THIVEYA THEIVENDRAN1,2,3, KAMAL SUD2,4, KAREN BYTH2,5, VINCENT W LEE1,2
1Department of Renal Medicine, Westmead Hospital, Westmead, Australia, 2Faculty of Medicine and Health, University of Sydney, Sydney, Australia, 3School of Medicine, Western Sydney University, Campbelltown, Australia, 4Department of Renal Medicine, Nepean Hospital, Kingswood, Australia, 5WSLHD Research and Education Network, Westmead Hospital, Westmead, Australia
Background
A single kidney transplant may not meet the lifelong need of kidney replacement therapy in all patients with end stage kidney disease. For patients returning to dialysis after kidney allograft failure, the effect of dialysis modality on patient survival and re-transplantation is unclear.
Aims
To examine patient survival and likelihood of re-transplantation among patients commenced on haemodialysis (HD) as compared to peritoneal dialysis (PD) after failure of first kidney allografts.
Methods
In this longitudinal cohort study using data from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), we included all adults who commenced dialysis between 1 January 2000 and 31 December 2019 after failure of their first kidney allografts. Statistical methods included Cox proportional hazards models for overall survival analysis, and competing risk analysis for time to re-transplantation.
Results
Of the 3470 patients, initial dialysis modality at day 90 post allograft failure was HD in 2755 (79.4%) and PD in 715 (20.6%). As compared to patients commencing on HD, patients commencing on PD were more likely to be under 60 years old (79.4% vs 74.2%), female (49.5% vs 35.7%), from New Zealand (23.8% vs 11.8%) and transition to the other dialysis modality for >180 days (46.2% vs 5.7%). After adjusting for these imbalances and for comorbidities, patients commencing on HD had lower risk of death than those commencing on PD (hazard ratio (HR) 0.83 [95% CI 0.71-0.97], p<0.02)) despite having a reduced likelihood of re-transplantation (HR 0.77 [95% CI 0.66 – 0.89], p<0.001).
Conclusion
Commencement of HD after kidney allograft failure is associated with improved patient survival but lower likelihood of re-transplantation.
Biography:
Thiveya is a Basic Physician Trainee at Concord Repatriation Hospital with a keen interest in all facets of nephrology and clinical research. She completed her Internship and Residency at Westmead Hospital, and enjoyed performing research on chronic kidney disease and dialysis modality following allograft failure. She completed her MBBS (Hons) at Western Sydney University in 2019, and investigated acute kidney injury in colonoscopy at Blacktown Hospital. Thiveya’s other interests include sustainability, cooking and playing soccer.