Urgent-Start Peritoneal Dialysis and Hemodialysis in ESRD Patients: Complications and Outcomes

Abstract

BackgroundSeveral studies have suggested that urgent-start peritoneal dialysis (PD) is a feasible alternative to hemodialysis (HD) in patients with end-stage renal disease (ESRD), but the impact of the dialysis modality on outcome, especially on short-term complications, in urgent-start dialysis has not been directly evaluated. The aim of the current study was to compare the complications and outcomes of PD and HD in urgent-start dialysis ESRD patients.MethodsIn this retrospective study, ESRD patients who initiated dialysis urgently without a pre-established functional vascular access or PD catheter at a single center from January 2013 to December 2014 were included. Patients were grouped according to their dialysis modality (PD and HD). Each patient was followed for at least 30 days after catheter insertion (until January 2016). Dialysis-related complications and patient survival were compared between the two groups.ResultsOur study enrolled 178 patients (56.2% male), of whom 96 and 82 patients were in the PD and HD groups, respectively. Compared with HD patients, PD patients had more cardiovascular disease, less heart failure, higher levels of serum potassium, hemoglobin, serum albumin, serum pre-albumin, and lower levels of brain natriuretic peptide. There were no significant differences in gender, age, use of steroids, early referral to a nephrologist, prevalence of primary renal diseases, prevalence of co-morbidities, and other laboratory characteristics between the groups. The incidence of dialysis-related complications during the first 30 days was significantly higher in HD than PD patients. HD patients had a significantly higher probability of bacteremia compared to PD patients. HD was an independent predictor of short-term (30-day) dialysis-related complications. There was no significant difference between PD and HD patients with respect to patient survival rate.ConclusionIn an experienced center, PD is a safe and feasible dialysis alternative to HD for ESRD patients with an urgent need for dialysis.

Peritoneal Dialysis as an Option for Unplanned Dialysis Initiation in Patients with End-Stage Renal Disease and Diabetes Mellitus

“…A previous large, retrospective study at this center including 657 ESRD patients, of whom 136 (20.7%) had diabetes, found that a break-in period of < 1 week might be related to a minor increased risk of mechanical complications but had no major effect on technique survival in PD patients [21]. Another previous large, retrospective study (n = 178, including 51 diabetics) in our center reported that urgent-start PD resulted in fewer short-term dialysis-related complications, fewer dialysis-related complications requiring re-insertion, and less bacteremia compared with urgent-start HD, with no significant difference in patient survival [22]. A retrospective study at our center also found that urgent-start PD reduced the incidence of short-term dialysis-related complications compared with urgent-start HD in older patients with ESRD, without affecting survival [23].…”

Early-start and conventional-start peritoneal dialysis: a Chinese cohort study on outcome

“…Hemodialysis (HD) is still the first choice for the unplanned dialysis patients, although the permanent access needed to be constructed later [5]. Previous studies have shown comparable patients' survival and technique survival between PD and HD when started unexpectedly; however, the latter has a higher incidence of dialysis-related complications and bacteremia [6][7][8]. Given the comparable patients' survival and less medical costs, early-start PD might be a reasonable alternative for unplanned renal replacement therapy.…”

Is surgical PD catheter insertion safe for urgent‐start peritoneal dialysis?

“…More recently, Jin et al published their experience with USPD following surgical implantation of the PD catheters . At their institution, all Tenckhoff catheters were inserted by nephrologists using laparotomy technique.…”

“…A closer look at the above studies highlights a few points, which might help reduce mechanical complications in the setting of USPD. Some investigators have suggested that placing a purse‐string suture around the deep cuff can prevent catheter leaks when PD is initiated urgently; however, others reporting comparable results have not used it in their PD catheter insertion protocols . Similarly, keeping the insertion site lateral to the midline and pushing the deep cuff into the rectus muscle below the anterior rectus sheath has also been recommended …”

“…Some investigators have suggested that placing a purse-string suture around the deep cuff can prevent catheter leaks when PD is initiated urgently 4,9 ; however, others reporting comparable results have not used it in their PD catheter insertion protocols. 1,5 Similarly, keeping the insertion site lateral to the midline and pushing the deep cuff into the rectus muscle below the anterior rectus sheath has also been recommended. 1,4,9 The two most important factors, agreed upon by most investiga- postures.…”