Peritoneal Dialysis as an option for unplanned initiation of chronic dialysis

Dias, Dayana Bitencourt; Banin, Vanessa Burgugi; Mendes, Maria Célia; Barretti, Pasqual; Ponce, Daniela

doi:10.1111/hdi.12418

Cited by 6 publications

(11 citation statements)

References 17 publications

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“…Mechanical complications with need for intervention occurred in 17.1% and peritonitis in 14.2%. Patients and technique survival in the first 180 days were higher than 80%, and the impact on the growing of chronic PD program was higher than 80% in only 360 days [24].…”

Section: Urgent-start Pd In Developing Countriesmentioning

confidence: 84%

“…Supine position was adopted during the sessions. After hospital discharge, patients were kept in IPD, in alternated days or daily, according to the clinical and laboratorial evaluation [17,23,24].…”

Section: Urgent-start Pd In Developing Countriesmentioning

confidence: 99%

“…During the IPD, training of families and/or patients was performed and, when necessary, small home adaptations to receive the therapy were done. After that, the patient was included in the program of chronic PD, with home treatment and monthly nephrologist consult [17,23,24]. Figure 1 shows the flowchart of the urgentstart PD program in Dialysis Unit of Brazilian Clinical Hospital.…”

Section: Urgent-start Pd In Developing Countriesmentioning

confidence: 99%

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Peritoneal Dialysis as an Urgent-Start Option for Incident Patients on Chronic Renal Replacement Therapy: World Experience and Review of Literature

Dias¹,

Mendes²,

Alves³

et al. 2020

Blood Purif

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Chronic kidney disease is a significant problem of public health worldwide, and up to 60% of patients start dialysis in an unplanned manner without a definitive dialysis access. Recently, peritoneal dialysis (PD) has emerged as an alternative to unplanned chronic dialytic method, and the world collective experience shows that PD can be an efficient, safe, and cost-effective alternative with comparable outcomes to the planned PD and urgent-start hemodialysis (HD). More importantly, as compared to urgent-start HD using a central venous catheter, urgent-start PD has significantly fewer incidences of catheter-related bloodstream infections, dialysisrelated mechanical complications, and need for dialysis catheter reinsertions during the initial time of the therapy. An integrative review was conducted on PD urgent start compared to HD urgent start and to planned PD, identifying its potential advantages and limitations. Literature search was performed within multiple databases, and observational studies on clinical experience with urgent PD were reviewed and appraised.

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Section: Urgent-start Pd In Developing Countriesmentioning

confidence: 84%

Section: Urgent-start Pd In Developing Countriesmentioning

confidence: 99%

Section: Urgent-start Pd In Developing Countriesmentioning

confidence: 99%

See 1 more Smart Citation

Peritoneal Dialysis as an Urgent-Start Option for Incident Patients on Chronic Renal Replacement Therapy: World Experience and Review of Literature

Dias¹,

Mendes²,

Alves³

et al. 2020

Blood Purif

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show abstract

“…Initiating dialytic therapy in an urgent scenario is a very common situation worldwide. 21 The majority of patients admitted to the hospital service with some indication for immediate renal replacement therapy (RRT) are treated with HD with a CVC, 22–23 despite studies pointing to higher morbidity and mortality under these conditions, especially during the first months of therapy. 8,9…”

Section: Discussionmentioning

confidence: 99%

Urgent-start dialysis: Comparison of complications and outcomes between peritoneal dialysis and haemodialysis

et al. 2020

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Background: Few studies have evaluated the viability and outcomes between peritoneal dialysis (PD) and haemodialysis (HD) in urgent-start renal replacement therapy (RRT). This study aimed to compare infectious and mechanical complications related to urgent-start PD and HD. Secondary outcomes were to identify risk factors for complications and mortality related to urgent-start dialysis. Methods: A quasi-experimental study with incident patients receiving PD and HD in a Brazilian university hospital, between July 2014 and December 2017. Subjects included individuals with final-stage chronic kidney disease who required immediate RRT, that is, HD through central venous catheter or PD in which the catheter was implanted by a nephrologist and utilized for 72 h, without previous training. Patients with PD were subjected, initially, to high-volume PD for metabolic compensation. After hospital discharge, they remained in intermittent PD in the dialysis unit until training was completed. Mechanical and infectious complications were compared, as well as the recovery of renal function and survival. Results: In total, 93 patients were included in PD and 91 in HD. PD and HD groups were similar regarding age (58 ± 17 vs. 60 ± 15 years; p = 0.49), frequency of diabetes mellitus (37.6% vs. 50.5%; p = 0.10), other comorbidities (74.1% vs. 71.4%; p = 0.67) and biochemical parameters at the beginning of RRT, that is, creatinine (9.1 ± 4.1 vs. 8.0 ± 2.8; p = 0.09), serum albumin (3.1 ± 0.6 vs. 3.3 ± 0.6; p = 0.06) and haemoglobin (9.5 ± 1.8 vs. 9.8 ± 2.0; p = 0.44). After a minimum follow-up period of 180 days and a maximum follow-up period of 2 years, there was no difference regarding mechanical complications (24.7% vs. 37.4%; p = 0.06) or bacteraemia (15.0% vs. 24.0%; p = 0.11); however, there was a difference regarding infection of the exit site (25.8% vs. 39.5%; p = 0.04) and diuresis maintenance [700 (0–1500) vs. 0 (0–500); p < 0.001], with better results in the PD group. There was better phosphorus control at 180 days in the PD group (62.4% vs. 41.8%; p = 0.008), with a lower requirement for phosphate binder usage (28% vs. 55%; p < 0.001), erythropoietin (18.3% vs. 49.5%; p < 0.001) and anti-hypertensives (11.8% vs. 30.8%; p = 0.003). Time to death was similar between groups. In the multivariate analysis, PD was a predictor of renal function recovery [odds ratio: 3.95 (1.01–15.4)]. Conclusion: PD is a viable and safe alternative to HD in a scenario of urgent-start RRT with complication rates and outcomes similar to those of HD, highlighting the results regarding renal function recovery.

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“…18 PD has been seen as a viable and safe alternative to HD in unplanned dialysis starts in developed and developing nations, nurturing the growth of PD programs. 19,20,21,22,23 Casaretto et al 24 and Ghaffari et al 25 reported that urgent-start PD programs call for novel infrastructure and specific care processes. The medical team has to be ready and available to implant peritoneal catheters in emergency settings, with the active participation of nephrologists.…”

Section: Introductionmentioning

confidence: 99%