Outcomes of Peritoneal Dialysis after Kidney Transplant Failure: A Single-Center Experience*

Objective: Despite advancements in graft survival, the kidney allograft failure is increasingly leading to the initiation of
dialysis. While studies indicate no significant differences in survival among dialysis modalities, there are concerns about negative clinical outcomes associated with peritoneal dialysis (PD) in this population.

Methods: This retrospective study analyzed 19 patients who initiated PD following kidney transplant failure (PD-postTx) from January 2010 to June 2022, comparing them with 70 transplant-naive patients who began PD during the same time frame (PD-noTx group). Acomparison of residual diuresis, episodes of peritonitis, time on PD therapy, and patient survival was performed between 2 groups.

Results: The PD-postTx group was younger and less likely to have diabetes than the PD-noTx group. Compared to PD-noTx patients, PD-postTx patients had more peritonitis episodes (35.7% vs. 68.4%, P = .011) and significant decline in urine vol ume at the end of the first year (P = .002). Residual kidney function (RKF) reduced the risk of peritonitis (OR 0.262, 95%CI 0.105-0.653; P = .040). -PD-postTx patients had a higher probability of transfer to hemodialysis. Three and 5-year PD survival were 81.7%, 65.4%, and 98.5%, 91.9% in PD-postTx and PD-noTx groups, respectively (P = .015). Multiple analysis showed a trend toward PD discontinuation in previously transplanted patients (HR 2.772, 95%CI 0.899-8.543; P = .076). Patient sur vival rates were comparable in both groups.

Conclusion: A prior history of transplantation poses a risk for PD discontinuation and peritonitis; but not for mortality in PD patients. The preservation of RKF may significantly contribute to the protection of peritonitis and the improvement of time on PD therapy.

Cite this article as: Kumru G, Akkan Eren Ş, Şengul Ş, Ateş K, Keven K. Outcomes of peritoneal dialysis after kidney transplant failure: A single center experience. Turk J Nephrol. 2025;34(4):297-303.