Yaorong Liu1, Lin Zhang, Aiwu Lin, Zhaohui Ni, Jiaqi Qian, Wei Fang. 1. Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Molecular Cell Lab for Kidney Disease, Shanghai, PR China.
Abstract
OBJECTIVES: Peritoneal dialysis (PD) is one of the first-line modalities of renal replacement therapy in patients with end-stage renal disease. Guidelines recommended a break-in period of at least 2 weeks before full PD start. However, the optimal duration of the break-in period is still unclear. In the present study, we investigated the effect of various break-in periods on short-term outcomes in patients on PD. ♢ METHODS: All patients who underwent Tenckhoff catheter implantation and initiated PD in Renji Hospital, Shanghai Jiao Tong University School of Medicine, between 1 January 2001 and 31 December 2010 were included. Patients were grouped according to the duration of their break-in period: 7 days or less (BI ≤ 7), 8 - 14 days (BI8-14), and more than 14 days (BI>14). Kaplan-Meier curves and log-rank tests were used to compare short-term outcomes in the various groups. ♢ RESULTS: Our study enrolled 657 patients (44.5% men), of whom 344, 137, and 176 patients were in the respective break-in groups. Compared with BI>14 patients, BI ≤ 7 patients had a lower estimated glomerular filtration rate (5.34 ± 1.86 mL/min/1.73 m(2) vs 6.55 ± 1.71 mL/min/1.73 m(2), p < 0.001) and lower serum albumin (33.29 ± 5.36 g/L vs 36.64 ± 5.40 g/L, p < 0.001). The incidence of mechanical complications during the first 6 months was significantly higher in BI ≤ 7 patients than in BI>14 patients (8.4% vs 1.7%, p = 0.004). However, we observed no significant differences between the three groups with respect to the prevalence of catheter dysfunction requiring surgical intervention (p > 0.05). Logistic regression analysis showed that BI ≤ 7 [relative risk: 4.322; 95% confidence interval (CI): 1.278 to 14.608; p = 0.019] was an independent predictor of catheter dysfunction, but not of catheter dysfunction requiring surgical intervention (p > 0.05). Catheter dysfunction [hazard ratio (HR): 20.087; 95% CI: 7.326 to 55.074; p < 0.001] and peritonitis (HR: 4.533; 95% CI: 1.748 to 11.751; p = 0.002) were risk factors for technique failure during the first 6 months, but BI ≤ 7 was not correlated with technique failure. ♢ CONCLUSIONS: Patients starting PD with a break-in period of less than 1 week might experience a minor increased risk of mechanical complications, but no major effect on technique survival.
OBJECTIVES: Peritoneal dialysis (PD) is one of the first-line modalities of renal replacement therapy in patients with end-stage renal disease. Guidelines recommended a break-in period of at least 2 weeks before full PD start. However, the optimal duration of the break-in period is still unclear. In the present study, we investigated the effect of various break-in periods on short-term outcomes in patients on PD. ♢ METHODS: All patients who underwent Tenckhoff catheter implantation and initiated PD in Renji Hospital, Shanghai Jiao Tong University School of Medicine, between 1 January 2001 and 31 December 2010 were included. Patients were grouped according to the duration of their break-in period: 7 days or less (BI ≤ 7), 8 - 14 days (BI8-14), and more than 14 days (BI>14). Kaplan-Meier curves and log-rank tests were used to compare short-term outcomes in the various groups. ♢ RESULTS: Our study enrolled 657 patients (44.5% men), of whom 344, 137, and 176 patients were in the respective break-in groups. Compared with BI>14 patients, BI ≤ 7 patients had a lower estimated glomerular filtration rate (5.34 ± 1.86 mL/min/1.73 m(2) vs 6.55 ± 1.71 mL/min/1.73 m(2), p < 0.001) and lower serum albumin (33.29 ± 5.36 g/L vs 36.64 ± 5.40 g/L, p < 0.001). The incidence of mechanical complications during the first 6 months was significantly higher in BI ≤ 7 patients than in BI>14 patients (8.4% vs 1.7%, p = 0.004). However, we observed no significant differences between the three groups with respect to the prevalence of catheter dysfunction requiring surgical intervention (p > 0.05). Logistic regression analysis showed that BI ≤ 7 [relative risk: 4.322; 95% confidence interval (CI): 1.278 to 14.608; p = 0.019] was an independent predictor of catheter dysfunction, but not of catheter dysfunction requiring surgical intervention (p > 0.05). Catheter dysfunction [hazard ratio (HR): 20.087; 95% CI: 7.326 to 55.074; p < 0.001] and peritonitis (HR: 4.533; 95% CI: 1.748 to 11.751; p = 0.002) were risk factors for technique failure during the first 6 months, but BI ≤ 7 was not correlated with technique failure. ♢ CONCLUSIONS:Patients starting PD with a break-in period of less than 1 week might experience a minor increased risk of mechanical complications, but no major effect on technique survival.
Authors: Ana Figueiredo; Bak-Leong Goh; Sarah Jenkins; David W Johnson; Robert Mactier; Santhanam Ramalakshmi; Badri Shrestha; Dirk Struijk; Martin Wilkie Journal: Perit Dial Int Date: 2010 Jul-Aug Impact factor: 1.756
Authors: Hui Xue; Joachim H Ix; Weiling Wang; Steven M Brunelli; Michael Lazarus; Raymond Hakim; Eduardo Lacson Journal: Am J Kidney Dis Date: 2012-11-16 Impact factor: 8.860
Authors: Htay Htay; David W Johnson; Jonathan C Craig; Armando Teixeira-Pinto; Carmel M Hawley; Yeoungjee Cho Journal: Cochrane Database Syst Rev Date: 2020-12-15