Clinical outcomes of incident peritoneal dialysis patients coming from kidney transplantation program: A case-control study

Autoři: Laurisson Albuquerque da Costa aff001;  Maria Cláudia Cruz Andreoli aff001;  Aluizio Barbosa Carvalho aff001;  Sérgio Antonio Draibe aff001;  José Osmar Medina Pestana aff001;  Maria Eugênia Fernandes Canziani aff001
Působiště autorů: Department of Internal Medicine, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil aff001
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article



Brazil ranks second in the absolute number of transplantations in the world. Despite improvements in graft survival, many patients will progress to graft loss and return to dialysis. Concerns exist regarding adverse clinical outcomes in this population when undergone peritoneal dialysis (PD).


To compare the occurrence of mortality, technique failure, and peritonitis among incident patients in PD coming from either Tx or pre-dialysis treatment.


A retrospective study in which 47 adult patients with Tx failure (Tx group) were matched for age, gender, diabetes mellitus (DM), modality and start year of PD, with 1:1 predialysis patient (nTx group). The Fine-Gray competing risk model was used to analyze mortality and technique failure.


Compared to nTx, the Tx group had a lower body mass index, serum potassium, and albumin concentrations. A higher ferritin level, transferrin saturation and the number of patients with positive serology for viral hepatitis were also observed in the Tx group. In the multivariate analysis, patients of the Tx group had 4.4-times higher risk of death (p = 0.007), with infection as the main cause. Technique failure and peritonitis were similar in both groups.


Previous Tx is a risk factor for mortality but not for technique failure or peritonitis in incident patients on a PD program.

Klíčová slova:

Albumins – Death rates – diabetes mellitus – Immunosuppressives – Medical dialysis – Medical risk factors – Peritonitis – Renal transplantation


1. Brazil. Associação Brasileira de Transplantes. Registro Brasileiro de Transplantes. Dimensionamento do Transplantes no Brasil e em cada Estado (2010–2017). [Accessed on 2019 Feb 25]. Available from:

2. United States Renal Data System. 2018 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2018.

3. de Castro Rodrigues Ferreira F, Cristelli MP, Paula MI, Proença H, Felipe CR, Tedesco-Silva H, et al. Infectious complications as the leading cause of death after kidney transplantation: analysis of more than 10,000 transplants from a single center. J Nephrol. 2017.

4. Molnar MZ, Ichii H, Lineen J, Foster CE, Mathe Z, Schiff J, et al. Timing of return to dialysis in patients with failing kidney transplants. Semin Dial. 2013;26(6):667–74. doi: 10.1111/sdi.12129 24016076

5. Rao PS, Schaubel DE, Saran R. Impact of graft failure on patient survival on dialysis: a comparison of transplant-naive and post-graft failure mortality rates. Nephrol Dial Transplant. 2005;20(2):387–91. doi: 10.1093/ndt/gfh595 15585512

6. Sasal J, Naimark D, Klassen J, Shea J, Bargman JM. Late renal transplant failure: an adverse prognostic factor at initiation of peritoneal dialysis. Perit Dial Int. 2001;21(4):405–10. 11587406

7. Benomar M, Vachey C, Lobbedez T, Henriques J, Ducloux D, Vernerey D, et al. Peritoneal dialysis after kidney transplant failure: a nationwide matched cohort study from the French Language Peritoneal Dialysis Registry (RDPLF). Nephrol Dial Transplant. 2018.

8. Mujais S, Story K. Patient and technique survival on peritoneal dialysis in patients with failed renal allograft: a case-control study. Kidney Int Suppl. 2006(103):S133–7. doi: 10.1038/ 17080105

9. Duman S, Aşçi G, Töz H, Ozkahya M, Ertilav M, Seziş M, et al. Patients with failed renal transplant may be suitable for peritoneal dialysis. Int Urol Nephrol. 2004;36(2):249–52. doi: 10.1023/b:urol.0000034678.84908.9b 15368705

10. Badve SV, Hawley CM, McDonald SP, Mudge DW, Rosman JB, Brown FG, et al. Effect of previously failed kidney transplantation on peritoneal dialysis outcomes in the Australian and New Zealand patient populations. Nephrol Dial Transplant. 2006;21(3):776–83. doi: 10.1093/ndt/gfi248 16280374

11. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12. doi: 10.7326/0003-4819-150-9-200905050-00006 19414839

12. Chaudhri S, Thomas AA, Samad N, Fan SL. Peritoneal dialysis in patients with failed kidney transplant: single centre experience. Nephrology (Carlton). 2016.

