PREEMPTIVE KIDNEY TRANSPLANTATION VERSUS HEMODIALYSIS AS INITIAL KIDNEY REPLACEMENT THERAPY: A PROPENSITY SCORE-MATCHED COHORT STUDY ubanamadako@yahoo.co.jp

 

PREEMPTIVE KIDNEY TRANSPLANTATION VERSUS HEMODIALYSIS AS INITIAL KIDNEY REPLACEMENT THERAPY: A PROPENSITY SCORE-MATCHED COHORT STUDY

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Japan

Oral only

Kidney transplantation (KT) and hemodialysis (HD) are key kidney replacement therapies (KRT) for end-stage kidney disease. However, few studies have directly compared survival outcomes between preemptive kidney transplantation (PKT) and initial HD as the first KRT modality.

This retrospective cohort study included 260 PKT recipients and 1,415 incident HD patients from the Nagoya Daini Hospital KT database and a multicenter HD database (Aichi cohort study of prognosis in patients newly initiated into dialysis). Propensity score matching was performed using age, sex, diabetes, cardiovascular disease (CVD) history, activities of daily living, body mass index, and baseline laboratory data. The primary outcome was all-cause mortality. Cox proportional hazards models and restricted mean survival time (RMST) analysis were used to assess survival differences.

After matching, 75 PKT and 225 HD patients were analyzed. The median follow-up was 1,492 days (IQR: 1,195–1,823). PKT was associated with a significantly lower risk of death compared to HD (hazard ratio [95% CI]: 0.07 [0.01–0.53]) and longer survival (1825-day RMST difference [95% CI]: 151 days [0.35–0.60]). This benefit was primarily driven by reduced CVD-related mortality. Subgroup analysis showed greater RMST gains for PKT in males, diabetic patients, those aged ≥65, and those with prior CVD.

PKT as the initial KRT modality is associated with significantly better survival than de novo HD, particularly among elderly patients, males, and those with diabetes or CVD.