Time Spent on Dialysis May Predict Transplant Patient's Longevity

COLUMBUS, Ohio -- The longer patients with kidney disease remain on dialysis before receiving a transplant, the more likely they are to die prematurely, new research shows.

In a study of 523 people, researchers found that only 7 percent of those who had never been on dialysis died within seven years after receiving a kidney transplant. However, 23 percent of the patients who had been on dialysis for one to two years died, as did 44 percent of the patients who had been on dialysis three years or longer.

The results suggest that the ideal situation for a patient with kidney disease is an immediate transplant, said Fernando Cosio, professor of internal medicine at Ohio State University and co-author of the study. However, many patients waiting for a suitable transplant spend an average of one to two years on dialysis.

“Dialysis is clearly not an advantage,” Cosio said. “Unless kidney failure is a surprise, which is rare, it doesn’t help patients at all to go through dialysis before a transplant.”

The 523 patients in the study received kidney transplants at Ohio State between 1984 and 1991. Cosio and his colleagues followed up on patients who survived at least six months after the transplant and kept tabs on each patient’s health and longevity for about seven years. The researchers only included people who survived at least six months so they could exclude patients who immediately rejected the donor kidney or died of surgical complications.

The study -- published in a recent issue of Kidney International -- showed that people who remained on dialysis for three or more years were more likely to die of infection than those on dialysis for two years or less.

People who are on dialysis a long time may be more likely to die of infection because kidney disease suppresses patients’ immune systems, particularly over a long term, Cosio said. Malnutrition, which is often a complication of long-term dialysis, may have also played a role in infectious death rates.

In looking at the overall effect of dialysis on mortality rates, the researchers also found that pre-transplant health risks such as smoking, diabetes and heart disease increase a kidney transplant patient’s odds of dying.

“The longer a person is on dialysis, the more likely it is that person will die and their death appears to be related to pre-transplant factors,” Cosio said.

Cosio said pre-transplant health factors are crucial in determining a patient’s longevity.

“A physician can predict a patient’s transplant success in most cases by looking at the health risk factors at the time the patient comes to the clinic before the transplant.”

Cosio said part of the answer to increasing patient survival after the transplant includes encouraging preventive care well before starting dialysis, such as cutting out cigarettes and controlling blood pressure in addition to limiting the time spent on dialysis.

Contact: Fernando Cosio, (614) 293-4997; Cosio.1@osu.edu Written by Holly Wagner, (614) 292-8310; Wagner.235@osu.edu