*Purpose: Perceived non-adherence with diet and dialysis prescription prior to transplant may be seen as a risk for non-adherence with immunosuppression post-transplant. The importance of compliance with dialysis on post- transplant outcomes has not been sufficiently tested.

*Methods: We performed a single-center retrospective analysis of parameters that may be used to assess diet and dialysis adherence [treatment time variance, potassium, phosphorus] on post-transplant one year graft and patient survival in 101 consecutive renal transplant recipients from April 2015 to October 2018 for whom pre-transplant dialysis data was available.

*Results: Average variance from monthly prescribed treatment time was 3.94 +/- 5.97 hours (notably the average dialysis treatment was 3.83 hours). Minimal variance from treatment time, as defined by less than 2 hours per month variance, was achieved by 54.5% of patients in the month prior to transplant. 78.2% maintained serum potassium levels below the target of 5.5 for three consecutive months prior to transplant. 26.7% of patients were able to maintain serum phosphorus less than 5.5 for three months prior to transplant. Of the 101 patients studied, only 11 were able to maintain all three parameters [minimal variance from treatment time, potassium less than 5.5, and phosphorus less than 5.5] for three consecutive months pre-transplant; see Table 1 for characteristics of these patients. There were no differences in one year graft and patient survival in patients who were able to maintain any or all of the parameters.

*Conclusions: Pre-transplant patients overwhelmingly do not maintain diet and dialysis adherence consistently. The utility of using potassium, phosphorus and variance from prescribed dialysis treatment time in recipient selection is unclear.

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