title: The role of pretransplantation renal replacement therapy modality in kidney allograft and recipient survival.
abstract: BACKGROUND
  The effect of pretransplantation renal replacement therapy (RRT) modality on allograft and recipient survival outcome is not well understood.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Utah School of Medicine, Salt Lake City, UT, USA. alex.goldfarb@hsc.utah.edu
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Goldfarb-Rumyantzev
authors.forename: John F
authors.initials: JF
authors.lastname: Hurdle
authors.forename: John D
authors.initials: JD
authors.lastname: Scandling
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Baird
authors.forename: Alfred K
authors.initials: AK
authors.lastname: Cheung
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D002648:Child; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery / Q000628:therapy*; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000706:statistics & numerical data; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality*; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D017582:Renal Replacement Therapy / Q000379:methods* / Q000706:statistics & numerical data; D012086:Reoperation; D016019:Survival Analysis; D014019:Tissue Donors / Q000706:statistics & numerical data; D014184:Transplantation, Homologous; D017211:Treatment Failure; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data