The Association of Pre-Kidney Transplant Dialysis Modality with de novo Posttransplant Heart Failure

Authors

Colin R Lenihan
Sai Liu
Medha Airy
Carl Walther
Maria E Montez-Rath
Wolfgang C Winkelmayer

Publication Date

1-1-2021

Journal

Cardiorenal Medicine

DOI

10.1159/000518535

PMID

34515084

PMCID

PMC8678165

PubMedCentral® Posted Date

9-2-2022

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Aged, Female, Heart Failure, Humans, Kidney Transplantation, Male, Medicare, Renal Dialysis, Treatment Outcome, United States, heart failure, end-stage renal disease, hemodialysis, peritoneal dialysis, kidney transplantation, outcomes, cohort study, USRDS

Abstract

BACKGROUND: Heart failure (HF) after kidney transplantation is a significant but understudied problem. Pretransplant dialysis modality could influence incident HF risk through differing cardiac stressors. However, whether pretransplant dialysis modality is associated with the development of posttransplant HF is unknown.

METHODS: We used the US Renal Data System to assemble a cohort of 27,701 patients who underwent their first kidney transplant in the USA between the years 2005 and 2012 and who had Medicare fee-for-service coverage for >6 months preceding their transplant date. Patients with any HF diagnosis prior to transplant were excluded. Detailed baseline patient characteristics and comorbidities were abstracted. The outcome of interest was de novo posttransplant HF. Pretransplant dialysis modality was defined as the dialysis modality used at the time of transplant. We conducted time-to-event analyses using Cox regression. Death was treated as a competing risk in the study's primary analysis. Graft failure was included as a time-varying covariate.

RESULTS: Among eligible patients, 81% were treated with hemodialysis prior to transplant, and hemodialysis patients were more likely to be male, had a shorter dialysis vintage, and had more diabetes and vascular disease diagnoses. When adjusted for all available demographic and clinical data, pretransplant treatment with hemodialysis (vs. peritoneal dialysis) was associated with a 19% increased risk in de novo posttransplant HF, with sub-distribution HR 1.19 (95% CI: 1.09-1.29).

CONCLUSIONS: Our results suggest that choice of pretransplant dialysis modality may impact the development of posttransplant HF.

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