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Gardezi AI, Aziz F, Parajuli S. The Role of Peritoneal Dialysis in Different Phases of Kidney Transplantation. KIDNEY360 2022; 3:779-787. [PMID: 35721606 PMCID: PMC9136899 DOI: 10.34067/kid.0000482022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/23/2022] [Indexed: 04/28/2023]
Abstract
The utilization of peritoneal dialysis (PD) has been increasing in the past decade owing to various government initiatives and recognition of benefits such as better preservation of residual renal function, quality of life, and lower cost. The Advancing American Kidney Health initiative aims to increase the utilization of home therapies such as PD and kidney transplantation to treat end stage kidney disease (ESKD). A natural consequence of this development is that more patients will receive PD, and many will eventually undergo kidney transplantation. Therefore, it is important to understand the effect of pretransplant PD on posttransplant outcomes such as delayed graft function (DGF), rejection, thrombosis, graft, and patient survival. Furthermore, some of these patients may develop DGF, which raises the question of the utility of PD during DGF and its risks. Although transplant is the best renal replacement therapy option, it is not everlasting, and many transplant recipients must go on dialysis after allograft failure. Can PD be a good option for these patients? This is another critical question. Furthermore, a significant proportion of nonrenal solid organ transplant recipients develop ESKD. Is PD feasible in this group? In this review, we try to address all of these questions in the light of available evidence.
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Affiliation(s)
- Ali I. Gardezi
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Fahad Aziz
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sandesh Parajuli
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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2
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Andrade López AC, Bande Fernández JJ, Rodríguez Suárez C, Astudillo Cortés E. Peritoneal dialysis in non-renal solid organ transplants, experience in our center. Nefrologia 2022; 42:210-212. [PMID: 36153919 DOI: 10.1016/j.nefroe.2020.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/24/2020] [Indexed: 06/16/2023] Open
Affiliation(s)
- Ana Cristina Andrade López
- Área de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
| | | | - Carmen Rodríguez Suárez
- Área de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Elena Astudillo Cortés
- Área de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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3
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Mejia C, Yadav A. Kidney Disease After Nonkidney Solid Organ Transplant. Adv Chronic Kidney Dis 2021; 28:577-586. [PMID: 35367026 DOI: 10.1053/j.ackd.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 11/11/2022]
Abstract
Nonkidney solid organ transplants (NKSOTs) are increasing in the United States with improving long-term allograft and patient survival. CKD is prevalent in patients with NKSOT and is associated with increased morbidity and mortality especially in those who progress to end-stage kidney disease. Calcineurin inhibitor nephrotoxicity is a main contributor to CKD after NKSOT, but other factors in the pretransplant, peritransplant, and post-transplant period can predispose to progressive kidney dysfunction. The management of CKD after NKSOT generally follows society guidelines for native kidney disease. Kidney-protective and calcineurin inhibitor-sparing immunosuppression has been explored in this population and warrants a discussion with transplant teams. Kidney transplantation in NKSOT recipients remains the kidney replacement therapy of choice for suitable candidates, as it provides a survival benefit over remaining on dialysis.
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Côté JM, Ethier I, Cardinal H, Pépin MN. Peritoneal Dialysis After Liver Transplantation: A Systematic Review. Can J Kidney Health Dis 2021; 8:20543581211029722. [PMID: 34350006 PMCID: PMC8293848 DOI: 10.1177/20543581211029722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/25/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Chronic kidney disease following liver transplantation is a major long-term complication. Most liver transplant recipients with kidney failure will be treated with dialysis instead of kidney transplantation due to noneligibility and shortage in organ availability. In this population, the role of peritoneal dialysis (PD) as a modality of kidney replacement therapy (KRT) remains unclear. Objective: To determine the feasibility regarding safety, technique survival, and dialysis efficiency of PD in liver transplant recipients requiring KRT for maintenance dialysis. Design: Systematic review. Setting: Interventional and observational studies reporting the use of PD after liver transplantation. Patients: Adult liver transplant recipients with kidney failure treated with maintenance KRT. Measurements: Extracted data included eligibility criteria, study design, demographics, and PD modality. The following outcomes of interest were extracted: rate of peritonitis and microorganisms involved, noninfectious peritoneal complications, technique survival, and kidney transplantation-censored technique survival. Non-PD complications included overall survival, liver graft dysfunction, and hospitalization rate. Methods: The following databases were searched until July 2020: MedLine/PubMed, EMBASE, CINAHL, and Cochrane Library. Two reviewers independently screening all titles and abstracts of all identified articles. Due to the limited sample size, observational designs and study heterogeneity expected, no meta-analysis was pre-planned. Descriptive statistics were used to report all results. Results: From the 5263 identified studies, 4 were included in the analysis as they reported at least 1 outcome of interest on a total of 21 liver transplant recipients, with an overall follow-up duration on PD of 19.0 (Interquartile range [IQR]: 9.5-29.5) months. Fifteen episodes of peritonitis occurred in a total cumulative PD follow-up of 514 patient-months, representing an incidence rate of 0.35 per year. These episodes did not result in PD technique failure, mortality, or impairment of liver graft function. Limitations: Limitations include the paucity of studies in the field and the small number of patients included in each report, a risk of publication bias and the impossibility to directly compare hemodialysis to PD in this population. These results, therefore, must be interpreted with caution. Conclusions: Based on limited data reporting the feasibility of PD in liver transplant recipients with kidney failure, no signal was associated with an increased risk of infectious complications. Long-term studies evaluating this modality need to be performed. Registration (PROSPERO): CRD42020218374.
