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Is overhydration in CAPD patients a contraindication to renal transplantation?
B Issad1, C Mouquet, M O Bitker
1Department of Nephrology, Hôpital de la Pitié, Paris, France.
Insights
Renal transplantation outcomes in continuous ambulatory peritoneal dialysis (CAPD) patients are comparable to hemodialysis patients. However, CAPD patients often present with overhydration, increasing cardiovascular risks during transplantation.
Area of Science:
- Nephrology
- Transplantation Medicine
- Cardiovascular Physiology
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a treatment for end-stage renal disease.
- Renal transplantation (TR) is a definitive treatment option for CAPD patients.
- Overhydration is a potential complication in CAPD patients.
Purpose of the Study:
- To evaluate renal transplantation outcomes in CAPD patients.
- To assess hemodynamic status and complications in CAPD patients undergoing TR.
- To identify factors influencing TR success in CAPD patients.
Main Methods:
- Retrospective analysis of 56 CAPD patients undergoing renal transplantation over 14 years.
- Comparison of patient and graft survival, plasma creatinine, and rejection episodes with hemodialysis (HD) pre-TR.
- Assessment of pulmonary artery pressure (PAP) and postoperative complications like ascites.
Main Results:
- One-year actuarial patient and graft survival rates were 96% and 86%, respectively.
- No significant difference in outcomes compared to HD patients pre-TR.
- Elevated PAP (average 21.1 +/- 7.4 mm Hg) noted in CAPD patients, suggesting frequent overhydration.
Conclusions:
- Renal transplantation is a viable option for CAPD patients with outcomes similar to HD patients.
- Overhydration in CAPD patients is common and poses cardiovascular risks during TR.
- Pre-transplant detection and management of overhydration are crucial for reducing cardiovascular complications.
Abstract:
Over a 14 year period, 56 of 415 CAPD patients (34 male, 22 female), aged 42.7 +/- 11 years, underwent renal transplantation (TR). A cadaver kidney was used in 53 patients (kidney-pancreas in 2), and a human leucocyte antibody (HLA) identical related donor organ was used in 3. Underlying renal diseases were chronic glomerulonephritis in 30 patients, diabetic nephropathy in 10, interstitial nephropathy in 5, vascular in 4, polycystic kidney in 3, and undetermined in 4. Mean duration of CAPD prior to TR was 13 months (2-56 months). A three-week peritonitis episode-free interval was requested prior to TR. At year 1, actuarial patient and graft survival (96% and 86%, respectively), plasma creatinine, and number of rejection episodes were not different from those recorded in patients treated with hemodialysis (HD) prior to TR. At TR, pulmonary artery pressure (PAP) was elevated (average 21.1 +/- 7.4 mm Hg), > or = 25 mm Hg and > or = 30 mm Hg in 36% and 14.6% of CAPD patients, respectively. Post-TR, HD was performed in 4 patients; no peritoneal infection occurred. Postoperative sonography disclosed ascitis in 12.7% of CAPD patients. The PD catheter was removed two months post-TR. Hemodynamic findings at TR suggest a frequently underestimated overhydration in CAPD patients, which should be detected and treated in order to reduce acute cardiovascular complications at TR.