Practice patterns of dialysis access and outcomes in patients wait-listed early for kidney transplantation
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RESEARCH ARTICLE
Open Access
Practice patterns of dialysis access and outcomes in patients wait-listed early for kidney transplantation Raphaëlle Sylvestre1,2†, Natalia Alencar de Pinho1*† , Ziad A. Massy1,3, Christian Jacquelinet1,4, Mathilde Prezelin-Reydit5,6, Roula Galland7, Bénédicte Stengel1, Raphael Coscas1,2 and on behalf of the French REIN registry
Abstract Background: Early kidney transplantation (KT) is the best option for patients with end-stage kidney disease, but little is known about dialysis access strategy in this context. We studied practice patterns of dialysis access and how they relate with outcomes in adults wait-listed early for KT according to the intended donor source. Methods: This study from the REIN registry (2002–2014) included 9331 incident dialysis patients (age 18–69) waitlisted for KT before or by 6 months after starting dialysis: 8342 candidates for deceased-donor KT and 989 for livingdonor KT. Subdistribution hazard ratios (SHR) of KT and death associated with hemodialysis by catheter or peritoneal dialysis compared with arteriovenous (AV) access were estimated with Fine and Gray models. Results: Living-donor candidates used pretransplant peritoneal dialysis at rates similar to deceased-donor KT candidates, but had significantly more frequent catheter than AV access for hemodialysis (adjusted OR 1.25; 95%CI 1.09–1.43). Over a median follow-up of 43 (IQR: 23–67) months, 6063 patients received transplants and 305 died before KT. Median duration of pretransplant dialysis was 15 (7–27) months for deceased-donor recipients and 9 (5– 15) for living-donor recipients. Catheter use in deceased-donor candidates was associated with a lower SHR for KT (0.88, 95%CI 0.82–0.94) and a higher SHR for death (1.53, 95%CI 1.14–2.04). Only five deaths occurred in living-donor candidates, three of them with catheter use. Conclusions: Pretransplant dialysis duration may be quite long even when planned with a living donor. Advantages from protecting these patients from AV fistula creation must be carefully evaluated against catheterrelated risks. Keywords: Kidney transplantation, Donor type, Dialysis, Vascular access, Patient survival
* Correspondence: [email protected] † Raphaëlle Sylvestre and Natalia Alencar de Pinho contributed equally to this work. 1 Clinical Epidemiology Team, Paris-Saclay University, Paris-Sud University, UVSQ, CESP, Inserm, Villejuif, France Full list of author information is available at the end of the article
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. I
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