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

Badve, Sunil V., Hawley, Carmel M., McDonald, Stephen P., Mudge, David W., Rosman, Johan B., Brown, Fiona G., Johnson, David W. and ANZDATA Registry PD Working Comm (2006) Effect of previously failed kidney transplantation on peritoneal dialysis outcomes in the Australian and New Zealand patient populations. Nephrology Dialysis Transplantation, 21 3: 776-783. doi:10.1093/ndt/gfi248


Author Badve, Sunil V.
Hawley, Carmel M.
McDonald, Stephen P.
Mudge, David W.
Rosman, Johan B.
Brown, Fiona G.
Johnson, David W.
ANZDATA Registry PD Working Comm
Title Effect of previously failed kidney transplantation on peritoneal dialysis outcomes in the Australian and New Zealand patient populations
Journal name Nephrology Dialysis Transplantation   Check publisher's open access policy
ISSN 0931-0509
ISBN 0931-0509; 1460-2385
Publication date 2006
Sub-type Article (original research)
DOI 10.1093/ndt/gfi248
Volume 21
Issue 3
Start page 776
End page 783
Total pages 8
Editor N. Lameire
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Collection year 2006
Language eng
Subject 730118 Organs, diseases and abnormal conditions not elsewhere classified
110312 Nephrology and Urology
Formatted abstract
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.
Keyword Transplantation
Urology & Nephrology
Failed Renal Allograft
Patient Survival
Peritonitis
Technique Survival
Treatment Modality
Residual Renal-function
Transport
Failure
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
2007 Higher Education Research Data Collection
School of Medicine Publications
 
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Created: Wed, 15 Aug 2007, 10:00:32 EST