Early Initiation of Continuous Ambulatory Peritoneal Dialysis in Patients Undergoing Surgical Implantation of Tenckhoff Catheters

Abstract

Early initiation of CAPD with surgically implanted Tenckhoff catheters is feasible and safe. Shorter break-in periods are not associated with more catheter-related complications. The data from our peritoneal dialysis population suggest that early initiation is not associated with an increased number of complications. This needs to be confirmed in a randomized trial.

Urgent Peritoneal Dialysis Initiation: is it Better to Wait a Few Days than to Use the Catheter Immediately After its Implantation? A Randomized Controlled Trial

“…In a recent retrospective study, 226 patients who started CAPD ≤ 14 days after implantation were compared to 84 patients starting CAPD>14 days after implantation. Catheter-related complications within 6 months were no different between early and late groups (14.6 vs. 13.1% respectively) [11].…”

“…The authors of all the mentioned reports [3,9,11,[16][17][18][19][20] showed that a shortened break-in period for initiating the utilization of a TC is feasible and safe. However, the studies have substantial differences in their design and results.…”

“…Most importantly, the studies have different times elapsed from insertion to initiation of the TC utilization. Only one of the studies is a RCT [16], 3 are comparative retrospective studies with unmatched controls [3,11,19], and 4 are prospective observational studies without a comparison group [9,17,18,20]. The technique for TC placement was percutaneous in 4 [9,16,17,19], surgical in 2 [3,11], laparoscopic in 1 (20), and non-specified in 1 [18].…”

“…However, the results of the present study do not support such a speculation. Several studies address the issue of early initiation of PD therapy [3,9,11,[16][17][18][19][20]: A single-centre randomized controlled trial compared 21 patients, in whom exchange volume was gradually increased from 500 mL per 3 hours to full-volume exchange over 13 days to 38 patients, who received full-volume exchange per 6 hours from the day of catheter implantation. One-year catheter survival was very similar in the 2 groups: 84.2% and 85.7% respectively, the study provided no evidence that immediate full-volume exchange causes more short-or long-term complications compared to the stepwise volume increment method [16].…”

“…The 2 to 4 week break-in period would require bridge hemodialysis in some patients that need urgent dialysis therapy [9,11]. In some developing countries, such as in Mexico, there may not be availability of bridge hemodialysis, making it necessary to initiate the utilization of the TC immediately after its placement.…”