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Steroid Use and Infectious Complication in Peritoneal Dialysis After Kidney Transplant Failure

Background Peritoneal dialysis (PD) is one potential treatment option for patients starting dialysis after graft loss (DAGL). However, the infectious outcomes and their associations with steroid use remain undetermined in these patients. Methods A total of 41 DAGL patients undergoing PD were recruited. The patients were divided into low- and high-dose steroid groups according to the median level. Additionally, they were categorized into tapering and nontapering groups, for which the tapering regimen was defined as the withdrawal of steroids within 1 year after starting PD. Primary outcomes, such as peritonitis and exit site infection (ESI), were compared between DAGL and 712 transplant-naive (TN) patients. Results The overall risk of peritonitis was similar between the TN and DAGL groups. However, when the DAGL group was stratified by the steroid variable, the risk was higher in the high-dose or nontapering steroid groups than in the TN or counterpart steroid groups. The DAGL group had a higher risk of ESI than the TN group, irrespective of steroid dose. When the analysis was stratified by tapering regimen, the difference in ESI risks was seen only in the nontapering group and the TN group; the tapering group had a similar risk of ESI as that of the TN group. Conclusions The present study first addresses the risks of peritonitis and ESI together and then raises awareness of the high risk that should be considered after using high-dose steroids or the nontapering regimen in the DAGL patients.