title: Association of Pre-Transplant Dialysis Modality and Post-Transplant Outcomes: A Meta-Analysis.
abstract: ♦ BACKGROUND: It remains unclear whether post-transplant outcomes differ according to the pre-transplant dialysis modality (peritoneal dialysis [PD] versus hemodialysis [HD]). We performed a meta-analysis of studies that assessed either post-transplant mortality, graft survival, or delayed graft function (DGF) in both PD and HD patients. ♦ METHODS: Two independent authors searched English-language literature from January 1, 1980, through August 31, 2014, national conference proceedings, and reference lists. We used combinations of terms related to dialysis (hemodialysis, peritoneal dialysis, or renal replacement therapy), kidney transplant, and outcomes. Studies were included if they measured any of the 3 post-transplant study outcomes in both pre-transplant HD and PD. ♦ RESULTS: A total of 16 studies were included in the final analysis. Of these, 6 studies reported adjusted hazard ratio for mortality, pooled adjusted risk ratio: 0.89 (95% confidence interval [CI] 0.82 - 0.97) in favor of PD (p= 0.006). The same 6 studies reported adjusted hazard ratio for graft survival, pooled adjusted risk ratio: 0.97 (95% CI 0.92 - 1.01,p= 0.16). A total of 13 studies reported unadjusted DGF. Pooled odds ratio: 0.5 (95% CI 0.41 - 0.63) in favor of PD (p< 0.005). Significant heterogeneity observed for all outcomes: I2 = 72.7%, I2 = 59.9%, and I2 = 66.8%, respectively. ♦ CONCLUSIONS: Based on these results, pre-transplant PD is associated with better post-transplant survival than HD. Pre-transplant PD was also associated with decreased risk for DGF compared with HD, although these results were unadjusted. There was no significant difference in graft survival between pre-transplant HD and PD. These results suggest that PD may be the preferred dialysis modality for patients expected to receive a transplant.
authors.affiliation: Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.
authors.forename: Emily
authors.initials: E
authors.lastname: Joachim
authors.affiliation: Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.
authors.forename: Ali I
authors.initials: AI
authors.lastname: Gardezi
authors.affiliation: Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States mr.chan@hosp.wisc.edu.
authors.forename: Micah R
authors.initials: MR
authors.lastname: Chan
authors.affiliation: Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.
authors.forename: Jung-Im
authors.initials: JI
authors.lastname: Shin
authors.affiliation: Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.|Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.
authors.forename: Brad C
authors.initials: BC
authors.lastname: Astor
authors.affiliation: Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.
authors.forename: Sana
authors.initials: S
authors.lastname: Waheed
mesh_terms: D051799:Delayed Graft Function; D014943:Global Health; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation; D055031:Primary Graft Dysfunction / Q000453:epidemiology*; D006435:Renal Dialysis; D015996:Survival Rate / Q000639:trends
keywords: Dialysis; hemodialysis; peritoneal; transplant