title: Peritoneal dialysis and kidney transplant. A two-way ticket in an integrated renal replacement therapy model.
abstract: BACKGROUND
  Peritoneal dialysis (PD) seems to be a good option to initiate renal replacement therapy (RRT), but patients with graft failure choose PD less frequently than incident patients (de novo).
  
  
  OBJECTIVE
  To describe patient movements between PD and kidney transplantation (TX) and risk factors for failure of the PD technique.
  
  
  METHODS
  Multicentre observational study of patients starting PD between 2003 and 2009 with follow-up up until January 2010. Survival analysis based on switching from PD to HD as an event using Kaplan-Meier (KM) and forward, stepwise Cox proportional hazards models. Hazard ratio and 95% confidence intervals (HR [CI]) are shown. MAIN VARIABLE: Switch from PD to HD. Two-group comparison: PD post transplant (post-TX) patients (76) compared to pure incident PD (de novo-PD) patients (830).
  
  
  METHODS
  906 PD patients from 19 public hospitals with a mean age of 54.8 years (64.9% male); main ESRD aetiology: glomerulonephritis (25.4%), diabetes (16.7%), vascular-ischaemic (10.7%), interstitial (13.6%) and polycystic (11.2%). Comorbidity conditions: Charlson Index 5.1 (SD 2.4); 21.6% diabetes mellitus (DM), 24.0% cardiovascular (CV) events.
  
  
  RESULTS
  Mean follow-up period on PD: 1.85 years (95% CI [1.68-2.02 years]). KM estimation for switching to HD due to PD failure was 5.46 years [4.42-6.50 years]. At the end of follow-up, 88 patients had died, 154 had been transferred to HD and 306 had received a graft (annual rate for patients on waiting list: 0.49 TX per year on PD). The best Cox multivariate model for switching from PD to HD includes: post-TX (HR: 1.63 [1.01-2.63]), DM (HR: 1.69 [1.19-2.40]) and age (1.01 [1.00-1.02]) per year. Post-TX patients were younger (43.8 years vs 55.3 years) and with less comorbidity conditions than de novo-PD patients (DM 18.4% vs 21.9%; CV 15.8% vs 24.7%). However post-TX patients had worse clinical evolution with a rapid decline of renal function (∆-3.88 vs -1.8 ml/min per year); a higher admission rate (0.9 vs 0.62 per year) but similar peritonitis rate (0.45 vs 0.53 episodes per year). They also needed to be transferred to HD more frequently (28.9% vs 15.8%; P<.006) and needed more time to TX (4.8 years vs 1.7 years, Kaplan-Meier). Consequently, time spent on PD was higher in the post-TX group (2.8 vs 1.8 year).
  
  
  CONCLUSIONS
  Observational study with absence of a standard protocol to switch PD-HD.
  
  
  CONCLUSIONS
  PD seems to be a good first choice technique due to low mortality and high TX ratio in our area. A previous graft failure is associated with a higher rate of PD-failure but time spent on PD is enough to consider this technique as a good option.
authors: Servicio de Nefrología. H. U. Fundación Alcorcón (REDINREN), C/Budapest s/n, Alcorcón, Madrid, Spain jmportoles@fhalcorcon.es
authors: J
authors: J
authors: Portolés
authors: F
authors: F
authors: Moreno
authors: P
authors: P
authors: López-Sánchez
authors: J
authors: J
authors: Mancha
authors: M
authors: M
authors: Gómez
authors: E
authors: E
authors: Corchete
authors: G
authors: G
authors: Del Peso
authors: M A
authors: MA
authors: Bajo
authors: R
authors: R
authors: Llópez-Carratalá
authors: A
authors: A
authors: Fernández-Perpén
mesh_terms: D000328:Adult; D015897:Comorbidity; D003953:Diagnosis-Related Groups; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000706:statistics & numerical data; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data; D012306:Risk; D012494:Sampling Studies; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome