Transplant outcomes and dialysis modality

The prevalence of end-stage renal disease continues to rise, and patients are treated for increasing periods of time with hemodialysis, peritoneal dialysis, and transplantation. Transition from one treatment modality to another is common, and the astute clinician should be aware of a wide array of observational data regarding the advantages and disadvantages of certain modalities around these transition points. In this paper, we explore data that informs lifelong care of the ESRD patient. The discussion focuses on the impact of dialysis modality on the likelihood of transplantation, and then moves to short-term and long-term outcomes after transplantation. Large observational studies indicate that peritoneal dialysis patients may experience increased rates of graft thrombosis and early (3-month) graft failure. Importantly, however, compared to their HD counterparts PD patients enjoy advantages in shorter time to transplantation, decreased rates of delayed graft function (DGF), and enhanced long-term transplant survival.