Dataset Information

Early technical complications and long-term survival of urgent peritoneal dialysis according to break-in periods.

ABSTRACT:

Background

Guidelines recommend a break-in period of 2 weeks before starting peritoneal dialysis (PD), but PD within 14 days is also an acceptable and safe alternative to hemodialysis (HD) in patients with an urgent need. However, the effect of the break-in period within 48 hours or later had not been evaluated for early technical complications, long-term maintenance, and survival in patients starting urgent PD.

Methods

Of 360 patients with a surgically inserted PD catheter, we evaluated 190 patients who needed urgent PD and 29 patients who received conventional PD at a single center between January 2007 and December 2014 in this retrospective observational study. Enrolled patients were divided according to break-in period of <48 hours (P1) or 2-13 days (P2) before starting urgent PD. The primary endpoint was incidence of early technical complications and secondary endpoints included long-term PD maintenance, and patient survival.

Results

PD was started in 103 patients (54.2%) within 48 hours and in 87 patients (45.8%) within 2 to 13 days. The incidence of early technical complication was significantly higher in P1 group (28.2%) than in P2 group (10.3%) (P = 0.002). The need for a repositioning procedure was significantly greater in P1 group (14.6%) than in P2 group (3.4%) (P = 0.009). However, we observed no significant differences between the two groups with respect to the prevalence of catheter dysfunction requiring change to HD within 6 months or incidence of peritonitis or exit-site infection. There was no significant difference in PD maintenance and patient survival according to the break-in period between P1 and P2 as well as against the control group.

Conclusion

Urgent PD was associated with a low incidence of early technical complications if start was avoided within 48 hours after catheter insertion, and long-term PD maintenance was independent of the break-in period.

SUBMITTER: Kim K

PROVIDER: S-EPMC6203382 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Early technical complications and long-term survival of urgent peritoneal dialysis according to break-in periods.

Kim Kitae K Son Young Ki YK Lee Su Mi SM Kim Seong Eun SE An Won Suk WS

PloS one 20181026 10

<h4>Background</h4>Guidelines recommend a break-in period of 2 weeks before starting peritoneal dialysis (PD), but PD within 14 days is also an acceptable and safe alternative to hemodialysis (HD) in patients with an urgent need. However, the effect of the break-in period within 48 hours or later had not been evaluated for early technical complications, long-term maintenance, and survival in patients starting urgent PD.<h4>Methods</h4>Of 360 patients with a surgically inserted PD catheter, we ev ...[more]

PMID: 30365566

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Project description:IntroductionUrgent-start peritoneal dialysis (PD) in patients with newly diagnosed end-stage renal disease (ESRD) is a well-tolerated alternative to hemodialysis (HD). The primary aim of this study was to identify the demographic and clinical characteristics of ESRD patients, as well as the presurgical, surgical, and postsurgical factors associated with urgent-start PD complications.MethodsA retrospective cross-sectional observational study was performed on 102 patients with ESRD who merited urgent-start PD from January 2015 to June 2019. The primary clinical outcome measures were catheter leakage, dysfunction, and peritonitis, whereas the secondary outcomes were catheter removal, repositioning, and death. Statistical inferences were made with the χ2 or Fisher's exact test and independent samples t tests.ResultsOne hundred two subjects (65 men, 63.7%) 56.2 ± 15.1 years old were included in this study; 64 of the subjects had diabetes and hypertension (62.7%). Catheter leakage occurred in 8 patients (7.8%), catheter dysfunction in 27 patients (26.5%), and peritonitis in 14 patients (13.7%); meanwhile, catheter removal occurred in 6 patients (5.9%), catheter repositioning in 21 patients (20.6%), and death in 3 patients (2.9%). Peritonitis was associated with younger age (i.e., 47.0 ± 16.8 vs. 57.6 ± 14.4 years; P = 0.014; 95% confidence interval [CI]: 2.2-19.1; odds ratio [OR] 0.96; P = 0.018; 95% CI: 0.92-099), higher creatinine levels upon admission (i.e., 20.2 ± 9.8 vs. 14.1 ± 8.3; P = 0.014; 95% CI: -10.9 to -1.2), and heart failure (OR 4.79; P = 0.043; 95% CI: 1.05-21.88). Patients with abdominal hernia were 7.5 times more likely to have their catheter leak (OR 7.5; P = 0.036; 95% CI: 1.14-49.54). Catheter removal was associated with obesity (i.e., body mass index [BMI] of 31.6 ± 4.1 vs. 25.9 ± 4.9; P = 0.007; 95% CI: -9.8 to -1.6; OR 1.26; P = 0.013; 95% CI: 1.05-1.51) and Modification of Diet in Renal Disease glomerular filtration rate (MDRD-GFR) (i.e., 2.5 ± 0.6 vs. 3.7 ± 2.3; P = 0.003; 95% CI: 0.5-1.9).ConclusionPeritonitis was associated with younger age, higher creatinine levels upon admission, and heart failure; meanwhile, catheter removal was linked to obesity and lower glomerular filtration rate. Compared with previous reports, our study included patients in which PD was initiated shortly after catheter insertion, making the intervention a true urgent-start PD. This study contributes to the existing urgent-start PD literature by providing evidence that urgent-start PD with catheter opening within 72 hours has limited complications, making it a relatively safe option.

