Home dialysis is a successful strategy in nonrenal solid organ transplant recipients with end-stage renal disease

• Published in: Nephrology, dialysis, transplantation Vol. 25; no. 10; pp. 3425 - 3429
• Main Authors: Cornelis, Tom, Rioux, Jean-Philippe, Bargman, Joanne M., Chan, Christopher T.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.10.2010
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cohort Studies; Emergency and intensive care: renal failure. Dialysis management; Female; Hemodialysis, Home; home dialysis; Hospitalization - statistics & numerical data; Humans; Intensive care medicine; Kidney Failure, Chronic - therapy; Male; Medical sciences; Middle Aged; nocturnal home haemodialysis; Organ Transplantation - adverse effects; peritoneal dialysis; Peritonitis - epidemiology; Retrospective Studies; solid organ transplantation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Kidney disease; Extrarenal dialysis; Urinary system disease; Hemodialysis; Renal failure; home dialysis; Terminal stage; solid organ transplantation; Homotransplantation; nocturnal home haemodialysis; Peritoneal dialysis
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfq373

Background. Chronic kidney disease (CKD) is a common complication of solid organ transplantation with a substantial risk of progression to end-stage renal disease (ESRD). The impact of dialysis modality on morbidity and mortality is unknown in these patients. The aim of the present analysis was to describe our experience with home dialysis [peritoneal dialysis (PD) and home haemodialysis (HHD)] to assess the feasibility of this modality in patients who developed ESRD after nonrenal solid organ transplant (NRSOT). Methods. A retrospective observational cohort study with consecutive patients initiated on home dialysis after NRSOT from 2000 to 2009 was conducted. We collected data on patient demographics, laboratory parameters and blood pressure as well as clinical adverse events using our electronic clinical database. Results. Between 2000 and 2009, 25 patients [median age, 56 years; interquartile range (IQR), 43–65 years] initiated home dialysis. Ten patients started HHD and 15 patients initiated PD. The types of NRSOT were liver (n = 11), heart (n = 8), lung (n = 5) and heart–lung (n = 1). The median vintage of NRSOT at the time of dialysis initiation was 8.7 years (IQR, 6.3–11.4 years). The median home dialysis follow-up was 24 months (IQR, 15–53 months). The median values of blood pressure, phosphate, calcium, parathyroid hormone and haemoglobin were within the K/DOQI targets. The hospitalization and infection rates were 1 episode every 22 and 29 patient-months, respectively. Three patients switched to in-centre conventional HD during follow-up and eight patients died. Conclusions.. Home dialysis (PD and HHD) is a feasible and sustainable modality for patients with ESRD after NRSOT. Home dialysis offers several potential benefits, such as improved haemodynamic and metabolic control, which may be important in the NRSOT population. Home dialysis in patients who develop ESRD after NRSOT should be actively considered for this cohort.