Emily J See1, Yeoungjee Cho1,2, Carmel M Hawley1,2, Lauren R Jaffrey1, David W Johnson3,2,4. 1. Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia. 2. School of Medicine, The University of Queensland, Brisbane, Australia. 3. Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia david.johnson2@health.qld.gov.au. 4. Translational Research Institute, Brisbane, Australia.
Abstract
BACKGROUND: Significant interest in the practice of urgent-start peritoneal dialysis (PD) is mounting internationally, with several observational studies supporting the safety, efficacy, and feasibility of this approach. However, little is known about the early complication rates and long-term technique and peritonitis-free survival for patients who start PD urgently (i.e. within 2 weeks of catheter insertion), compared to those with a conventional start. METHODS: This single-center, matched case-control study evaluated patients commencing PD between 2010 and 2015. Urgent-start PD patients were matched 1:3 with conventional-start PD controls based on diabetic status and age. The primary outcomes were early complications, both following catheter insertion and PD commencement (within 4 weeks). Secondary outcomes included technique and peritonitis-free survival. RESULTS: A total of 104 patients (26 urgent-start, 78 conventional-start) were included. Urgent-start patients were more likely to be referred late, initiate PD in hospital, and be prescribed lower initial exchange volumes (p < 0.01). They experienced more frequent leaks post-catheter insertion (12% vs 1%, p = 0.047) and more frequent catheter migration following commencement of PD (12% vs 1%, p = 0.047). There were no significant differences in the rates of overall or infectious complications. Kaplan-Meier estimates of technique survival and time to first episode of peritonitis were comparable between the groups. CONCLUSION: Compared with conventional-start PD, urgent-start PD has acceptably low early complication rates and similar long-term technique survival. Urgent-start PD appears to be a safe way to initiate urgent renal replacement therapy in patients without established dialysis access.
BACKGROUND: Significant interest in the practice of urgent-start peritoneal dialysis (PD) is mounting internationally, with several observational studies supporting the safety, efficacy, and feasibility of this approach. However, little is known about the early complication rates and long-term technique and peritonitis-free survival for patients who start PD urgently (i.e. within 2 weeks of catheter insertion), compared to those with a conventional start. METHODS: This single-center, matched case-control study evaluated patients commencing PD between 2010 and 2015. Urgent-start PDpatients were matched 1:3 with conventional-start PD controls based on diabetic status and age. The primary outcomes were early complications, both following catheter insertion and PD commencement (within 4 weeks). Secondary outcomes included technique and peritonitis-free survival. RESULTS: A total of 104 patients (26 urgent-start, 78 conventional-start) were included. Urgent-start patients were more likely to be referred late, initiate PD in hospital, and be prescribed lower initial exchange volumes (p < 0.01). They experienced more frequent leaks post-catheter insertion (12% vs 1%, p = 0.047) and more frequent catheter migration following commencement of PD (12% vs 1%, p = 0.047). There were no significant differences in the rates of overall or infectious complications. Kaplan-Meier estimates of technique survival and time to first episode of peritonitis were comparable between the groups. CONCLUSION: Compared with conventional-start PD, urgent-start PD has acceptably low early complication rates and similar long-term technique survival. Urgent-start PD appears to be a safe way to initiate urgent renal replacement therapy in patients without established dialysis access.
Authors: Htay Htay; David W Johnson; Jonathan C Craig; Armando Teixeira-Pinto; Carmel M Hawley; Yeoungjee Cho Journal: Cochrane Database Syst Rev Date: 2021-01-27
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
Authors: Peace D Imani; Jennifer L Carpenter; Cynthia S Bell; Mary L Brandt; Michael C Braun; Sarah J Swartz Journal: BMC Nephrol Date: 2018-09-14 Impact factor: 2.388