Urgent Peritoneal Dialysis Initiation: is it Better to Wait a Few Days than to Use the Catheter Immediately After its Implantation? A Randomized Controlled Trial

Abstract

Background: High-grade evidence for recommendations about the appropriate lag-time from implantation to utilization of the catheter regarding urgent PD is lacking. The objective of this study was to compare immediate and delayed utilization of the Tenckhoff catheter in urgent PD.

Urgent-start peritoneal dialysis for patients with end stage renal disease: a 10-year retrospective study

“…Low catheter patency is a major concern in urgent-start PD because earlier-start PD may irritate the omentum and cause omental wrapping, thus leading to the catheter failure [9, 11, 21]. However, catheter patency rates were rarely reported in previous studies on urgent-start PD, whereas functional catheter problems (including catheter malfunction, catheter shift, and/or omental wrapping) reportedly fluctuated between 2.0 and 15.4% in previous studies [5, 11, 13, 14, 16]. In our study, 156 (7.6%) patients experienced functional catheter problems; 40.4% of their functional catheter problems occurred within 14 days after insertion, and 51.9% were rescued by the conservative methods.…”

“…Abdominal wall complications (especially pericatheter leakage, which happens early after catheter insertion) are also major concerns in urgent-start PD [9]. Reported incidence of dialysate leakage varies from 1.5 to 37% in regular PD patients [5, 24–27], but fluctuates between 0 and 13.5% in patients who receive urgent-start PD [5, 11, 13–16]. In theory, increased intraperitoneal infusion during PD will increase the intraperitoneal pressure, and eventually increase the risk of developing abdominal wall complications.…”