Urgent-start Peritoneal Dialysis for Patients with End Stage Renal Disease: a 10-year Retrospective Study

Overview

Journal BMC Nephrol

Publisher Biomed Central

Specialty Nephrology

Date 2019 Jul 4

PMID 31266466

Citations 19

Authors

Hongjian Ye

Xiao Yang

Chunyan Yi

Qunying Guo

Yafang Li

Qiongqiong Yang

Wei Chen

Haiping Mao

Jianbo Li

Yagui Qiu

Xunhua Zheng

Dihua Zhang

Jianxiong Lin

Zhijian Li

Zongpei Jiang

Fengxian Huang

Xueqing Yu

Affiliations

Soon will be listed here.

Abstract

Background: Urgent-start peritoneal dialysis (PD) can help patients with end-stage renal diseases (ESRD) that are referred late to dialysis. However, catheter patency and related complications of urgent-start PD have not been thoroughly clarified. We investigated the clinical outcomes of urgent-start PD in a Chinese cohort.

Methods: We enrolled ESRD patients who received urgent-start PD (starting PD within 14 days after catheter insertion) in our center from January 1, 2006 to December 31, 2014, and followed them up for 10 years. The primary outcome was catheter failure. Secondary outcomes included short-term and long-term complications related to urgent-start PD.

Results: Totally 2059 patients (58.9% male, mean age 47.6 ± 15.9 years) were enrolled. Few perioperative complications were observed, including significant hemorrhage (n = 3, 0.1%) and bowel perforation (n = 0). Early peritonitis occurred in 24 (1.2%) patients (0.28 episodes per patient-year). Within the first month after catheter insertion, functional catheter malfunction occurred in 85 (4.1%) patients, and abdominal wall complications (including hernia, hydrothorax, hydrocele, and leakage) in 36 (1.7%) patients. During a median 36.5 (17.7-61.4) months of follow-up, 75 (3.6%) patients experienced catheter failure, and 291 (14.1%) had death-censoring technique failure. At the end of 1-month, 1 -year, 3-year, and 5-year, catheter patency rate was 97.6, 96.4, 96.2, 96.2%; and technique survival rate was 99.5, 97.0, 90.3, 82.7%, respectively. After adjusting for confounders, every 5-year increase in age was associated with 19% decrease of risk for catheter failure (hazard ratio [HR]: 0.81, 95% confidence interval [CI]: 0.73-0.89). Male sex (HR: 1.43, 95% CI: 1.00-2.04), diabetic nephropathy (HR: 1.56, 95% CI: 1.08-2.25) and low hemoglobin levels (HR: 0.89, 95% CI: 0.81-0.98) were independent risk factors for abdominal wall complications.

Conclusions: Urgent-start PD is a safe and efficacious option for unplanned ESRD patients. A well-trained PD team, a standardized catheter insertion procedure by experienced nephrologists, and a carefully designed initial PD prescription as well as comprehensive follow-up care, might be essential for the successful urgent-start PD program.

Citing Articles

Comparative analysis of complications and technique survival in peritoneal dialysis catheter insertion: single purse-string suture vs. double purses-string suture.

Li X, Chen X, Gao H, Zhou Q, Liu W, Li P Ren Fail. 2024; 46(2):2435209.

PMID: 39659240 PMC: 11748857. DOI: 10.1080/0886022X.2024.2435209.

Pericatheter Leak Associated With Earlier Peritoneal Dialysis Initiation Does Not Influence Long-Term Outcomes.

Tsihlis G, Pirabhahar K, Sciberras F, Nicdao M, Aw L, Agoo A Kidney Int Rep. 2024; 9(9):2727-2738.

PMID: 39291194 PMC: 11403086. DOI: 10.1016/j.ekir.2024.07.004.

Rare Pathogens in Peritoneal Dialysis-Associated Peritonitis: A Comprehensive Case Study and Guideline Review.

Mohammadi A, Akhondi H, Joshi D, Mirabbasi S Am J Case Rep. 2024; 25:e943953.

PMID: 38831580 PMC: 11163831. DOI: 10.12659/AJCR.943953.

The prognostic values of estimating intraperitoneal pressure in the occurrence of abdominal wall complications in peritoneal dialysis patients.

Ma T, Li X, Hao J, Song D, Wang H, Liu T J Nephrol. 2024; 37(5):1351-1360.

PMID: 38512377 DOI: 10.1007/s40620-024-01913-y.

Comparison of immediate-start peritoneal dialysis without break-in period and conventional-start peritoneal dialysis: a two-center retrospective audit.

Wongpraphairot S, Choopun K, Sriphatphiriyakun T, Titawatanakul A, Chongsuvivatwong V, Phongphithakchai A Int Urol Nephrol. 2024; 56(7):2403-2409.

PMID: 38441870 DOI: 10.1007/s11255-024-03967-0.

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