title: Pretransplant dialysis duration and risk of death after kidney transplantation in the current era.
abstract: BACKGROUND
  Although longer pretransplant dialysis has been associated with poor kidney transplant outcome, no data about this association exist from the current era or from Europe. We studied the association of pretransplant dialysis duration on outcomes after kidney transplantation across two different time periods.
  
  
  METHODS
  All recipients of first kidney transplantation between 1990 and 2010 in Finland were included (N=3,105) in this observational follow-up study of an inception cohort. The association of the duration of pretransplant dialysis with patient and graft survival after transplantation was analyzed with multivariable Cox regression and competing risk analyses. The association of pretransplant dialysis duration with the risk of specific causes of death (cardiovascular, infectious, or other) was analyzed using competing risk analysis.
  
  
  RESULTS
  Longer duration of pretransplant dialysis was an independent risk factor for patient death after transplantation (risk ratio [RR] 1.14 per 1-year increase) in the whole study population, but not for graft loss. Risk of death was increased in patients with greater than 12 months of pretransplant dialysis. After further adjustment in patients transplanted in 2000 to 2010, longer duration of dialysis remained an independent risk factor (RR 1.23 per 1-year increase). Longer duration of dialysis was an independent predictor of death resulting from cardiovascular diseases (RR 1.14 per 1-year increase), but not for other causes.
  
  
  CONCLUSIONS
  The risk of death associated with longer duration of dialysis has not decreased over time, but remains an independent predictor of patient death after kidney transplantation because of increased risk of death resulting from cardiovascular diseases.
authors.affiliation: 1 Department of Medicine, Division of Nephrology, Helsinki University Central Hospital, Helsinki, Finland. 2 Department of Transplant Surgery, Helsinki University Central Hospital, Helsinki, Finland. 3 Finnish Registry for Kidney Diseases, Helsinki, Finland. 4Address correspondence to: Ilkka Helanterä M.D., Ph.D, Department of Medicine, Division of Nephrology, Helsinki University Hospital, Haartmaninkatu 4, Helsinki, Finland.
authors.forename: Ilkka
authors.initials: I
authors.lastname: Helanterä
authors.forename: Kaija
authors.initials: K
authors.lastname: Salmela
authors.forename: Lauri
authors.initials: L
authors.lastname: Kyllönen
authors.forename: Petri
authors.initials: P
authors.lastname: Koskinen
authors.forename: Carola
authors.initials: C
authors.lastname: Grönhagen-Riska
authors.forename: Patrik
authors.initials: P
authors.lastname: Finne
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012306:Risk; D013997:Time Factors; D014850:Waiting Lists