9.8%) were initially treated with PD and 29,448 (90.2%) with HD. Among those on HD, 11,284 (38.4%) and 18,127 (61.6%) used an arteriovenous access and central venous catheter (CVC), respectively. Compared to the HD group, the PD group was younger (median age 55 vs 51 years, p<0.001); more likely to be Caucasian (69.6% vs 63.4%, p<0.001) and received a living donor transplant (47.1% vs 33.8%, p<0.001); and less likely to have diabetes (28.6% vs 41.2%, p<0.001) and coronary artery disease (8% vs 12.2%, p<0.001). Over the study follow-up [median 6.6y(6.4-6.8y)], there were 10,534 deaths and 6,455 patients had at least one re-transplantation. Compared to HD, initiating PD after KAF was associated with a 14% lower risk of death (adjusted hazard ratio 0.86 [95% confidence interval 0.78 – 0.94]) after adjusting for demographics, donor type, comorbidities, ESKD etiology, albumin, creatinine, hemoglobin and dialysis vintage. The survival advantage was more pronounced when PD was compared to HD initiation via CVC

Conclusion

Among patients with KAF,PD is associated with improved long-term survival compared to HD. CVC for initial access among incident HD patients after KAF is associated with highest risk of mortality. Future studies should elucidate barriers to timely arteriovenous access placement and PD initiation in patients with KAF