Effect of previously failed kidney transplantation on peritoneal dialysis outcomes in the Australian and New Zealand patient populations

• Published in: Nephrology, dialysis, transplantation Vol. 21; no. 3; pp. 776 - 783
• Main Authors: Badve, Sunil V., Hawley, Carmel M., McDonald, Stephen P., Mudge, David W., Rosman, Johan B., Brown, Fiona G., Johnson, David W.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.03.2006; Oxford Publishing Limited (England)
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Australia - epidemiology; Biological and medical sciences; Disease-Free Survival; Emergency and intensive care: renal failure. Dialysis management; failed renal allograft; Female; Follow-Up Studies; Glomerulonephritis; Humans; Intensive care medicine; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - therapy; Kidney Transplantation - mortality; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; New Zealand - epidemiology; patient survival; Peritoneal Dialysis - methods; peritonitis; Population Surveillance; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Survival Rate - trends; technique survival; transplantation; Treatment Failure; treatment modality; New Zealand; Oceania; Australia; Kidney disease; Human; failed renal allograft; Urinary system disease; Prognosis; patient survival; treatment modality; Hemodialysis; Homograft; technique survival; Survival; Peritoneal dialysis; Extrarenal dialysis; Treatment; Abdominal disease; Renal failure; transplantation; Peritonitis
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfi248

Background. There is limited information about the outcomes of patients commencing peritoneal dialysis (PD) after failed kidney transplantation. The aim of the present study was to compare patient survival, death-censored technique survival and peritonitis-free survival between patients initiating PD after failed renal allografts and those after failed native kidneys. Methods. The study included all patients from the ANZDATA Registry who started PD between April 1, 1991 and March 31, 2004. Times to death, death-censored technique failure and first peritonitis episode were examined by multivariate Cox proportional hazards models. For all outcomes, conditional risk set models were utilized for the multiple failure data, and analyses were stratified by failure order. Standard errors were calculated by using robust variance estimation for the cluster-correlated data. Results. In total, 13 947 episodes of PD were recorded in 23 579 person-years. Of these, 309 PD episodes were started after allograft failure. Compared with PD patients who had never undergone kidney transplantation, those with failed renal allografts were more likely to be younger, Caucasian, New Zealand residents and life-long non-smokers with lower body mass index (BMI), poorer initial renal function and a longer period from commencement of the first renal replacement therapy to PD. On multivariate analysis, PD patients with failed kidney transplants had comparable patient mortality [weighted hazards ratio (HR) 1.09, 95% confidence interval (CI) 0.81–1.45, P = 0.582], death-censored technique failure (adjusted HR 0.91, 95% CI 0.75–1.10, P = 0.315) and peritonitis-free survival (adjusted HR 0.92, 95% CI 0.72–1.16, P = 0.444) with those PD patients who had failed native kidneys. Similar findings were observed in a subset of patients (n = 5496) for whom peritoneal transport status was known and included in the models as a covariate. Conclusion. Patients commencing PD after renal allograft failure experienced outcomes comparable with those with failed native kidneys. PD appears to be a viable option for patients with failed kidney allografts.