Urgent-start peritoneal dialysis versus conventional-start peritoneal dialysis for people with chronic kidney disease

Htay, Htay; Johnson, David W.; Craig, Jonathan C.; Teixeira‐Pinto, Armando; Hawley, Carmel; Cho, Yeoungjee

doi:10.1002/14651858.cd012913.pub2

Cited by 20 publications

(26 citation statements)

References 54 publications

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“…Our findings demonstrate that there were no sociodemographic or clinical differences between the US-PD and Plan-PD groups. More interestingly, there were no significant differences in 30-day complications, hospitalizations, and technique survival during the first year on therapy for patients who started urgent PD compared to Plan-PD initiation, indicating the efficiency and safety of PD in urgent situations, which is similar to most studies carried out on the topic 5 , 7 , 10 , 12 - 14 .…”

Section: Discussionsupporting

confidence: 72%

Urgent vs. planned peritoneal dialysis initiation: complications and outcomes in the first year of therapy

et al. 2022

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Introduction: Urgent-start peritoneal dialysis (US-PD) has been proposed as a safe modality of renal replacement therapy (RRT) for end-stage renal disease (ESRD) patients with an indication for emergency dialysis initiation. We aimed to compare the characteristics, 30-day complications, and clinical outcomes of US-PD and planned peritoneal dialysis (Plan-PD) patients over the first year of therapy. Methods: This was a single-center retrospective study that included incident adult patients followed for up to one year. US-PD was considered when incident patients started therapy within 7 days after Tenckhoff catheter implantation. Plan-PD group consisted of patients who started therapy after the breaking period (15 days). Mechanical and infectious complications were compared 30 days from PD initiation. Hospitalization and technique failure during the first 12 months on PD were assessed by Kaplan-Meier curves and the determinants were calculated by Cox regression models. Results: All patients starting PD between October/2016 and November/2019 who fulfilled the inclusion criteria were analyzed. We evaluated 137 patients (70 in the US-PD x 67 Plan-PD). The main complications in the first 30 days were catheter tip migration (7.5% Plan-PD x 4.3% US-PD - p= 0.49) and leakage (4.5% Plan-PD x 5.7% US-PD - p=0.74). Most catheters were placed using the Seldinger technique. The main cause of dropout was death in US-PD patients (15.7%) and transfer to HD in Plan-PD patients (13.4%). The occurrence of complications in the first 30 days was the only risk factor for dropout (OR = 2.9; 95% CI 1.1-7.5, p = 0.03). Hospitalization rates and technique survival were similar in both groups. Conclusion: The lack of significant differences in patients’ outcomes between groups reinforces that PD is a safe and applicable dialysis method in patients who need immediate dialysis.

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Section: Discussionsupporting

confidence: 72%

Urgent vs. planned peritoneal dialysis initiation: complications and outcomes in the first year of therapy

et al. 2022

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“…Our study reveals that the flow restriction rate was comparable between the 2 groups and consistent with 2 systematic reviews. 12 , 13 Retention of uremic toxins in advanced-stage CKD may alter gut microbiota, leading to decreased bowel movement, 26 , 27 and potentially causing PD catheter flow restriction because of tip migration. In our study, a laxative medication protocol for mitigating constipation before and after PD catheter insertion might explain the equivalent results of catheter-related complications between the groups.…”

Section: Discussionmentioning

confidence: 99%

“…Urgent-start PD, which is generally defined as an initiation of PD during the break-in period (within 14 days postcatheter insertion), 12 , 13 has been an important strategy to promote home dialysis. Brazil is an example of a country where this has been successfully applied, demonstrating that urgent-start dialysis resulted in a 256% increase in patients on chronic PD over 3 years.…”

mentioning

confidence: 99%

“…[1][2][3]7,8 Several factors contributing to the apparent preference for urgent-start temporary HD over urgent-start PD include the following: (i) HD catheter placement is a routine procedure, whereas the availability of experienced clinicians who are willing and able to place PD catheters at short notice is more limited; 9,10 (ii) nephrology training in PD has been suboptimal compared with HD; 7,10,11 and (iii) financial incentives have historically favored in-center HD. 10 Urgent-start PD, which is generally defined as an initiation of PD during the break-in period (within 14 days postcatheter insertion), 12,13 has been an important strategy to promote home dialysis. Brazil is an example of a country where this has been successfully applied, demonstrating that urgent-start dialysis resulted in a 256% increase in patients on chronic PD over 3 years.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Randomized Study of Urgent-Start Peritoneal Dialysis Versus Urgent-Start Temporary Hemodialysis in Patients Transitioning to Kidney Failure

Parapiboon

Sangsuk

Nopsopon

et al. 2022

Kidney International Reports

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“…A systematic review of 15 observational studies and 1 randomised controlled trial found that, compared to a conventional strategy of waiting at least 2 weeks before PD catheter use, an urgent-start approach is associated with increased risk of peri-catheter dialysate leak (RR 3.90, 95% CI 1.56-9.78). 61 In the randomised trial, 122 patients in a large tertiary centre in Australia were randomly assigned to commence PD at 1week, 2-weeks and 4-weeks from catheter placement; the trial was stopped early due to a higher rate of complications in the 1-week group. 18 Fluid leak occurred in 28.2% of the group commencing PD at 1-week, 9.5% at 2-weeks, and 2.4% at 4-weeks; differences were statistically significant.…”

Section: Early Complicationsmentioning

confidence: 99%