Introduction: In an effort to examine the relationship between ECF status and treatment modality, we analyzed spontaneous body weight reduction and osmotic excretion after renal transplantation in PD and preemptive transplant (PKT) compared to HD patients retrospectively.
Methods: From 2000 to 2016, a total of 42 PD patients had renal transplantation in this institution. After excluded those patients who were pediatric and cadaveric, 21 PD patients were identified in this analysis (PD group: 31.7 ± 11.6 yrs old at transplantation, ESRD duration is 32.9 ± 34.8 month, no diabetic patients). From 2000 to 2016, a total of 11 adult PKT patients were also examined (PKT group: 28.7 ± 17.9 yrs, GFR 7.9 ± 1.6 ml/min at transplant, no diabetic). From 2001 to 2002, a total of 29 living related renal transplant patients from HD support were the control (HD group: 36.4 ± 11.3 yrs, ESRD duration 37.5 ± 55.2 month, 2 diabetic). All patients had a good graft function using standard immunosuppression without any infection or severe acute rejection requiring dialysis. Body weight for a month and osmotic excretion for 24 hour (calculated by urine urea nitrogen) after renal transplantation were reviewed.
Results: The percentage of body weight loss at a month after transplantation was 6% for the PD group (50.5 ± 12.3 to 47.6 ± 11.8 kg, p = 0.002), 4.8% for the PKT group (53.9 ± 18.9 to 51.3 ± 17.7 kg, p = 0.0005), while 1% for the HD group (52.9 ± 12.4 to 52.1 ± 12.5 kg, p = 0.079). Graft function at a month after transplantation did not differ between those groups (serum creatinine 1.09 ± 0.46 in PD, 1.13 ± 0.36 in preemptive, 1.15 ± 0.51 mg/dl in HD group). Body mass index at a month after transplantation was also similar (19.6 for PD, 19.5 for PKT, 20.0 for HD group). Among PD and PKT group, 13 patients required HD support immediately before transplantation, other 19 patients did not. 24 hour osmotic excretion was greater in those patients without HD (387.3 ± 175.7) than those patients with HD support before transplantation (219.6 ± 75.3 mOsm, p = 0.006).
Conclusions: While there were no difference graft function and body mass index among 3 groups, body weight loss was greater in PD and PKT than HD group. Osmotic accumulation also exists in PD and PK T group without prior HD before transplant. Pre-transplant HD support should always be considered in PD and PKT patients.