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

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

doi:10.1159/000478970

Cited by 36 publications

(17 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The results confirm that PD can be a safe method of introducing RRT in unplanned acute dialysis settings. In general they are comparable with those of other authors, presented in Table 9 (Song et al, 2000; Banli et al, 2005; Povlsen and Ivarsen, 2006; Jo et al, 2007; Lobbedez et al, 2008; Yang et al, 2011; Casaretto et al, 2012; Ghaffari, 2012; Koch et al, 2012; Masseur et al, 2014; Alkatheeri et al, 2016; Bitencourt Dias et al 2016, 2017; Jin et al, 2016; Pai et al, 2016; Wong et al, 2016; Xu et al, 2017; Wang et al, 2017; Nayak et al, 2018). However, there are many methodological differences among these studies concerning patients population, the technique of peritoneal catheter placement, or length of break-in period.…”

Section: Discussionsupporting

confidence: 91%

Urgent-Start Peritoneal Dialysis as a Bridge to Definitive Chronic Renal Replacement Therapy: Short- and Long-Term Outcomes

et al. 2019

View full text Add to dashboard Cite

Background: The peritoneal dialysis (PD) urgent-start pathway, without typical 2-week break-in period, was meant for late-referral patients able and prone to join PD-first program, with its main advantages such as: keeping the vascular system intact, preserving their residual renal function and retaining life-style flexibility. We compared the short- and long-term outcomes of consecutive 35 patients after urgent- and 94 patients after the planned start of PD as the first choice.Methods: The study included all incident end-stage renal disease patients starting PD program between January 2005 and December 2015, classified into two groups: those with urgent (unplanned) and those with elective (planned) start. Urgent PD was initiated as an overnight automatic procedure (APD) with dwell volume gradually increased, and after 2–3 weeks, target PD method was established.Results: The mean time between catheter implantation and PD start was 3.5 ± 2.3 in urgent and 16.2 ± 1.7 days in planned-start groups (p < 0.00001). 51% of the patients in the urgent-start group required PD during first 48 h after catheter insertion. Mean follow-up of 17.6 ± 11.09 months (median: 19.0) was in the urgent-start group and 28.6 ± 26.6 months (median: 19.5) in the planned-start group. The early mechanical complications were observed more often in the urgent-start group (29 vs. 4%, p = 0.00005). The only significant predictors of early mechanical complications were serum albumin (p = 0.02) and time between the catheter insertion and PD start. The first year patient survival and technique survival censored for death and kidney transplantation were not significantly different between groups. In Cox proportional analysis the independent risk factors for patient survival as well as for method and patient survival appeared Charlson Comorbidity Index CCI (HR 1.4; p = 0.01 and 1.24; p = 0.02) and time from catheter implantation to PD start with HR 5.11; p = 0.03 and 4.29; p = 0.04 for <2 days, while time >14 days lost its predictive value (p = 0.07).Conclusion: Peritoneal dialysis may be a feasible and safe alternative to HD in patients who need to start dialysis urgently without established dialysis access, with an acceptable complications rates, as well as patient and technique survival.

show abstract

Section: Discussionsupporting

confidence: 91%

Urgent-Start Peritoneal Dialysis as a Bridge to Definitive Chronic Renal Replacement Therapy: Short- and Long-Term Outcomes

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The most frequent short-term complication in patients who started PD urgently was catheter tip migration and leakage, as previously described by other studies. [10][11][12] The most common cause of patient dropout was transfer to HD for both groups (two patients in ES-PD and three in US-PD). The second most common cause of dropout was death with no difference between groups, as previously shown in investigations that compared US-PD with plannedstart PD (after 15 days of catheter insertion).…”

Section: Resultsmentioning

confidence: 99%

Urgent vs. early-start peritoneal dialysis: patients' profile and outcomes

et al. 2021

View full text Add to dashboard Cite

ABSTRACT Introduction: Peritoneal dialysis (PD) has been considered a safe option of therapy in end-stage renal disease patients with urgent need of dialysis. Recently, it was proposed that Urgent-Start-PD (US-PD) be defined when PD starts within 72 hours after catheter placement and “early start” PD (ES-PD) when PD starts between 3 and 14 days after. We aimed to compare demographic and clinical characteristics between patients in US-PD and ES-PD as well as 30-day complications, 6-month hospitalization, and dropout rate. Methods: Adult patients starting PD within 14 days after catheter insertion (October/2016 - February/2019) were included and divided into US-PD group and ES-PD group based on the their PD initiation time. Clinical and demographic data, fill volume for the first PD session, 30-day complications, 6-month hospitalization, and dropout rate were assessed. Results: In our study, 72 patients were analyzed (US-PD=40, ES-PD=32) with mean age of 53.2±15.2 years old. No differences between US-PD and ES-PD regarding demographic characteristics, 30-day complications, 6-month hospitalization, and dropout events were found. The most frequent short-term complication in patients who started PD urgently was leakage. The most common cause of dropout was transfer to HD. Conclusion: Fifty five percent of our sample started PD less than 72 hours after catheter insertion. The lack of difference in the measured outcomes compared to patients that had therapy initiated after this period encourages the use of urgent PD when needed.

show abstract

“…Several previous urgent-start PD studies have reported peri-catheter leaks ranging from 2% to 33%, depending on the catheter break-in time, insertion technique, fill volumes, and strategies to secure the deep cuff. 1 , 2 , 4 , 5 The relatively low rate in this Mexican study is impressive considering the very short break-in time and the quite high fill volumes, mostly 2 liters, initially used. In other urgent-start PD cohorts, the patients were given an incremental prescription with low fill volumes to reduce this risk, as described by Povlsen et al.…”

mentioning

confidence: 72%

“…Urgent-start PD has recently become popular in North America but it needs to be noted that it often involves a longer break-in period than reported in this and other studies from Brazil, Denmark, and Poland. 1 , 2 , 5 , 6 , 7 It is useful, as we have previously proposed, to subdivide urgent-start PD into truly “urgent-start” cases in which PD is initiated within 72 hours of catheter insertion, and less urgent ones in which the break-in period is between 3 and 14 days, which we have termed “early start PD.” 9 In “early start” PD, the whole process may be carried out without hospital admission and patients may be well enough to receive PD training in association with the early use of the catheter. An initial incremental approach with supine automated PD and low dwell volumes may be feasible, and risks of leak and other complications should be correspondingly less.…”

mentioning

confidence: 99%