Peritoneal dialysis favorably influences early graft function after renal transplantation compared to hemodialysis

Background. Delayed graft function (DGF) and acute renal failure (ARF) afte r renal transplantation negatively influence short- and long-term graft out come. Peritoneal dialysis as pretransplantation dialysis modality was repor ted to influence favorably the recovery of renal function immediately after kidney transplantation. It has been hypothesized that fluid status was the factor explaining this better outcome. This hypothesis was tested in this study by multivariate analysis, also including other factors related to DGF and ARF. Methods. The records of peritoneal dialysis (PD; n=40) and hemodialysis (HD ; n=79) patients receiving a first cadaveric kidney transplantation at the University Hospital Gent were analyzed. Results. DGF and ARF were observed in 33 (27 HD and 6 PD, P=0.03) and 14 (1 4 HD and 6 PD, P=0.01) patients, respectively, The number of days needed to reach a serum creatinine 50% below that before transplantation (T-1/2(SCr) ), was correlated with cold ischemia time (CIT) (P<0.001) and body weight g ain (BWG) (P<0.01) and was inversely correlated with urinary output in the first 24 hr (P<0.001), fluid load (P<0.001), and central venous pressure (P <0.001). A multivariate model with CIT (P<0.001), PD as pretransplantation dialysis mode (P=0.01), urinary output in the first 24 hr (P=0.001), BWG (P =0.05), and fluid load (P=0.01) resulted in an R-2 of 0.32 (P<0.001), Using Cox regression analysis, the relative risk for a prolonged T-1/2(SCr) incr eased with 4%/hr CIT (P=0.01) and with 1%/kg BWG: (P=0.02), Fluid load decr eased the relative risk with 5%/liter (P<0.001) and PD as pretransplantatio n modality favorably modified the relative risk by a factor of 1.6 (P=0.01) , Conclusion. PD as pretransplantation dialysis modality can reduce the incid ence and the severity of delayed recovery of renal function after renal tra nsplantation. This protective effect was independent from CIT, and fluid st atus, two other major influencing factors.