Although long pretransplant dialysis has predicted poor kidney transplant outcome, most of these studies report US data from the 1990s. As immunosuppressive treatment has developed, and marked differences exist in dialysis practices between the US and Europe, little is known about this association in the modern era. We studied the effect of dialysis duration on outcomes after kidney transplantation across different time periods.
All first kidney transplant recipients between 1964-2010 in Finland were included (N=5205). Data from Finnish Registry for Kidney Diseases was used to analyze the risk of patient death and death-censored graft loss associated with the duration of pretransplant dialysis in multivariable Cox regression model (adjusted for age, sex, cause of ESRD, era of transplantation, and dialysis modality). For patients transplanted after 2000, the model was additionally adjusted for cardiovascular comorbidities, immunosuppression, and laboratory data pre and posttransplantation.
Longer duration of pretransplant dialysis was an independent risk factor for patient death after transplantation (Risk ratio 1.11 per one year increase, P<0.001), but not for death-censored graft loss. Risk of death was increased in patients with more than 12 months (mo) of dialysis compared to less than 6 mo of dialysis (RR 1.22 for 12-23 mo, RR 1.25 for 24-35 mo, RR 1.43 for 36-59 mo, and RR 2.07 for >60 mo of dialysis, P<0.001 for each). After further adjustment in patients transplanted after 2000, long duration of dialysis remained an independent risk factor (RR 1.30 per one year increase, P=0.008); already more than 6 mo of dialysis was associated with increased risk of death (RR 3.51 for 6-11 mo, P=0.04; RR 4.18 for 12-23 mo, P=0.02; RR 5.44 for 24-35 mo, P=0.01; and RR 7.22 for 36-59 mo of dialysis, P=0.004). In detailed analysis, longer duration of dialysis was an independent predictor of death due to cardiovascular causes (RR 1.15 per one year increase, P<0.001), but not due to other causes.
Long duration of pretransplant dialysis remains an independent predictor of patient death after transplantation also in the current era, due to increased risk of death due to cardiovascular causes. The risk seemed to have increased over time.
To cite this abstract in AMA style:Helanterä I, Salmela K, Kyllönen L, Koskinen P, Grönhagen-Riska C, Finne P. Longer Duration of Pretransplant Dialysis Is a Risk Factor for Death after Kidney Transplantation Also in the Current Era [abstract]. Am J Transplant. 2013; 13 (suppl 5). http://atcmeetingabstracts.com/abstract/longer-duration-of-pretransplant-dialysis-is-a-risk-factor-for-death-after-kidney-transplantation-also-in-the-current-era/. Accessed November 24, 2017.
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