Feasibility of a break-in period of less than 24 hours for urgent start peritoneal dialysis: a multicenter study

Abstract

Purpose Urgent start peritoneal dialysis (USPD) is an effective therapeutic method for end-stage renal disease (ESRD). However, whether it is safe to initiate peritoneal dialysis (PD) within 24 h unclear. We examined the short-term outcomes of a break-in period (BI) of 24 h for patients undergoing USPD. Methods This real-world, multicenter, retrospective cohort study evaluated USPD patients from five centers from January 2013 to August 2020. Patients were divided into BI ≤ 24 h or BI > 24 h groups. The Primary outcomes included incidence of mechanical and infectious complications. The secondary outcome was technique failure. Moreover, we presented a subgroup analysis for patients who did not receive temporary hemodialysis (HD). Results A total of 871 USPD patients were included: 470 in the BI ≤ 24 h and 401 in the BI > 24 h groups. Mechanical and infectious complications did not differ between the two groups across the follow-up timepoints (2 weeks, 1 month, 3 months, and 6 months) ( p > 0.05). Multiple logistic regression analysis revealed that BI ≤ 24 h was not an independent risk factor for mechanical complications, catheter migration, or infectious complications ( p > 0.05). A BI ≤ 24 h was not an independent significant risk factor for technique failure by multivariate Cox regression analysis ( p > 0.05). The subgroup analysis of patients who did not receive temporary HD returned the same results. Conclusion Initiating PD within 24 h of catheter insertion was not associated with increased mechanical complications, infectious complications, or technique failures.

Modified minimally invasive laparoscopic peritoneal dialysis catheter insertion with internal fixation

“…In this study, laparoscopic surgery did not increase the operative time, time from operation to starting PD and time from operation to discharge, which would not affect patient management. Although guidelines recommend a break-in period of at least 2 weeks before PD starts, starting USPD within 2 weeks after catheter insertion has no major influence on catheter-related complications [ 19 ]. To minimize the risk of leakage, these patients started automated PD in the supine position with a small-volume PD prescription.…”

A randomized controlled comparative study of different fluid exchange modes in urgent-start peritoneal dialysis in patients with end-stage renal disease: automated peritoneal dialysis combined with manual fluid exchange vs. manual fluid exchange alone

“…Recently, percutaneous catheterization was more and more widely used in USPD. A real-world, multicenter, retrospective cohort study found percutaneous catheterization was more commonly used for a break interval <24 h and laparoscopic or open surgery method was more commonly used for a break interval >7 days [ 22 ]. Another study compared percutaneous with surgical implantation in USPD [ 23 ].…”

Automated peritoneal dialysis in urgent‐start dialysis ESRD patients: Safety and dialysis adequacy

“…We followed this commonly used definition of urgent-start PD (who require dialysis initiation less than 2 weeks) [7,[28][29][30][31] when we conducted this study. However, several recent published data reported their successful experience of urgent-start PD with less than 72-h break-in period [32][33][34][35][36], which we did not take it into consideration. Therefore, further exploration are needed to verify the feasibility of urgent-start PD less than 72 h. It is a single center, self-matched design, which limits the generalizability of the results.…”