Urgent-start peritoneal dialysis versus haemodialysis 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.cd012899

Cited by 17 publications

(21 citation statements)

References 26 publications

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“…A Cochrane analysis looking at urgent start dialysis with PD compared to HD 12 concluded that “urgent-start PD may reduce the risk of bacteraemia and had uncertain effects on other complications of dialysis and technique and patient survival.” Again, they commented that direct comparison of the two techniques for inducing urgent dialysis was bedevilled by the great heterogeneity of the study matter.…”

Section: Discussionmentioning

confidence: 99%

Changing the peritoneal dialysis access algorithm with a precise technique of percutaneous Seldinger PD catheter placement

et al. 2022

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Background: In 1953, Swedish radiologist Sven Seldinger introduced a technique for blood vessel or hollow organ access using a needle, guide wire and catheter. Over the last two decades, this technique has been used for Peritoneal Dialysis (PD) catheter placement, “Seldinger PD” (SPD). To improve the safety and accuracy of SPD, ultrasound, X-ray guidance, contrast imaging and micropuncture techniques have been incorporated to a greater or lesser extent. Methods: This manuscript describes a new and rigorous technique of SPD developed at our unit and results in the first 64 cases. One of our goals was to replace emergency Central Vein Catheter Hemodialysis with “Urgent-Start” PD. We therefore sought to develop a procedure that was ultra-safe, minimally invasive and readily done on the sickest patients under Local Anesthetic. As the technique was new to our unit, and because of progressive modifications of the technique, some of the results reflect our “learning curve.” In addition, 55% of the patients referred to our program had “crashed” into renal failure, 32% were deemed “unfit for General Anaesthesia” by the Anaesthetists and 53% were moderately to severely obese, resulting in a very morbid and vulnerable cohort. Results: Despite this, we had no procedure related mortality, no organ injury and no significant bleeding. Technical success was 97% (intention-to-treat). Urgent Start PD was used in 36%; overall, 3/61 catheters placed experienced PD fluid leak. Correct catheter tip placement – in the Pelvic Pouch – was documented in all cases; significant catheter migration was seen in 18% of those with imaging follow-up, only two requiring revision. Most catheter migrations occurred early in our series before our low peritoneal puncture technique became standard. Conclusions: We believe this SPD technique is safe, precise, clinically and financially cost-effective and can replace other forms of PD placement in most situations.

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Section: Discussionmentioning

confidence: 99%

Changing the peritoneal dialysis access algorithm with a precise technique of percutaneous Seldinger PD catheter placement

et al. 2022

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“…The safety of urgent-start PD remained controversial. Htay et al 11 reviewed seven observational studies (991 participants) comparing urgent-start PD to HD initiated using a CVC. The findings suggested that urgent-start PD may reduce the incidence of catheter-related bacteremia compared to HD initiated with a CVC, but exhibited uncertain effects on the risk of peritonitis, exit-site bleeding, catheter malfunction, catheter re-adjustment, technique survival, or patient survival compared with HD initiated using a CVC.…”

Section: Discussionmentioning

confidence: 99%

“…1 Meanwhile, there has been an increasing interest in urgent-start PD as judged by the number of published articles among PD practitioner. [9][10][11] Urgent-start PD, defined as use of the PD catheter within 14 days of insertion, may obviate the need for HD via CVC, therefore reduced the risk of CVC-related complication and benefit for the prognosis.…”

Section: Discussionmentioning

confidence: 99%

Automated peritoneal dialysis as a cost-effective urgent-start dialysis option for ESRD patients: A prospective cohort study

