[Peritoneal dialysis in patients with chronic kidney-graft failure]

Patients with chronic kidney-graft failure who are starting peritoneal dialysis (PD) treatment need special consideration. The question of whether mortality is higher in these patients than in those who have not received a transplant is controversial. However, some studies suggest that differences in mortality between these groups are mainly explained by variations in age, duration of dialysis and comorbidity. One study showed similar survival between patients with chronic graft failure treated with hemodialysis (HD) and those on PD, but there is some evidence that residual renal function in PD patients with chronic graft failure declines faster than in PD-patients without transplants. Until now there have been no data on whether PD has a positive influence on the course of residual renal clearances compared with the influence of HD. The fact that PD patients with transplants show significantly higher peritoneal transport rates than patients without transplants may have an influence on technique survival. In patients with chronic graft failure, the type and dose of immunosuppressive therapy, as well as its influence on the incidence of acute rejections, residual renal function and infection rates, are also controversial. Immunosuppressive therapy may preserve residual graft function, but these patients have a higher risk of Gram-negative peritonitis, a shorter interval between start of dialysis and first episode of peritonitis, and a higher risk of catheter infections with Staphylococcus aureus than PD patients without transplants. In conclusion, PD is an acceptable treatment option for patients with chronic kidney-graft failure provided that the above clinical aspects are considered (e.g., intensified monitoring of infections and residual renal function).