[Peritoneal dialysis after renal graft loss: against maintenance of immunosuppression]

It is well known that the existence of residual renal function (RRF) in peritoneal dialysis (PD) is related, amongst others, to improved results in nutrition, cardiovascular morbidity, and technique and patient survival. It appears natural to think that this fact, obvious in the population who starts replacement therapy, should also occur in dialysis patients in whom RRF depends on a transplant, which could justify maintenance of immunosuppressive treatment (IST). However, there are currently no studies showing a correlation between RRF of the graft and survival on dialysis. At the same time, IST maintenance in an attempt to preserve glomerular filtration rate would involve risks (cardiovascular morbidity, infections, etc.) that could counteract the theoretical beneficial effect on RRF or even worsen prognosis. The available literature analyzing this controversy is scarce and is mostly based on small and retrospective series providing conflicting results. The decision about what to do with IST and how to do it in patients with chronic kidney transplant dysfunction arriving to dialysis should be based on opinions. When faced with this situation, and because of the significant negative effects of IST at cardiovascular and infectious level, the main causes of morbidity and mortality in uremic patients, we advocate discontinuation of IST when PD is started until future studies on the subject are available.