Jin

et al. 2022

Int J Artif Organs

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Background Several studies have reported the feasibility of urgent-start peritoneal dialysis (PD) as an alternative to hemodialysis (HD) using a central venous catheter (CVC). However, the cost-effectiveness of automated peritoneal dialysis (APD) as an urgent-start dialysis modality has not been directly evaluated, especially in China. Methods We prospectively enrolled patients with end-stage renal disease (ESRD) who required urgent-start dialysis at a single center from March 2019 to November 2020. Patients were grouped according to their urgent-start dialysis modality (APD and HD). Urgent-start dialysis conducted until 14 days after PD catheter insertion. Then, PD was maintained. Each patient was followed until July 2021 or death or loss to follow-up. The primary outcome was the incidence of short-term dialysis-related complications. The secondary outcome was the cost and duration of the initial hospitalization. Technique survival, peritonitis-free or bacteriamia-free survival and patient survival were also compared. Results Sixty-eight patients were included in the study, of whom 36 (52.9%) patients were in APD group. Mean follow-up duration was 20.1 months. Compared with the HD group, the APD group had significantly fewer short-term dialysis-related complications. The cost of initial hospitalization was also significantly lower in APD patients. There was no significant difference between APD and HD patients with respect to duration of the initial hospitalization, technique survival rate, peritonitis-free or bacteriemia-free survival rate, and patient survival rate. Conclusion Among ESRD patients with an urgent need for dialysis, APD as urgent-start dialysis modality, compared with HD using a CVC, resulted in fewer short-term dialysis-related complications and lower cost.

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“…Despite higher dialysis-related complications associated with UHD, no difference in overall mortality between the two groups has been reported [20,63,[78][79][80]. A systemic review comparing outcomes between UHD and urgent-start PD was recently concluded [81]. The preliminary results suggest a lower risk of bacteremia and catheter malfunction but no difference in mortality among urgent-start PD patients compared to UHD patients [82].…”

Section: Outcomes Of Urgent-start Pdmentioning

confidence: 99%

How To Build a Successful Urgent-Start Peritoneal Dialysis Program

Rajora

Shastri

Pirwani³

et al. 2020

Kidney360

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In-center hemodialysis (HD) remains the predominant dialysis therapy in patients with ESKD. Many patients with ESKD present in late stage, requiring urgent dialysis initiation, and the majority start HD with central venous catheters (CVCs), which are associated with poor outcomes and high cost of care. Peritoneal dialysis (PD) catheters can be safely placed in such patients with late-presenting ESKD, obviating the need for CVCs. PD can begin almost immediately in the recumbent position, using low fill volumes. Such PD initiations, commencing within 2 weeks of the catheter placement, are termed urgent-start PD (USPD). Most patients with an intact peritoneal cavity and stable home situation are eligible for USPD. Although there is a small risk of PD catheter–related mechanical complications, most can be managed conservatively. Moreover, overall outcomes of USPD are comparable to those with planned PD initiations, in contrast to the high rate of catheter-related infections and bacteremia associated with urgent-start HD. The ongoing coronavirus disease 2019 pandemic has further exposed the vulnerability of patients with ESKD getting in-center HD. PD can mitigate the risk of infection by reducing environmental exposure to the virus. Thus, USPD is a safe and cost-effective option for unplanned dialysis initiation in patients with late-presenting ESKD. To develop a successful USPD program, a strong infrastructure with clear pathways is essential. Coordination of care between nephrologists, surgeons or interventionalists, and hospital and PD center staff is imperative so that patient education, home visits, PD catheter placements, and urgent PD initiations are accomplished expeditiously. Implementation of urgent-start PD will help to increase PD use, reduce cost, and improve patient outcomes, and will be a step forward in fostering the goal set by the Advancing American Kidney Health initiative.

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

Cited by 17 publications

References 26 publications

Changing the peritoneal dialysis access algorithm with a precise technique of percutaneous Seldinger PD catheter placement

Changing the peritoneal dialysis access algorithm with a precise technique of percutaneous Seldinger PD catheter placement

Automated peritoneal dialysis as a cost-effective urgent-start dialysis option for ESRD patients: A prospective cohort study

How To Build a Successful Urgent-Start Peritoneal Dialysis Program

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