Does the choice of dialysis modality prior to renal transplantation affect transplant outcomes for patients with end-stage renal disease (ESRD)? Results of a new study suggest it does not.

More than 660,000 Americans are receiving treatment for ESRD, according to the National Kidney Foundation. Of these, more than 193,000 have a functioning kidney transplant and 468,000 are dialysis patients.

Kidney transplantation is the preferred treatment, but the shortage of donor kidneys prevents many patients from getting the organs they need, so patients must undergo dialysis for an average of three to five years until an organ becomes available.

Controversy regarding pre-transplant dialysis modality choice continues, with each side presenting data that supports either peritoneal dialysis (PD) or hemodialysis (HD) as the preferred modality, especially as it relates to kidney transplantation outcomes. Many people find PD more convenient, but many medical professionals worry that PD will affect the outcomes of kidney transplantation.

The authors of a new study investigated the outcomes in a study of 251 patients and found no real difference between the two modalities.

In fact, after receiving kidneys from donors after cardiac death, recipients who had previously been on HD or PD had similar rates of complications, according to the results of the study. They also had similar patient, graft, and death-censored graft survival rates.

The authors of this study noted that some data suggested increased risks of early graft failure in patients who underwent PD prior to surgery. Some research shows equivalent transplant outcomes for hemodialysis and peritoneal dialysis, while others show that PD patients had better patient survival, graft function, and delayed graft function outcomes.

Researchers Investigate Effects of Pre-transplant Hemodialysis vs. Peritoneal Modality on Kidney Transplantation Outcomes

The research team conducted a prospective study that included a cohort of 251 patients who underwent first kidney transplantation from donors after cardiac death (DCD) between January 2014 and December 2016. The patient group included 104 patients who underwent HD and 98 PD patients prior to undergoing their first kidney transplant.

The control group included an additional five patients who underwent pre-emptive renal transplantation. The investigators stated that the PD and HD groups were well matched regarding their demographic and baseline characteristics. Duration of follow-up post-transplantation was 12 and 12.5 months in the PD and HD groups, respectively.

There was no significant different between the two groups in the rates of delayed graft function (18.3 vs. 16.3 percent, respectively), patient survival (96.2 vs. 96.9 percent), or graft survival (93.3 vs. 93.9 percent). Death-censored graft survival were also similar at (97.1 vs. 96.9 percent). No graft failures or deaths occurred in the group of patients who received pre-emptive transplants. The groups also had similar acute rejection and surgical complication rates, and similar rates of infection.

The authors concluded their study by saying, "Our results indicate that outcome of first KT from DCD is not affected by pre-transplant dialysis modality of PD or HD in aspects of recovery of renal function, complications as well as patient and graft survival."

Dr. Xiajing Che, of Shanghai Jiao Tong University in Shanghai, China, and colleagues reported their findings in BMC Nephrology.