Ferruh Artunc1,2,3, Sandra Rueb4,5,6, Karolin Thiel7, Christian Thiel7, Katarzyna Linder4,5,6, Dorothea Baumann4,5,6, Hanno Bunz4,5,6, Thomas Muehlbacher4,5,6, Moritz Mahling4,5,6, Michael Sayer4, Marlies Petsch4, Martina Guthoff4,5,6, Nils Heyne4,5,6. 1. Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Tübingen, Germany, ferruh.artunc@med.uni-tuebingen.de. 2. Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany, ferruh.artunc@med.uni-tuebingen.de. 3. German Centre for Diabetes Research (DZD), München-Neuherberg, Germany, ferruh.artunc@med.uni-tuebingen.de. 4. Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Tübingen, Germany. 5. Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany. 6. German Centre for Diabetes Research (DZD), München-Neuherberg, Germany. 7. Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany.
Abstract
BACKGROUND: Unplanned start of renal replacement therapy is common in patients with end-stage renal disease and often accomplished by hemodialysis (HD) using a central venous catheter (CVC). Urgent start using peritoneal dialysis (PD) could be an alternative for some of the patients; however, this requires a hospital-based PD center that offers a structured urgent start PD (usPD) program. METHODS: In this prospective study, we describe the implementation of an usPD program at our university hospital by structuring the process from presentation to PD catheter implantation and start of PD within a few days. For clinical validation, we compared the patient flow before (2013-2015) and after (2016-2018) availability of usPD. RESULTS: In the 3 years before the availability of usPD, 14% (n = 12) of incident PD patients (n = 87) presented in an unplanned situation and were initially treated with HD using a CVC. In the 3 years after implementation of the usPD program, 18% (n = 18) of all incident PD patients (n = 103) presented in an unplanned situation of whom n = 12 (12%) were treated with usPD and n = 6 (6%) with initial HD. usPD significantly reduced the use of HD by 57% (p = 0.0005). Hospital stay was similar in patients treated with usPD (median 9 days) compared to those with elective PD (8 days), and significantly lower than in patients with initial HD (26 days, p = 0.0056). CONCLUSIONS: Implementation of an usPD program reduces HD catheter use and hospital stay in the unplanned situation.
BACKGROUND: Unplanned start of renal replacement therapy is common in patients with end-stage renal disease and often accomplished by hemodialysis (HD) using a central venous catheter (CVC). Urgent start using peritoneal dialysis (PD) could be an alternative for some of the patients; however, this requires a hospital-based PD center that offers a structured urgent start PD (usPD) program. METHODS: In this prospective study, we describe the implementation of an usPD program at our university hospital by structuring the process from presentation to PD catheter implantation and start of PD within a few days. For clinical validation, we compared the patient flow before (2013-2015) and after (2016-2018) availability of usPD. RESULTS: In the 3 years before the availability of usPD, 14% (n = 12) of incident PDpatients (n = 87) presented in an unplanned situation and were initially treated with HD using a CVC. In the 3 years after implementation of the usPD program, 18% (n = 18) of all incident PDpatients (n = 103) presented in an unplanned situation of whom n = 12 (12%) were treated with usPD and n = 6 (6%) with initial HD. usPD significantly reduced the use of HD by 57% (p = 0.0005). Hospital stay was similar in patients treated with usPD (median 9 days) compared to those with elective PD (8 days), and significantly lower than in patients with initial HD (26 days, p = 0.0056). CONCLUSIONS: Implementation of an usPD program reduces HD catheter use and hospital stay in the unplanned situation.
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: Michael Sayer; Christian Thiel; Martin Schenk; Alfred Königsrainer; Nils Heyne; Andreas L Birkenfeld; Ferruh Artunc; Karolin Thiel Journal: J Nephrol Date: 2021-07-08 Impact factor: 3.902