Impact of unplanned peritoneal dialysis start on patients' outcomes—A multicenter cohort study

Abstract

BackgroundPatients with end-stage kidney disease (ESKD) who start unplanned dialysis therapy are more likely to be treated with hemodialysis (HD) using a central venous catheter, which has been associated with a greater risk of infections and other complications, as well as with a higher long-term risk of death. Urgent-start PD is an alternative that has been suggested as an option for starting dialysis in these cases, with potentially better patient outcomes. However, the definition of urgent-start PD is not homogeneous, and no study, to our knowledge, has compared clinical outcomes among urgent start, early start, and conventional start of PD. In this study, we aimed to compare these types of initiation of dialysis therapy in terms of a composite outcome of patient survival and technique failure.MethodsThis is a retrospective, multicenter, cohort study, involving data from 122 PD clinics in Brazil. We used the following: Urgent-start groups refer to patients who initiated PD within 72 h after the PD catheter insertion; early-start groups are those starting PD from 72 h to 2 weeks after the catheter insertion; and conventional-start groups are those who used the PD catheter after 2 weeks from its insertion. We analyzed the composite endpoint of all causes of patient's mortality and technique failure (within the initial 90 days of PD therapy) using the following three different statistical models: multivariate Cox, Fine and Gay competing risk, and a multilevel model.ResultsWe included 509 patients with valid data across 68 PD clinics. There were 38 primary outcomes, comprising 25 deaths and 13 technique failures, with a total follow-up time of 1,393.3 months. Urgent-start PD had no association with the composite endpoint in all three models.ConclusionUnplanned PD seems to be a safe and feasible option for treatment for patients with non-dialysis ESKD in urgent need of dialysis.

Comparison of Unplanned/Urgent‐Start Versus Conventional‐Start Peritoneal Dialysis: A Systematic Review and Meta‐Analysis

“…Primary screening of the databases identified 842 citations. Following duplicates removal, 70 full‐text articles underwent secondary screening, and a total of 27 studies that satisfied the eligibility criteria were included in the analysis (Figure 1) [9–12, 17–39].…”

The influence of different peritoneal dialysis techniques on wound infection in patients with peritoneal dialysis tube

“…This study included 3034 PD participants, 1458 urgent start PD and 1576 conventional initiated PD. [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] The overall sample size was between 7 and 433 individuals. Urgent start PDs were greater with respect to the risk of leakage from the conduit than with the conventional baseline PD (OR, 2.48; 95% CI, 1.72, 3.59, p < 0.00001), Figure 3.…”

“…The results are presented in Table 2. This study included 3034 PD participants, 1458 urgent start PD and 1576 conventional initiated PD 18–32 . The overall sample size was between 7 and 433 individuals.…”

“…9 In this meta-analysis, 3034 PD patients were enrolled at baseline, 1758 in the urgent-initiated PD arm and 15,76 in the conventional PD group. [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] Patients with urgent-initiated PD were at a greater risk for conduit fluid leaks than those with conventional PD. But they were similar with respect to the risk of peritonitis, catheter dysfunction, catheter exit site infection and bleeding.…”

“…In this meta‐analysis, 3034 PD patients were enrolled at baseline, 1758 in the urgent‐initiated PD arm and 15,76 in the conventional PD group 18–32 . Patients with urgent‐initiated PD were at a greater risk for conduit fluid leaks than those with conventional PD.…”