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Affiliation(s)
- Jean Maxime Côté
- Division of Nephrology, Department of Medicine, Centre hospitalier de l'Université de Montréal, QC, Canada.,Research Center, Centre hospitalier de l'Université de Montréal, QC, Canada.,Clinical Research Centre, University College Dublin, Ireland
| | - Isabelle Ethier
- Division of Nephrology, Department of Medicine, Centre hospitalier de l'Université de Montréal, QC, Canada.,Research Center, Centre hospitalier de l'Université de Montréal, QC, Canada.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Héloïse Cardinal
- Division of Nephrology, Department of Medicine, Centre hospitalier de l'Université de Montréal, QC, Canada.,Research Center, Centre hospitalier de l'Université de Montréal, QC, Canada
| | - Marie-Noëlle Pépin
- Division of Nephrology, Department of Medicine, Centre hospitalier de l'Université de Montréal, QC, Canada
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Andrade López AC, Bande Fernández JJ, Rodríguez Suárez C, Astudillo Cortés E. Peritoneal dialysis in non-renal solid organ transplants, experience in our center. Nefrologia 2021; 42:S0211-6995(20)30210-1. [PMID: 33500160 DOI: 10.1016/j.nefro.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/16/2020] [Accepted: 09/24/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ana Cristina Andrade López
- Área de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
| | | | - Carmen Rodríguez Suárez
- Área de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Elena Astudillo Cortés
- Área de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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Saiprasertkit N, Nihei CH, Bargman JM. Peritoneal Dialysis in Orthotopic Liver Transplantation Recipients. Perit Dial Int 2017; 38:44-48. [PMID: 29162680 DOI: 10.3747/pdi.2017.00134] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 08/30/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In many dialysis programs, there is resistance to initiating peritoneal dialysis (PD) in liver transplant patients needing renal replacement therapy. This retrospective study reviews the outcome of PD in liver transplant patients at a major transplantation and dialysis center. METHOD We performed a retrospective cohort study in patients who underwent liver transplants and received PD between 1991 and 2016. Patient demographics, laboratory parameters, and adverse events were collected from our electronic database. RESULTS Between 1991 and 2016, 14 patients underwent liver transplants and subsequently received PD. The mean age was 59.0 ± 7.1 years; 42.8% women; the mean time from transplant to PD initiation was 9.7 ± 2.8 years; average follow-up on PD was 31.3 months (range: 9 - 87 months). Hepatitis C was the main cause of liver failure necessitating the transplant (8 patients). Calcineurin inhibitor toxicity was the lead cause of end-stage renal disease (ESRD) (12 patients). The overall peritonitis rate was 39.8 patient-months (0.3 episodes per year at risk). There was 1 patient with relapsing peritonitis, and 1 patient had severe peritonitis and died. Mean survival was 58.9 ± 11.3 months, 4 patients died, 4 received a kidney transplant, 1 patient was transitioned to hemodialysis due to poor ultrafiltration, 1 patient was transferred to another program, 2 remained on PD and 2 patients recovered renal function. Eight patients underwent liver biopsies during their time on PD without complication. CONCLUSION There appears to be no specific concern related to liver transplant patients undergoing PD. Peritonitis and mortality rates were no different from other solid organ recipients or even from the general PD population. The hepatic graft was never threatened, even during peritonitis. Therefore, these patients should not be denied the option of PD.
