Application of automated peritoneal dialysis in urgent-start peritoneal dialysis patients during the break-in period

Liu, Shengmao; Zhuang, Xiaohua; Zhang, Min; Wu, Yanfeng; Liu, Min; Guan, Shaopeng; Liu, Shujun; Miao, Lining; Cui, Wenpeng

doi:10.1007/s11255-018-1785-1

Cited by 23 publications

(21 citation statements)

References 29 publications

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“…Percutaneous PD catheter insertion facilitates timely catheter placement. Automated PD effectively remove uremic toxins, correct electrolyte and volume imbalance, while did not increase in the incidence of early complications during the short break-in period [25]. Therefore, more and more unplanned ESRD patients had the chance to choose PD as an alternative of urgent-start dialysis, with two times of patients in the post-2005 group than that of pre-2005 group.…”

Section: Discussionmentioning

confidence: 99%

Early-start and conventional-start peritoneal dialysis: a Chinese cohort study on outcome

Wang

et al. 2020

Renal Failure

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Background: Early-start peritoneal dialysis (PD) is an effective option for patients need unplanned dialysis. However, there are few studies on the long-term prognosis of early-start PD patients. Methods: In this retrospective study, 635 eligible patients from 1 March 1996 to 30 September 2016 were included, and divided into three groups according to the duration of break-in period: 3 days or less, 4-13 days and more than 14 days. Patients started PD within 2 weeks and after 2 weeks were defined as early-start and conventional-start, respectively. The primary outcome was all-cause mortality, and the secondary outcome measures were peritonitis free survival and technical survival. Mechanical and infectious complications in the first 180 days were also analyzed. Results: Early-start PD patients were more likely to have higher serum total carbon dioxide and creatinine levels and lower serum albumin, Kt/v, creatinine clearance (Ccr) and residual glomerular filtration rate (rGFR) levels at the start of PD. The median follow-up period was 30 months (interquartile range, 13-53 months). A worse survival was observed in the early-start group than that in the conventional-start group (p < 0.001), even adjustment for the covariates (HR 1.549, 95%CI 1.104-2.173, p ¼ 0.011). In the subgroup analysis, in patients commencing PD after 2006 early-start and conventional-start PD patients had comparable survival. No differences were observed in the rate of infectious and mechanical complications, peritonitis-free survival and technique survival between early-start and conventional-start PD patients. Conclusions: Early-start PD could be a safe and effective strategy for patients needing unplanned dialysis initiation with the progress of technology on PD.

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Section: Discussionmentioning

confidence: 99%

Early-start and conventional-start peritoneal dialysis: a Chinese cohort study on outcome

Wang

et al. 2020

Renal Failure

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“…However, this issue needs to be demonstrated by additional studies. Of note, APD avoids leakage 10 and achieves adequate dialysis 36 concurrently by reducing dwell volumes and increasing the number of exchanges, respectively.…”

Section: Discussionmentioning

confidence: 99%

Urgent-start peritoneal dialysis in chronic kidney disease patients: A systematic review and meta-analysis compared with planned peritoneal dialysis and with urgent-start hemodialysis

Xieyi

Tang

et al. 2020

Perit Dial Int

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An increasing number of studies have focused on whether peritoneal dialysis (PD) can be used for the urgent initiation of dialysis in patients with chronic kidney disease (CKD). We performed this systematic review and meta-analysis to evaluate the feasibility and safety of urgent-start PD compared with those of planned PD and urgent-start hemodialysis (HD) in this population. PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), clinicaltrials.gov , and China National Knowledge Infrastructure (CNKI) were searched for relevant studies. Conference abstracts were also searched in relevant websites. The meta-analysis was performed using RevMan 5.3 software. A total of 15 trials involving 2426 participants were identified. The quality of the included studies was fair, but the quality of evidence was very low. Unadjusted meta-analysis showed that urgent-start PD had significantly higher mortality than planned PD, while adjusted meta-analysis did not show a significant difference. Higher incident of leakage and catheter mechanical dysfunction were observed in urgent-start PD. However, peritonitis, exit-site infection, or PD technique survival were comparable between urgent-start and planned PD. The all-cause mortality was comparable in urgent-start PD and urgent-start HD. Bacteremia was significantly lower in the urgent-start PD group than with urgent-start HD. Based on limited evidences, PD may be a viable alternative to HD for CKD patients requiring urgent-start dialysis. Because of the inconsistent results and the low quality of evidence, a definitive conclusion could not be drawn for whether urgent-start PD was comparable with planned PD. Therefore, high-quality and large-scale studies are needed in the future.

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“…Another study compared urgent-start APD with urgent-start CAPD (1-3 days after catheter insertion) and concluded that during the initial 9-day break-in period, APD resulted in better solute clearance, had similar complications but also led to a significant decline in serum albumin. The study suggested that a combination regimen of 6 days on APD followed by 3 days of CAPD was the most appropriate choice [107].…”

Section: Urgent Start Of Pdmentioning

confidence: 99%

APD or CAPD: one glove does not fit all

Roumeliotis

Leivaditis

et al. 2020

Int Urol Nephrol

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The use of Automated Peritoneal Dialysis (APD) in its various forms has increased over the past few years mainly in developed countries. This could be attributed to improved cycler design, apparent lifestyle benefits and the ability to achieve adequacy and ultrafiltration targets. However, the dilemma of choosing the superior modality between APD and Continuous Ambulatory Peritoneal Dialysis (CAPD) has not yet been resolved. When it comes to fast transporters and assisted PD, APD is certainly considered the most suitable Peritoneal Dialysis (PD) modality. Improved patients' compliance, lower intraperitoneal pressure and possibly lower incidence of peritonitis have been also associated with APD. However, concerns regarding increased cost, a more rapid decline in residual renal function, inadequate sodium removal and disturbed sleep are APD's setbacks. Besides APD superiority over CAPD in fast transporters, the other medical advantages of APD still remain controversial. In any case, APD should be readily available for all patients starting PD and the most important indication for its implementation remains patient's choice.

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Application of automated peritoneal dialysis in urgent-start peritoneal dialysis patients during the break-in period

Cited by 23 publications

References 29 publications

Early-start and conventional-start peritoneal dialysis: a Chinese cohort study on outcome

Early-start and conventional-start peritoneal dialysis: a Chinese cohort study on outcome

Urgent-start peritoneal dialysis in chronic kidney disease patients: A systematic review and meta-analysis compared with planned peritoneal dialysis and with urgent-start hemodialysis

APD or CAPD: one glove does not fit all

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