The role of pretransplantation renal replacement therapy modality in kidney allograft and recipient survival
The effect of pretransplantation renal replacement therapy (RRT) modality on allograft and recipient survival outcome is not well understood. We studied allograft and recipient survival by using US Renal Data System records from January 1, 1990, to December 31, 1999, with a follow-up period through...
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Published in | American journal of kidney diseases Vol. 46; no. 3; p. 537 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
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United States
01.09.2005
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Abstract | The effect of pretransplantation renal replacement therapy (RRT) modality on allograft and recipient survival outcome is not well understood.
We studied allograft and recipient survival by using US Renal Data System records from January 1, 1990, to December 31, 1999, with a follow-up period through December 31, 2000 (n = 92,844; 60% males; 70% white; 23% black). Pretransplantation and predominant RRT modality during the end-stage renal disease (ESRD) period and number and specific combinations of RRT modalities were evaluated.
Compared with hemodialysis (HD), a Cox model showed that peritoneal dialysis (PD) immediately before transplantation predicts a 3% lower risk for graft failure (P < 0.05) and 6% lower risk for recipient death (P < 0.001). When predominant RRT modality was analyzed (modality used for > 50% of the ESRD time), PD (hazard ratio [HR], 0.97; P < 0.05) had a protective effect for graft survival compared with HD. Better recipient survival also was associated with PD (HR, 0.96; P < 0.05). Increased number of RRT modalities during the ESRD course was associated with increased risk for graft failure (HR, 1.04 per additional modality used; P < 0.005) and recipient death (HR, 1.11 per additional modality used; P < 0.001). Any combination or any single modality (except for PD + HD for graft survival and PD + HD and PD + HD + transplantation for recipient survival) had protective effects on graft and recipient survival compared with HD.
Our results suggest that compared with PD, HD as an RRT modality immediately before transplantation or as a predominant RRT modality during the ESRD course, used alone or in combination with other RRT modalities, is associated with increased risks for graft failure and recipient death. Increased number of RRT modalities used during the ESRD course is associated with worsening of graft and recipient survival. |
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AbstractList | The effect of pretransplantation renal replacement therapy (RRT) modality on allograft and recipient survival outcome is not well understood.
We studied allograft and recipient survival by using US Renal Data System records from January 1, 1990, to December 31, 1999, with a follow-up period through December 31, 2000 (n = 92,844; 60% males; 70% white; 23% black). Pretransplantation and predominant RRT modality during the end-stage renal disease (ESRD) period and number and specific combinations of RRT modalities were evaluated.
Compared with hemodialysis (HD), a Cox model showed that peritoneal dialysis (PD) immediately before transplantation predicts a 3% lower risk for graft failure (P < 0.05) and 6% lower risk for recipient death (P < 0.001). When predominant RRT modality was analyzed (modality used for > 50% of the ESRD time), PD (hazard ratio [HR], 0.97; P < 0.05) had a protective effect for graft survival compared with HD. Better recipient survival also was associated with PD (HR, 0.96; P < 0.05). Increased number of RRT modalities during the ESRD course was associated with increased risk for graft failure (HR, 1.04 per additional modality used; P < 0.005) and recipient death (HR, 1.11 per additional modality used; P < 0.001). Any combination or any single modality (except for PD + HD for graft survival and PD + HD and PD + HD + transplantation for recipient survival) had protective effects on graft and recipient survival compared with HD.
Our results suggest that compared with PD, HD as an RRT modality immediately before transplantation or as a predominant RRT modality during the ESRD course, used alone or in combination with other RRT modalities, is associated with increased risks for graft failure and recipient death. Increased number of RRT modalities used during the ESRD course is associated with worsening of graft and recipient survival. |
Author | Cheung, Alfred K Hurdle, John F Goldfarb-Rumyantzev, Alexander S Baird, Bradley C Scandling, John D |
Author_xml | – sequence: 1 givenname: Alexander S surname: Goldfarb-Rumyantzev fullname: Goldfarb-Rumyantzev, Alexander S email: alex.goldfarb@hsc.utah.edu organization: University of Utah School of Medicine, Salt Lake City, UT, USA. alex.goldfarb@hsc.utah.edu – sequence: 2 givenname: John F surname: Hurdle fullname: Hurdle, John F – sequence: 3 givenname: John D surname: Scandling fullname: Scandling, John D – sequence: 4 givenname: Bradley C surname: Baird fullname: Baird, Bradley C – sequence: 5 givenname: Alfred K surname: Cheung fullname: Cheung, Alfred K |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/16129217$$D View this record in MEDLINE/PubMed |
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SubjectTerms | Adolescent Adult African Americans - statistics & numerical data Aged Child Comorbidity European Continental Ancestry Group - statistics & numerical data Female Follow-Up Studies Graft Rejection - epidemiology Graft Survival Humans Kidney Failure, Chronic - surgery Kidney Failure, Chronic - therapy Kidney Transplantation - statistics & numerical data Male Middle Aged Pancreas Transplantation - statistics & numerical data Peritoneal Dialysis - statistics & numerical data Postoperative Complications - mortality Proportional Hazards Models Renal Dialysis Renal Replacement Therapy - methods Renal Replacement Therapy - statistics & numerical data Reoperation Survival Analysis Tissue Donors - statistics & numerical data Transplantation, Homologous Treatment Failure Treatment Outcome |
Title | The role of pretransplantation renal replacement therapy modality in kidney allograft and recipient survival |
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