Actions Speak Louder Than Labs – The Impact of Dialysis Compliance on Posttransplant Outcomes
1Hospital of the U of Pennsylvania, Philadelphia, PA, 2University of Pennsylvania, Philadelphia, PA, 3Children's Hospital of Pennsylvania, Philadelphia, PA, 4University of Alabama at Birmingham, Birmingham, AL
Meeting: 2019 American Transplant Congress
Abstract number: 409
Keywords: Graft failure, Kidney transplantation, Outcome, Survival
Session Information
Session Time: 8:30am-9:15am
Presentation Time: 9:00am-9:15am
Location: Veterans Auditorium
*Purpose: Non-adherence is a modifable risk factor for poor posttransplant outcomes. While the factors contributing to posttransplant non-adherence are complex, noncompliance with the dialysis prescription is often used by transplant physicians as a surrogate marker for posttransplant non-adherence. Dialysis noncompliance is often factored into decisions regarding transplant candidacy, yet the association between the two is tenuous. In this study we examine the association between measures of dialysis non-compliance and posttransplant outcomes.
*Methods: We performed a retrospective cohort study using statistically de-identified 2004-2014 data from a large dialysis provider linked to the OPTN dataset. The cohort was limited to 9543 hemodialysis patients with evaluable lab data and who were transplanted. The primary exposure was dialysis non-compliance defined as hyperkalemia (K>5.2 mEq/L), hyperphosphatemia (Phos>5.5mEq/L), intradialytic weight gain (IDWG) >5kg, treatment shortened by >30min or missed dialysis treatment (not hospitalized or vacation). Multivariable cox regression models were constructed for the outcomes of death and graft loss.
*Results: Noncompliant patients were younger, male, more frequently African American or lived in an urban area. Median household income was higher in the group with hyperkalemia or hyperphosphatemia but lower in those with large IDWG, shortened or missed treatments. In adjusted models accounting for age, sex, race, cause of ESRD, income, insurance, distance to the transplant center, comorbidities, PRA, HLA mismatch, KDPI and immunosuppression, only large IDWG, shortened and missed treatments were associated with death. All 5 non-compliance measures were associated with an increased risk of graft loss but only shortened treatments were associated with acute rejection (AR) within the first year, see Table 1.
*Conclusions: Pretransplant dialysis behaviors have a limited association with patient survival or acute rejection. Shortened treatments, but not hyperkalemia or hyperphosphatemia, may identify patients at increased risk for poor outcomes
| Death | Graft Loss | AR | ||||
| aHR | 95% CI | aHR | 95% CI | OR | 95% CI | |
| K>5.2 | 0.99 | 0.87-1.12 | 1.13 | 1-1.26 | 1.09 | 0.87-1.36 |
| Phos>5.5 | 0.98 | 0.86-1.11 | 1.25 | 1.11-1.4 | 1.02 | 0.81-1.28 |
| IDWG>5kg | 1.37 | 1.20-1.56 | 1.31 | 1.16-1.47 | 1.15 | 0.91-1.46 |
| Shortened treatment | 1.16 | 1.01-1.31 | 1.85 | 1.42-2.4 | 1.59 | 1.24-2.04 |
| Missed treatment | 1.24 | 1.08-1.43 | 1.15 | 1.02-1.31 | 1.09 | 0.86-1.39 |
To cite this abstract in AMA style:
Sawinski D, Lindner H, Schults J, Locke J, Reese P. Actions Speak Louder Than Labs – The Impact of Dialysis Compliance on Posttransplant Outcomes [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/actions-speak-louder-than-labs-the-impact-of-dialysis-compliance-on-posttransplant-outcomes/. Accessed May 18, 2025.« Back to 2019 American Transplant Congress