Comparison of mortality and complications between urgent‐start peritoneal dialysis and urgent‐start hemodialysis: A systematic review and meta‐analysis

Ding, Xinyu; Gao, Weijie; Guo, Yingbo; Cai, Qian; Bai, Yu

doi:10.1111/sdi.13001

Cited by 10 publications

(5 citation statements)

References 33 publications

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“…However, this delay has led to a low adoption rate of PD and left many patients without a viable dialysis plan, relegating them to HD. With the recent progress in PD catheter insertion technique, urgent-start PD is now a comparable and even superior option when compared to urgent-start HD via a central vein catheter [22,25]. We here demonstrate that the hybrid PD catheter insertion approach is a secure and effective option for prompt initiation of PD in ESKD patients.…”

Section: Discussionmentioning

confidence: 71%

Hybrid Method for Peritoneal Dialysis Catheter Insertion: A New Technique for Improved Outcomes and Reduced Costs

Li¹,

Chen²,

Tsai³

et al. 2023

Am J Nephrol

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Introduction: Peritoneal dialysis (PD) is a well-established treatment choice for end-stage kidney disease (ESKD). While there are several methods for PD catheter insertion, they each have limitations. In this study, we present a new hybrid method for PD catheter insertion and compare it to the conventional laparoscopic method. Methods: This retrospective study included 171 patients who were undergoing their first PD catheter insertion, and a total of 20% of the enrolled patients had a past medical history of abdominal surgery. Out of these, 101 patients underwent the laparoscopic method and 70 underwent a new invented hybrid method. The study aimed to compare the surgical outcomes, incidence of early and late complications, hospital stay, and medical expenses between the two groups. Results: There were no notable differences in basic demographic features and comorbid conditions between the two groups. The results of our data revealed that the hybrid group had a significantly shorter break-in period and did not require temporary hemodialysis. Additionally, length of hospital stay and medical costs were significantly lower in the hybrid group (all p < 0.05). The incidence of early complications was lower in the hybrid group, while the incidence of late complications was comparable between the two groups. Conclusion: Our study demonstrates that the hybrid method of PD catheter insertion provides a safe and efficient alternative to the traditional laparoscopic method, enabling urgent-start PD and reducing hospital stays and medical expenses. Our findings support the use of the hybrid method as a new standard of care for ESKD patients undergoing PD catheter insertion.

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Section: Discussionmentioning

confidence: 71%

Hybrid Method for Peritoneal Dialysis Catheter Insertion: A New Technique for Improved Outcomes and Reduced Costs

Li¹,

Chen²,

Tsai³

et al. 2023

Am J Nephrol

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“…Ding et al [35] recently published a systematic review and meta-analysis of seven studies comparing urgentstart PD with urgent-start HD, with mortality as the primary outcome, and dialysis-related infectious complications and mechanical complications as secondary outcomes. Their pooled analysis showed a significantly reduced risk of all-cause mortality in patients on urgentstart PD as compared to urgent-start HD.…”

Section: Discussionmentioning

confidence: 99%

Urgent-Start Peritoneal Dialysis: Brazilian Experience

Alves¹,

Calice‐Silva²,

Rufino³

et al. 2023

Blood Purif

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Introduction: Unplanned peritoneal dialysis (PD) is an important option for chronic kidney disease (CKD) patients requiring kidney replacement therapy urgently as it offers the convenience of home-based therapy. The objective of this study was to assess the Brazilian urgent-start PD program in three different dialysis centers where there is shortage of hemodialysis (HD) beds. Methods: This prospective, multicentric cohort study included incident patients with stage 5 CKD and no permanent vascular access established who started urgent PD between July 2014 and July 2020 in three different hospitals. Urgent-start PD was defined as initiation of treatment up to 72 h after catheter placement. Patients were followed up from catheter insertion and assessed according to mechanical and infectious complications related to PD, patients, and technique survival. Results: Over 6 years, 370 patients were included in all three study centers. Mean patient age was 57.8 ± 16.32 years. Diabetic kidney disease was the main underlying condition (35.1%) and uremia was the main cause for dialysis indication (81.1%). Concerning complications related to PD, 24.3% had mechanical complications, 27.3% had peritonitis, 28.01% had technique failure, and 17.8% died. On logistic regression, hospitalization (p = 0.003) and exit site infection (p = 0.002) were identified as predictors of peritonitis, while mechanical complications (p = 0.004) and peritonitis (p < 0.001) were identified as predictors of technique failure and switching to HD. Age (p < 0.001), hospitalization (p = 0.012), and bacteremia (p = 0.021) were observed to predict death. The number of patients on PD increased at least 140% in all three participating centers. Conclusion: PD is a feasible option for patients starting dialysis in an unplanned manner and may be a useful tool for reducing shortage of HD beds.

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“…b Patients with peritoneal dialysis could not include analysis due to hemodialysis modality specific variable (n = 100). [18]. Dias et al found that the frequency of catheterrelated bacteremia and mechanical complications were 24.1% and 37.4% in patients with urgent-start HD [7].…”

Section: Discussionmentioning

confidence: 99%

“…Another meta‐analysis conducted in 2021 revealed that observational studies indicate lower mortality and lower risk of mechanical complications with urgent‐start PD versus urgent‐start HD. They also found that the risk of infectious complications was not different between the two dialysis modalities in contrast to Htay's meta‐analysis [18]. Dias et al found that the frequency of catheter‐related bacteremia and mechanical complications were 24.1% and 37.4% in patients with urgent‐start HD [7].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of early‐start peritoneal dialysis (PD) and the comparison with urgent‐start hemodialysis and conventional‐start PD

et al. 2022

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Background: Limited data in the literature is comparing early-start peritoneal dialysis (PD), urgent-start hemodialysis (HD) with the jugular central venous catheter (CVC), and conventional-start PD. Methods: This retrospective study was conducted with 148 patients with early-start PD, 104 patients with conventional-start PD, and 100 patients with urgent-start HD. Early-start PD was defined as catheter break-in time between 3 and 14 days. Results:The occurrence of dialysate-leakage was similar between PD groups (p = 0.1). Bleeding at the catheter site was detected in 8 (2.3%) patients with CVC. There was no significant difference in catheter dysfunction and revision.PD groups had statistically similar peritonitis rates (p = 0.5). 19% (19/100) of patients suffered CVC-related bloodstream infection and one patient died due to septic shock. Technique survival was significantly higher at early-start PD than the conventional-start PD at 6 months (p = 0.02). Conclusion:Initiating early-start PD is comparable with conventional-start PD, and it may be an alternative dialysis modality to avoid bloodstream infections in suitable patients.

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Comparison of mortality and complications between urgent‐start peritoneal dialysis and urgent‐start hemodialysis: A systematic review and meta‐analysis

Cited by 10 publications

References 33 publications

Hybrid Method for Peritoneal Dialysis Catheter Insertion: A New Technique for Improved Outcomes and Reduced Costs

Hybrid Method for Peritoneal Dialysis Catheter Insertion: A New Technique for Improved Outcomes and Reduced Costs

Urgent-Start Peritoneal Dialysis: Brazilian Experience

Outcomes of early‐start peritoneal dialysis (PD) and the comparison with urgent‐start hemodialysis and conventional‐start PD

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