N KHANAL1,2, PD LAWTON3, A CASS3, SP MCDONALD1,2
1School of Medicine, University of Adelaide, Adelaide, South Australia; 2Australia & New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide; 3Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory
Aim: To determine the relationship of dialysis attendance with subsequent kidney transplant outcomes among NT transplant recipients
Background: In assessment for potential kidney transplantation, surveys suggest nephrologists are concerned that missing dialysis may portend poor post-transplant outcomes. In fact, little is known about the association of dialysis attendance and outcomes of kidney transplantation. We examined the relationship of prior dialysis modality and facility haemodialysis (FHD) attendance with subsequent outcomes in NT kidney transplant recipients.
Methods: Data: NT hospital separations data, linked with demographic, comorbidity and transplant information from ANZDATA. Inclusion criteria: All NT based ESKD patients who started dialysis between 1st January 1995 and 31st December 2011 and received a kidney transplant by 30th June 2012 (n=113). Predictors: dialysis modality or attendance at FHD up to two years before transplantation. Outcome measure: all-cause graft survival post transplantation (including patient death).
Results: There were 67 patients receiving FHD subsequently transplanted, of whom 48 (71.6%) were Indigenous. Based on weekly FHD attendance, patients were divided in three groups: <2.5/week (n=10), 2.50 to 2.75/week (n=14) and >2.75/week (n=43). There were 48 outcome events. Compared to participants receiving self-care dialysis, n=46, hazard ratio (HR) for graft loss or patient death was 1.02 (95% CI, 0.61-1.69) in participants receiving FHD. Among FHD, compared to those attending >2.75 sessions/week, there was no significant trend observed for patients attending 2.50-2.75/week (HR 1.82 [95% CI 0.85-3.85]) or <2.5/week (HR 1.49 [95% CI 0.58-3.81]). With dialysis attendance (sessions per week) examined as a continuous variable, there was no significant trend of association, HR 0.62 (95% CI 0.15-2.60).
Conclusions: In the NT, facility haemodialysis attendance variation was not associated with post-transplant graft and patient survival.