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Patterns and Significance of Renal Replacement Therapy Use after Kidney Transplantation: A 10-year national cohort study

Tsai, Ching-Wei1,2; Ting, I-Wen1; Yeh, Hung-Chieh1; Kuo, Chin-Chi1,2

doi: 10.1097/

1Nephrology Division, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; 2Big Data Center, China Medical University Hospital, Taichung, Taiwan.

CMUH Kidney Research Group.

Introduction: The use of renal replacement therapy (RRT) among kidney transplant recipients may associate with delay graft function (DGF) and acute graft loss in the first 6-month post-transplant follow-up or chronic graft loss in late post-transplant period. However, its epidemiological pattern and clinical significance remain undescribed in the current literature.

Methods: We constructed a population-based kidney transplantation cohort using the Taiwan National Health Insurance claims data between year 2004 and 2012. Renal replacement therapy (RRT) includes hemodialysis or peritoneal dialysis. We estimated time to RRT since discharge from transplant admission to describe the distribution of RRT after kidney transplant. Delayed graft function or acute graft loss was defined as reviving RRT in the first 6 months after transplant whereas chronic graft loss was defined as receiving RRT after 6 months of transplant.

Results: During the study period, a total of 2,506 patients (2,547 person-times) received kidney transplantation. Mean age was 43.8 ± 12.7 years and 52% were men. Four hundred and seventy (18.9% of the study cohort) kidney transplant recipients experienced at least one session of renal replacement therapy (RRT) [hemodialysis (HD) vs. peritoneal dialysis (PD), 91.5% vs. 8.5%]. About 30% of graft recipients received their first RRT (HD vs. PD, 88.3% vs. 11.7%) within the first 90 days after transplantation and 40% (HD vs. PD, 87.6% vs. 12.4%) within 180 days. The median time to RRT was 540 days (1.48 years). Compared to those without need of RRT support, recipients who ever received RRT tended to have higher mortality proportion (23% vs. 8%).

Conclusion: The incident proportion of receiving RRT therapy was about 40 % in the first 6 months of kidney transplantation. The need of hemodialysis support is a critical factor associated with mortality outcome. Characteristics associated with RRT use, particularly immunosuppressant utilization, require further investigation.

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