Unplanned Start on Peritoneal Dialysis Right after Pd Catheter Implantation for Older People with End-Stage Renal Disease

Abstract

Unplanned start on dialysis remains a major problem for the dialysis community worldwide. Late-referred patients with end-stage renal disease (ESRD) and urgent need for dialysis are overrepresented among older people. These patients are particularly likely to be started on in-center hemodialysis (HD), with a temporary vascular access known to be associated with excess mortality and increased risks of potentially lethal complications such as bacteremia and central venous thrombosis or stenosis.The present paper describes in detail our program for unplanned start on automated peritoneal dialysis (APD) right after PD catheter implantation and summarizes our experiences with the program so far. Compared with planned start on PD after at least 2 weeks of break-in between PD catheter implantation and initiation of dialysis, unplanned start may be associated with a slight increased risk of mechanical complications but apparently no detrimental effect on mortality, peritonitis-free survival, or PD technique survival.In our opinion and experience, the risk of serious complications associated with the implantation and immediate use of a PD catheter is less than the risk of complications associated with unplanned start on HD with a temporary central venous catheter (CVC). Unplanned start on APD is a gentle, safe, and feasible alternative to unplanned start on HD with a temporary CVC that is also valid for the latereferred older patient with ESRD and urgent need for dialysis. Perit Dial Int

Comparison of outcomes between emergent-start and planned-start peritoneal dialysis in incident ESRD patients: a prospective observational study

“…This clinical scenario is somewhat reminescent of the resurgent momentum of urgent-start PD program, in which patients starting PD within 2 weeks after placement of the PD catheter exhibited outcomes comparable to the traditionally planned counterpart [ 5 , 7 , 8 ]. It is advocated that urgent-start PD be a sound treatment option for late-referred CKD patients who do not have a mature vascular access at the time of dialysis initiation [ 6 , 10 , 21 ]. Similarly, data accrued from this study suggest that post-initiation PD can be a relatively safe long-term dialysis treatment for late-referred CKD patients, given the poor outcome of the concurrent emergent-start HD-CVC patients who commenced long-term dialysis with a tunneled cuffed CVC.…”

“…Despite wide-spread promotion of planned-start dialysis therapy for patients with advanced chronic kidney disease (CKD), there remain patients who are referred ultra-late to the nephrologists, [ 4 , 10 ] and acute dialysis has to be initiated via a temporary hemodialysis (HD) catheter due to life-threatening uremic emergency [ 11 , 12 ]. After stabilization of vital conditions, most such patients tend to choose HD out of convenience as the long-term dialysis modality, [ 10 , 13 ] although some may select post-initiation PD, i.e., emergent-start PD, as the treatment option. Compared to the above-mentioned urgent-start PD which is considered a safe and effective option of dialysis initiation, data are still limited regarding the impact of emergent-start PD in new-onset patients with ESRD [ 13 ].…”

Urgent-Start Peritoneal Dialysis: The First Year of Brazilian Experience

“…Ivarsen and Povlsen [1], Povlsen et al [8] and Liu et al [16] showed that total mechanical complications occurred significantly more in urgent-start than conventional start PD [1,8,16]. They noted that there was an increased need for surgical replacement of PD catheter in the urgent group.…”

“…In our study, the rate of technique survival was 86% at 180 days. Povlsen et al [8] and Ivarsen and Povlsen [1] looked at technique survival at 3 months in their urgent start PD group and it was 86.7 vs. 90%, respectively [8,1]. Song et al [17] showed that catheter survival at 1 year was about 85%.…”

“…Few studies have described patients' experience with urgent-start PD [4,5,6,7,8]. Some reports have compared urgent-start HD to PD and found that urgent-start PD is a safe and effective alternative to HD for unplanned dialysis starts [4,5].…”