13. Yang KS, Kim JI, Moon IS, Choi BS, Park CW, Yang CW, et al. The clinical outcome of end-stage renal disease patients who return to peritoneal dialysis after renal allograft failure. Transplant Proc. 2013;45(8):2949–52. doi: 10.1016/j.transproceed.2013.08.080 24157010

14. Joshi U, Guo Q, Yi C, Huang R, Li Z, Yu X, et al. Clinical outcomes in elderly patients on chronic peritoneal dialysis: a retrospective study from a single center in China. Perit Dial Int. 2014;34(3):299–307. doi: 10.3747/pdi.2012.00209 24293663

15. Coronel F, Cigarrán S, Herrero JA. Morbidity and mortality in diabetic patients on peritoneal dialysis. Twenty-five years of experience at a single center. Nefrologia. 2010;30(6):626–32. doi: 10.3265/Nefrologia.pre2010.Jul.10553 21113211

16. Brar A, Markell M, Stefanov DG, Timpo E, Jindal RM, Nee R, et al. Mortality after Renal Allograft Failure and Return to Dialysis. Am J Nephrol. 2017;45(2):180–6. doi: 10.1159/000455015 28110327

17. Yelken BM, Gorgulu N, Caliskan Y, Yazici H, Turkmen A, Yildiz A, et al. Comparison of nutritional status in hemodialysis patients with and without failed renal allografts. Clin Transplant. 2010;24(4):481–7. doi: 10.1111/j.1399-0012.2009.01097.x 19788450

18. Ansell D, Udayaraj UP, Steenkamp R, Dudley CR. Chronic renal failure in kidney transplant recipients. Do they receive optimum care?: data from the UK renal registry. Am J Transplant. 2007;7(5):1167–76. doi: 10.1111/j.1600-6143.2007.01745.x 17355238

19. Kaysi S, Hadj Abdelkader M, Aniort J, Garrouste C, Philipponnet C, Deteix P, et al. Chronic renal failure complications and management in kidney transplanted and nontransplanted patients. Transplant Proc. 2012;44(10):2997–3000. doi: 10.1016/j.transproceed.2012.05.084 23195013

20. Marcén R, del Castillo D, Capdevila L, Fernandez-Fresnedo G, Rodrigo E, Cantarell C, et al. Achieving chronic kidney disease treatment targets in renal transplant recipients: results from a cross-sectional study in Spain. Transplantation. 2009;87(9):1340–6. doi: 10.1097/TP.0b013e3181a23837 19424034

21. Mehrotra R, Duong U, Jiwakanon S, Kovesdy CP, Moran J, Kopple JD, et al. Serum albumin as a predictor of mortality in peritoneal dialysis: comparisons with hemodialysis. Am J Kidney Dis. 2011;58(3):418–28. doi: 10.1053/j.ajkd.2011.03.018 21601335

22. Wang Q, Bernardini J, Piraino B, Fried L. Albumin at the start of peritoneal dialysis predicts the development of peritonitis. Am J Kidney Dis. 2003;41(3):664–9. doi: 10.1053/ajkd.2003.50128 12612991

23. Miskulin DC, Tangri N, Bandeen-Roche K, Zhou J, McDermott A, Meyer KB, et al. Intravenous iron exposure and mortality in patients on hemodialysis. Clin J Am Soc Nephrol. 2014;9(11):1930–9. doi: 10.2215/CJN.03370414 25318751

24. Zitt E, Sturm G, Kronenberg F, Neyer U, Knoll F, Lhotta K, et al. Iron supplementation and mortality in incident dialysis patients: an observational study. PLoS One. 2014;9(12):e114144. doi: 10.1371/journal.pone.0114144 25462819

25. Ishida JH, Marafino BJ, McCulloch CE, Dalrymple LS, Dudley RA, Grimes BA, et al. Receipt of Intravenous Iron and Clinical Outcomes among Hemodialysis Patients Hospitalized for Infection. Clin J Am Soc Nephrol. 2015;10(10):1799–805. doi: 10.2215/CJN.01090115 26416943

26. Bargman JM, Thorpe KE, Churchill DN, Group CPDS. Relative contribution of residual renal function and peritoneal clearance to adequacy of dialysis: a reanalysis of the CANUSA study. J Am Soc Nephrol. 2001;12(10):2158–62. 11562415

27. Hu SL, Joshi P, Kaplan M, Lefkovitz J, Poenariu A, Dworkin LD, et al. Rapid Change in Residual Renal Function Decline Is Associated with Lower Survival and Worse Residual Renal Function Preservation in Peritoneal Dialysis Patients. Perit Dial Int. 2017;37(4):477–81. doi: 10.3747/pdi.2016.00211 28676514

28. Madar H, Korzets A, Ori Y, Herman M, Levy-Drummer RS, Gafter U, et al. Residual renal function in peritoneal dialysis after renal transplant failure. Perit Dial Int. 2010;30(4):470–4. doi: 10.3747/pdi.2009.00168 20628109

29. Davies SJ. Peritoneal dialysis in the patient with a failing renal allograft. Perit Dial Int. 2001;21 Suppl 3:S280–4.

30. Chen A, Martz K, Rao PS. Does allograft failure impact infection risk on peritoneal dialysis: a North American Pediatric Renal Trials and Collaborative Studies Study. Clin J Am Soc Nephrol. 2012;7(1):153–7. doi: 10.2215/CJN.03160411 22246284

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