*Purpose: Missed hemodialysis sessions confer heightened morbidity and mortality for ESRD patients. The effect of missed dialysis in the month prior to transplant on the immediate post-transplant course of kidney transplant recipients is unclear.

*Methods: We performed a single-center retrospective analysis of dialysis compliance and adequacy (KT/V) pre-transplant on post-transplant outcomes in 101 consecutive renal transplant recipients from April 2015 to October 2018 for whom pre-transplant dialysis data was available.

*Results: 36.6% of kidney transplant recipients missed at least one dialysis session in the month prior to transplant (average 0.79 +/- 1.42 missed treatments, maximum 7). Missed dialysis was significantly associated with need for urgent dialysis prior to transplant (p<0.001) (most often secondary to hyperkalemia) and correlated with delayed graft function (DGF) (p<0.001) post-transplant. There was no association of missed dialysis with length of hospitalization, 90 day readmission rates, or wound complications (Table 1). Pre-transplant KT/V did correlate with length of hospitalization (p<0.04). Pre-transplant serum potassium in the month prior to transplant was not significantly different in the patients with missed or inadequate treatments. Pre-transplant renin angiotensin system blockade did correlate with both DGF (p <0.001) and missed dialysis (p<0.001).

*Conclusions: Kidney transplant recipients who have missed or inadequate dialysis prior to transplantation are at increased risk of delayed graft function and prolonged hospitalization. Strategies aimed to improve dialysis compliance could potentially reduce risk of DGF and shorten hospitalization.

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