Kidney transplant recipients with inadequate dialysis before transplantation have increased risks for delayed graft function and longer hospitalization, Aparna Padiyar, MD, of University Hospitals Cleveland Medical Center, and colleagues reported at the 2019 American Transplant Congress in Boston.

In their single-center retrospective analysis of 101 consecutive kidney transplant recipients, 37 (36.6%) missed 1 or more dialysis sessions in the month before transplantation (average 0.79; maximum 7). Missing dialysis was significantly associated with the need for urgent dialysis prior to transplantation, most often for hyperkalemia, even though pre-transplant serum potassium levels did not differ markedly for this group.

The proportion of patients who experienced delayed graft function was significantly higher among patients who missed 1 or more dialysis sessions than those who did not (86.4% vs 18.6%).

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Use of renin-angiotensin-system blockade before transplant correlated with both missed dialysis and DGF, the investigators reported.

Receiving inadequate pre-transplant KT/V was significantly associated with longer hospitalization.

“Strategies aimed to improve dialysis compliance could potentially reduce risk of DGF and shorten hospitalization,” Dr Padiyar and the team suggested.

Commenting on the new study, Edgardo Laurel, MD, a transplant nephrologist at Banner–University Medicine Transplant Institute in Phoenix, Arizona, noted that the association of missed HD sessions with worse outcomes is well known.

“It is not surprising that kidney transplant recipients who have missed HD or inadequate dialysis prior to transplantation are at increased risk of increased length of stay during their transplant hospitalizations, most likely due to uremia and fluid overload,” Dr Laurel told Renal & Urology News. He noted that missed HD prior to transplantation cannot explain the increased risk for DGF, but superimposing fluid overload or uremia could be a factor. Dr Laurel said he advocates transplant program monitoring and enforcement of dialysis adherence among potential transplant recipients.

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Padiyar A, Agrawal A, Hricik D, et al. The effect of missed hemodialysis treatment prior to transplant. Presented at the 2019 American Transplant Congress in Boston, June 1 to 4. Abstract D12.