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

Abstract

<b><i>Introduction:</i></b> The best timing of peritoneal dialysis (PD) initiation after catheter implantation is still controversial. It is necessary to explore whether there exists a waiting period to minimize the risk of complications. <b><i>Methods:</i></b> A systematic review and meta-analysis were searched in multiple electronic databases published from inception to February 29, 2020, to identify cohort studies for evaluating the outcome and safety of unplanned-start PD (<14 days after catheter insertion). Risks of bias across studies were evaluated using Newcastle-Ottawa Quality Assessment Scale. <b><i>Results:</i></b> Fourteen cohort studies with a total of 2,401 patients were enrolled. We found that early-start PD was associated with higher prevalence of leaks (RR: 2.67, 95% CI, 1.55–4.61) and omental wrap (RR: 3.28, 95% CI, 1.14–9.39). Furthermore, patients of unplanned-start PD in APD group have higher risk of leaks, while those in CAPD group have a higher risk of leaks, omental wrap, and catheter malposition. In shorter break-in period (BI) group, the risk of suffering from catheter obstruction and malposition was higher for patients who started dialysis within 7 days after the surgery than for patients within 7–14 days. No significant differences were found in peritonitis (RR: 1.00; 95% CI, 0.78–1.27) and exit-site infections (RR: 1.12; 95% CI, 0.72–1.75). However, shorter BI was associated with higher risk of mortality and transition to hemodialysis (HD) while worsen early technical survival, with pooled RR of 2.14 (95% CI, 1.52–3.02), 1.42 (95% CI, 1.09–1.85) and 0.95 (95% CI, 0.92–0.99), respectively. <b><i>Conclusions:</i></b> Evidence suggests that patients receiving unplanned-start PD may have higher risks of mechanical complications, transition to HD, and even mortality rate while worsening early technical survival, which may not be associated with infectious complications. Rigorous studies are required to be performed.

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

“…We did not detect any difference in the infection rate between both modes of PD. This aligns with the previous reviews and hypothesis that with modern catheter insertion techniques and PD regimes, the risk of infectious complications is comparable irrespective of the timing of PD initiation [40]. Skills of the interventional radiologists play an instrumental role in this outcome, as the technique of catheter placement, type of catheter chosen, and post-insertion care can significantly influence infection rates.…”

Prognosis of urgent initiation of peritoneal dialysis: a systematic review and meta-analysis

“…For the inclusion criteria methodology, we referred to the previously published article by Yin et al. [ 16 ]. Studies were evaluated using the following eligibility criteria: (i) cohort studies (prospective or retrospective) published as original research; (ii) studies involving patients with chronic kidney disease >18 years of age; (iii) studies comparing the outcomes of emergency-initiated PD (<14 d after catheter insertion) with those of routine PD (≥14 d after catheter insertion); and (iv) studies that provided data on patient/renal outcomes for >2 years or adverse event rate data.…”

“…Previous meta-analyses [ 16 ] compared the Clinical Prognostic Outcome of unplanned peritoneal dialysis, and we updated the literature based on this, as well as adding and focusing on the comparison of outcomes with BI < 7. Therefore, our study evaluated the outcomes and safety of different urgent initiation strategies compared to conventional PD concerning the BI period, including mechanical and infectious complications, technique survival rates, and transition to HD.…”

Risk factors of different mortality periods in older patients with end-stage renal disease undergoing urgent-start peritoneal dialysis: a retrospective observational study

“…The number of patients using renal replacement therapy has been estimated to at least double globally by 2030, with the most rapid increase occurring in Asia [ 1 ]. Due to complicating factors such as late referrals and unforeseen deterioration of renal function, many patients require an urgent start of dialysis treatment [ 2 ]. Although peritoneal dialysis (PD) has unique advantages, such as hemodynamic stability, protection of residual kidney function, no need for vascular access, and lower technical requirements [ 3 , 4 ], urgent-start hemodialysis (USHD) is preferred as the first option in most cases [ 5 ].…”