Harold Simmons Center for Chronic Disease Research and Epidemiology, Harbor-University of California at Los Angeles Medical Center, Torrance, CA 90509-2910, USA.
Clin J Am Soc Nephrol. 2012 Feb;7(2):332-41. doi: 10.2215/CJN.07110711. Epub 2011 Dec 8.
The influence of pretransplant dialysis modality on post-transplant outcomes is not clear. This study examined associations of pretransplant dialysis modality with post-transplant outcomes in a large national cohort of kidney transplant recipients.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Linking the 5-year patient data of a large dialysis organization to the Scientific Registry of Transplant Recipients, 12,416 hemodialysis and 2092 peritoneal dialysis patients who underwent first kidney transplantation were identified. Mortality or graft failure and delayed graft function risks were estimated by Cox regression (hazard ratio) and logistic regression (odds ratio), respectively.
Recipients treated with peritoneal dialysis pretransplantation had lower (21.9/1000 patient-years [95% confidence interval: 18.1-26.5]) crude all-cause mortality rate than those recipients treated with hemodialysis (32.8/1000 patient-years [30.8-35.0]). Pretransplant peritoneal dialysis use was associated with 43% lower adjusted all-cause and 66% lower cardiovascular death. Furthermore, pretransplant peritoneal dialysis use was associated with 17% and 36% lower unadjusted death-censored graft failure and delayed graft function risk, respectively. However, after additional adjustment for relevant covariates, pretransplant peritoneal dialysis modality was not a significant predictor of death-censored graft failure delayed graft function, respectively. Similar trends were noted on analyses using a propensity score matched cohort of 2092 pairs of patients.
Compared with hemodialysis, patients treated with peritoneal dialysis before transplantation had lower mortality but similar graft loss or delayed graft function. Confounding by residual selection bias cannot be ruled out.
移植前透析方式对移植后结局的影响尚不清楚。本研究在一个大型全国性肾移植受者队列中，研究了移植前透析方式与移植后结局的关系。
设计、地点、参与者和测量：将一个大型透析机构的 5 年患者数据与移植受者登记处相联系，确定了 12416 名血液透析和 2092 名腹膜透析患者接受首次肾移植。使用 Cox 回归（风险比）和 logistic 回归（优势比）分别估计死亡率或移植物失功风险和延迟移植物功能风险。
与接受血液透析治疗的患者相比（21.9/1000 患者-年[95%置信区间：18.1-26.5]），接受腹膜透析治疗的患者移植前全因死亡率较低（32.8/1000 患者-年[30.8-35.0]）。移植前腹膜透析的使用与调整后的全因和心血管死亡风险分别降低 43%和 66%相关。此外，移植前腹膜透析的使用与未调整的死亡风险相关的移植物失功和延迟移植物功能风险分别降低 17%和 36%。然而，在进一步调整相关协变量后，移植前腹膜透析方式与死亡风险相关的移植物失功和延迟移植物功能风险无显著相关性。在使用 2092 对患者的倾向评分匹配队列进行的分析中也观察到了类似的趋势。
与血液透析相比，移植前接受腹膜透析治疗的患者死亡率较低，但移植物丢失或延迟移植物功能的发生率相似。不能排除残余选择偏倚的混杂作用。
