Comparative Study on the Outcomes of Elective-Start versus Urgent-Start Peritoneal Dialysis Catheter Placement

Abstract

The aim of this study is to compare the outcomes of the elective-start versus urgent-start use of peritoneal dialysis (PD) catheters using percutaneous radiologic or laparoscopic techniques. Patients having their first peritoneal dialysis catheter placed and used between January 2005 and January 2018 were identified, and their medical records were retrospectively reviewed. Two groups were identified: elective-start (n = 211) and urgent-start (n = 29). Patient’s demographics were similar between the two groups with the exception of age, which was higher in the elective-start group. The catheter complication rates and catheter removal rates at 3 and 12 months, mean days-to-first complication, mean days-to-catheter removal, and overall patient survival at 12 months were analyzed. Catheter complication rates at 3 and 12 months were similar between the two groups (27.8% and 48.9%, respectively, in the elective-start group versus 35.9% and 54.2%, respectively, in the urgent-start group, p=0.415). The catheter removal rates at 3 and 12 months were also similar between the two groups (p=0.088). Catheter leak was higher in the urgent-start group (13.8% versus 3.3%, respectively, p=0.011). There was no difference between the elective-start and the urgent-start groups in the mean days-to-first complication (95 vs 69, p=0.086), mean days-to-catheter removal (145 vs 127, p=0.757), and overall patient survival at 12 months (100% vs 97%, p=0.41). In conclusion, apart from catheter leak, there were similar rates of catheter complication and removal for PD catheter used for the elective-start compared to the urgent-start PD. Furthermore, the technique of placement did not affect the outcomes.

Factors Associated With Urgent-Start Peritoneal Dialysis Catheter Complications in ESRD

“… 15 Compared with elective-start PD, urgent-start PD had lower rates of catheter dysfunction (i.e., 17.2% vs. 28.4%) yet higher rates of catheter leakage (13.8% vs. 3.3%). 16 The high number of leaks in this study could be associated with the short catheter break-in time. The time to catheter opening has also been proven to affect the frequency of complications.…”

Peritoneal Dialysis Catheter Placement: Percutaneous and Peritoneoscopic Techniques

“…2 36 37 38 It also allows for urgent initiation of PD and avoidance of temporary vascular access catheters in late-referred ESRD patients, without significant increase in the complication rate in comparison to elective-start PD. 2 39 In a meta-analysis of 13 studies with a total of 2,681 patients, Boujelbane et al found no significant difference in catheter survival between percutaneous and surgical placement of PD catheters. 40 Furthermore, Abdel Aal et al found similar survival and complication rates between fluoroscopically inserted PD catheters and those which were inserted laparoscopically.…”

Early outcomes of peritoneal dialysis in a middle-income country: A retrospective cohort study of a large dialysis network in Colombia

“…14 Also, early use of PD (break-in period of fewer than 7 days) was associated with catheter dysfunction and peritonitis 7 and, in another study, with an increased rate of leaks. 15 Other cohort studies corroborate that the first year of PD therapy is a period with high morbidity, especially in the first months of this treatment. 16…”