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Affiliation(s)
| | - Camila H Nihei
- Division of Nephrology, Universidade de Sao Paulo, Sao Paulo, Brazil
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Buffet A, Guillouët S, Lobbedez T, Ficheux M, Lanot A, Béchade C. Safety of Peritoneal Dialysis after Nonrenal Solid-Organ Transplantation. Perit Dial Int 2017; 38:37-43. [PMID: 29162679 DOI: 10.3747/pdi.2017.00125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 08/18/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND End-stage renal disease is a well-known complication after solid-organ transplantation, mostly as a result of calcineurin-inhibitor therapy. Among recipients of solid-organ transplants other than kidneys, peritoneal dialysis (PD) has been considered an accessory technique as an increased risk of infectious complications has been reported. The aim of our study was to evaluate the outcome of patients with a liver, heart, or lung transplant who underwent PD for replacement therapy. METHODS This was a retrospective, monocentric study. Every adult patient starting PD between January 1, 2001, and December 31, 2016, at our center was included. The history of previous solid-organ transplantation was determined. For the statistical analysis, we considered 2 groups of patients: 1 group having a history of transplantation of an organ other than the kidney (lung, heart, liver), and 1 group that was starting dialysis without any prior history of organ transplantation. Patients who had previously undergone kidney transplantation were excluded. The events of interest were the first peritonitis episode, death, and PD failure, defined as transfer to hemodialysis. RESULTS A total of 383 patients started PD during this period, 13 of whom had a history of organ transplantation. We found no significant difference between the solid-organ transplantation patients and those without a history of transplantation in terms of the occurrence of peritonitis (HR [hazard ratio] 0.91 [0.37 - 2.22]), death (HR 0.83 [0.26 - 2.63]), and PD failure (HR 1.01 [0.32 - 3.22]). CONCLUSION Peritoneal dialysis appears to be an effective replacement therapy for patients with a previous history of solid-organ transplantation.
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Affiliation(s)
- Anne Buffet
- Néphrologie, CUMR, CHU de Caen, Caen, France
| | | | - Thierry Lobbedez
- Néphrologie, CUMR, CHU de Caen, Caen, France .,Normandie université, Unicaen, UFR de médecine, Caen, France.,RDPLF, Pontoise, France
| | | | - Antoine Lanot
- Néphrologie, CUMR, CHU de Caen, Caen, France.,Normandie université, Unicaen, UFR de médecine, Caen, France
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Guru P, Prakash R, Sheth H, Bender F, Burr R, Piraino B. Comparison of survival of patients with heart and lung transplants on peritoneal dialysis and hemodialysis. Perit Dial Int 2015; 35:98-101. [PMID: 25700463 DOI: 10.3747/pdi.2013.00299] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Pramod Guru
- University of Pittsburgh School of Medicine 518 Scaife Hall, Pittsburgh, PA
| | - Rachita Prakash
- University of Pittsburgh School of Medicine 518 Scaife Hall, Pittsburgh, PA
| | - Heena Sheth
- University of Pittsburgh School of Medicine 518 Scaife Hall, Pittsburgh, PA
| | - Filitsa Bender
- University of Pittsburgh School of Medicine 518 Scaife Hall, Pittsburgh, PA
| | - Renee Burr
- University of Pittsburgh School of Medicine 518 Scaife Hall, Pittsburgh, PA
| | - Beth Piraino
- University of Pittsburgh School of Medicine 518 Scaife Hall, Pittsburgh, PA
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François K, Bargman JM. Evaluating the benefits of home-based peritoneal dialysis. Int J Nephrol Renovasc Dis 2014; 7:447-55. [PMID: 25506238 PMCID: PMC4260684 DOI: 10.2147/ijnrd.s50527] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Peritoneal dialysis (PD) is an effective renal replacement strategy for patients suffering from end-stage renal disease. PD offers patient survival comparable to or better than in-center hemodialysis while preserving residual kidney function, empowering patient autonomy, and reducing financial burden to payors. The majority of patients suffering from kidney failure are eligible for PD. In patients with cardiorenal syndrome and uncontrolled fluid status, PD is of particular benefit, decreasing hospitalization rates and duration. This review discusses the benefits of chronic PD, performed by the patient or a caregiver at home. Recognition of the benefits of PD is a cornerstone in stimulating the use of this treatment strategy.
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Affiliation(s)
- Karlien François
- Division of Nephrology, University Health Network Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Joanne M Bargman
- Division of Nephrology, University Health Network Toronto General Hospital, University of Toronto, Toronto, ON, Canada
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Cornelis T, Kooman JP, van der Sande FM. Intensive home hemodialysis: the best treatment in the best system. Nephrol Dial Transplant 2011; 26:3067-8; author reply 3068. [DOI: 10.1093/ndt/gfr348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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