Melo Ana Gabriela J T, Barbosa Géssica Sabrine B, V R Cortes Daniela Del P, Ribeiro Rayra G, Araujo Luiza K, Pereira Benedito J, Abensur Hugo, Moysés Rosa M A, Elias Rosilene M
Division of Nephrology, Department of Medicine, Hospital das Clinicas HCFMUSP, São Paulo, Brazil.
Universidade Nove de Julho (UNINOVE), São Paulo, Brazil.
Int Urol Nephrol. 2022 May;54(5):1123-1126. doi: 10.1007/s11255-021-02980-x. Epub 2021 Sep 6.
There is a paucity of data on the prognosis for patients returning to peritoneal dialysis (PD) after a failed transplant. PD has an advantage over hemodialysis in preserving residual renal function, which is associated with better outcomes.
We have reviewed the electronic charts of patients on PD in a tertiary academic hospital for the last 8 years. We have compared technique survival, peritonitis-free survival, and residual diuresis in two groups: patients with graft failure which returned to PD (PD-KTx, N = 18) and patients starting PD for other causes (PD-not KTx, N = 163).
The median follow-up was similar between groups [42(16,71) in PD-not KTx vs. 48(22,90) months in PD-KTx, p = 0.293]. Kaplan-Meier survival comparing PD-KTx and PD-not KTx showed no difference in technique survival (p = 0.196), and peritonitis-free survival (log-rank 0.238), which were confirmed in a fully adjusted Cox regression. Diuresis at baseline and at the end of the first year was similar between groups (p = 0.799 and p = 0.354, respectively). Six out of 18 patients from the PD-KTx group had the immunosuppression maintained and none of those had peritonitis. The reduction of diuresis across the first year of PD was significant for all patients, except for those on continued immunosuppressive therapy.
PD is a worthy dialysis alternative after a failed kidney transplant, providing similar outcomes when compared to patients who started PD for other reasons.
关于移植失败后重新开始腹膜透析（PD）患者的预后数据较少。在保留残余肾功能方面，PD比血液透析具有优势，而残余肾功能与更好的预后相关。
我们回顾了一家三级学术医院过去8年中接受PD治疗患者的电子病历。我们比较了两组患者的技术生存率、无腹膜炎生存率和残余尿量：移植失败后重新开始PD的患者（PD-KTx，N = 18）和因其他原因开始PD的患者（PD-not KTx，N = 163）。
两组的中位随访时间相似[PD-not KTx组为42(16,71)个月，PD-KTx组为48(22,90)个月，p = 0.293]。比较PD-KTx组和PD-not KTx组的Kaplan-Meier生存率显示，技术生存率（p = 0.196）和无腹膜炎生存率（对数秩检验p = 0.238）无差异，这在完全调整的Cox回归中得到证实。两组在基线和第一年结束时的尿量相似（分别为p = 0.799和p = 0.354）。PD-KTx组的18名患者中有6名维持了免疫抑制治疗，且这些患者均未发生腹膜炎。除了继续接受免疫抑制治疗的患者外，所有患者在PD治疗的第一年尿量均显著减少。
肾移植失败后，PD是一种值得选择的透析方式，与因其他原因开始PD的患者相比，其预后相似。
