Early Start Peritoneal Dialysis: Technique Survival in Long-Term Follow-Up

Abstract

Background/Aims: Peritoneal dialysis (PD) has gained interest over the last decade as a viable option for early start dialysis. It is still unknown if shorter break-in periods and less time for proper patient evaluation and training could influence technique survival in comparison to planned-start PD. Methods: A prospective and observational study that compared technique survival in a cohort of patients who started either early or planned PD. Early start PD was defined as break-in period from 3 to 14 days with no previous nephrologist follow-up or patient training. Results: A total of 154 patients were included (40 as early start PD), followed by a median time of 381 days. Comparing early vs. planned-start PD, groups were similar concerning age 56 (40; 70) vs. 48 (32; 63) years, p=0.071, body mass index (BMI) 23.3 ± 4.2 vs. 23.8 ± 4.0 kg/m², p=0.567 and male gender (60 vs. 48%, p=0.201), respectively. Comparing early vs. planned-start groups, there were no differences regarding PD dropout for peritonitis (7.5 vs. 11.4%, p=0.764), catheter dysfunction (12.5 vs. 17.5%, p=0.619) and patient burnout (0 vs. 4.4%, p=0.328), respectively. Less patients in early start group quit PD for peritoneal membrane failure in comparison to planned-start group (2.5 vs. 16.7%, p=0.026). In multivariate cox-regression analysis, the only factors independently associated with technique failure were BMI> 25 kg/m² (p=0.033) and Diabetes Mellitus (p=0.013), whereas no differences regarding early vs. planned-PD start were observed (p=0.184). Conclusion: Despite the adverse scenario for initiating dialysis, early start PD had similar outcomes in comparison to planned-start PD in long-term follow-up.

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

“…Eleven of the included studies 2,18 –27 compared the outcomes of urgent-start PD with those of planned PD, three 28 –30 compared the outcomes of urgent-start PD with those of urgent-start HD, whereas one study 31 compared the outcomes of urgent-start PD with those of both planned PD and urgent-start HD concurrently. In the only RCT study, 27 participants were randomized to the urgent-start PD group or the planned PD group.…”

“…Most studies reported outcomes observed during the short-term follow-up, two studies 21,22 reported technique survival in a longer follow-up. Two studies 18,26 reported different follow-up periods between the two groups; thus, data pertaining to this subject were not extracted for meta-analysis.…”

“…Eight 2,20 –22,24 –26,30 studies reported PD technique survival rate, and the unadjusted meta-analysis of both case–control studies and cohort studies showed no significant difference between the two groups (2 case–control studies, 160 participants, RR: 0.91, 95% CI: 0.91–1.00, p = 0.05, heterogeneity: p = 0.50, I 2 = 0%; six cohort studies, 1340 patients, RR: 0.97, 95% CI: 0.93–1.01, p = 0.19, heterogeneity: p = 0.36, I 2 = 9%; Figure 5). After death and transplantation being censored, one of the case–control studies 24 showed no significant difference between the two groups (56 participants, RR: 0.95, 95% CI: 0.82–1.09, p = 0.43).…”

Outcome and Safety of Unplanned-Start Peritoneal Dialysis according to Break-In Periods: A Systematic Review and Meta-Analysis

“…The recent review [13] also demonstrated that using the lowest possible dwell volume based on patient’s size and keeping the patient in strict supine position during treatment for initial 2 weeks were the most critical factors in minimizing the risk of catheter leaks and malfunction. Furthermore, recent studies [29, 30, 38] showed that immediate PD after catheter insertion is feasible, catheter implantation technology might have contributed to the mechanical complication. Stegmayr [18] reported that optimizing the success rate for PD catheter placement requires physicians to focus on insertion of the catheters.…”

“…Among these studies, the early technique survival rate varies from 75% (unplanned-start PD) versus 86.5% (conventional PD) at 3 months to 68 versus 80% at 1 year, which showed that unplanned-start PD might be detrimental to early technique survival of patients. However, a number of observational studies showed that PD initiated immediately after catheter insertion might have no major effect on technique survival [25, 30, 31]. Younger patient population, lower incidence of comorbidities, and better center management were the possible reasons to explain that.…”