Safety of Urgent Initiation of Peritoneal Dialysis
In case of urgent need for kidney function replacement, hemodialysis (HD) with a temporary venous catheter has long been the standard solution. However, it has several disadvantages such as increased mortality or the risk of bacteremia and central venous stenosis. Additionally, multiple procedures are needed to create a permanent venous access. Therefore, there is a growing global interest in urgently initiated peritoneal dialysis (PD), with several clinical studies attesting to its safety, efficacy, and feasibility. However, little has been known about early PD complications and the long-term prognosis of patients in terms of technical and infectious complications.
Introduction
Compared to conventional PD initiation, where the catheter is left in place for several weeks to minimize the theoretical risk of mechanical complications, urgent peritoneal dialysis is initiated within 2 weeks after catheter placement. This eliminates the need for bridging HD required by some patients with conventional initiation. At the same time, it spares the patient the need for temporary vascular access and provides a solution that can be used in home care, is comfortable, and cost-effective for the healthcare system.
Study Objectives
Initial insights were provided by a monocentric controlled study conducted between 2010 and 2015. Patients with urgent PD initiation were compared with matched controls with conventional PD initiation in a 1:3 ratio. The primary parameters observed were early complications within 4 weeks of catheter placement and dialysis initiation. Secondary parameters included continued use of the method and time to the onset of peritonitis.
Results
A total of 104 patients were enrolled in the study (26 with urgent and 78 with conventional PD initiation). Urgent patients were typically sent for examination late, started PD in the hospital, and had prescribed lower initial volumes (p < 0.01). They experienced more mechanical complications after catheter placement in terms of fluid leakage (12 vs. 1%; p = 0.047) and more frequent catheter displacement after PD initiation (12 vs. 1%; p = 0.047). However, no significant difference was observed in the incidence of overall and infectious complications. Kaplan-Meier curves for continued method use and time to the first episode of peritonitis showed comparable results in both groups.
Conclusion
Compared to conventional PD initiation, urgent PD has an acceptably low incidence of acute complications and demonstrates similar continued use of the method and time to first peritonitis. It appears to be a safe method for the urgent replacement of renal functions in patients without established HD access.
(pez)
Source: See E. J., Cho Y., Hawley C. M. et al. Early and late patient outcomes in urgent-start peritoneal dialysis. Perit Dial Int 2017; 37 (4): 414−419, doi: 10.3747/pdi.2016.00158.
Did you like this article? Would you like to comment on it? Write to us. We are interested in your opinion. We will not publish it, but we will gladly answer you.