Project description: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.

Project description:Introduction: Preservation of peritoneal function is essential in long-term peritoneal dialysis. Biocompatible dialysis solutions might prevent or postpone the membrane alteration resulting in ultrafiltration failure and consecutive morbidity and mortality.Methods: We conducted an observational cohort study in which we made a longitudinal comparison between the course of peritoneal solute and fluid transport during treatment with conventional and biocompatible solutions. Therefore, prospectively collected peritoneal transport data from the yearly standard peritoneal permeability analysis were analyzed in 251 incident patients treated between 1994 and censoring in 2016. Fluid transport included small pore and free water transport. Solute transport was assessed by creatinine mass transfer area coefficient and glucose absorption. Linear mixed models including change point analyses were performed. Interaction with peritonitis was examined.Results: One hundred thirty-five patients received conventional and 116 biocompatible solutions. Sixty-seven percent (conventional) and 64% (biocompatible) of these underwent minimally three transport measurements. Initially, biocompatible fluids showed higher small solute transport and lower ultrafiltration than conventional fluids up to 3 years. Thereafter, conventional fluids showed an increase in small solute transport (+2.7 ml/min per year; 95% confidence interval [CI]: 0.9 to 4.5) and a decrease of free water transport (-28.0 ml/min per year; 95% CI: -60.4 to 4.4). These were minor or absent in biocompatible treatment. Peritonitis induced a decrease of transcapillary ultrafiltration after 2 years on dialysis with conventional solutions (-291 ml/min per year; 95% CI: -550 to -32) while this was absent in biocompatible treatment.Conclusion: Despite a higher initial solute transport with biocompatible solutions, these have less influence on functional long-term peritoneal alterations than conventional solutions.

Project description:BACKGROUND:Urgent-start peritoneal dialysis (PD) can help patients with end-stage renal diseases (ESRD) that are referred late to dialysis. However, catheter patency and related complications of urgent-start PD have not been thoroughly clarified. We investigated the clinical outcomes of urgent-start PD in a Chinese cohort. METHODS:We enrolled ESRD patients who received urgent-start PD (starting PD within 14?days after catheter insertion) in our center from January 1, 2006 to December 31, 2014, and followed them up for 10?years. The primary outcome was catheter failure. Secondary outcomes included short-term and long-term complications related to urgent-start PD. RESULTS:Totally 2059 patients (58.9% male, mean age 47.6?±?15.9?years) were enrolled. Few perioperative complications were observed, including significant hemorrhage (n?=?3, 0.1%) and bowel perforation (n?=?0). Early peritonitis occurred in 24 (1.2%) patients (0.28 episodes per patient-year). Within the first month after catheter insertion, functional catheter malfunction occurred in 85 (4.1%) patients, and abdominal wall complications (including hernia, hydrothorax, hydrocele, and leakage) in 36 (1.7%) patients. During a median 36.5 (17.7-61.4) months of follow-up, 75 (3.6%) patients experienced catheter failure, and 291 (14.1%) had death-censoring technique failure. At the end of 1-month, 1 -year, 3-year, and 5-year, catheter patency rate was 97.6, 96.4, 96.2, 96.2%; and technique survival rate was 99.5, 97.0, 90.3, 82.7%, respectively. After adjusting for confounders, every 5-year increase in age was associated with 19% decrease of risk for catheter failure (hazard ratio [HR]: 0.81, 95% confidence interval [CI]: 0.73-0.89). Male sex (HR: 1.43, 95% CI: 1.00-2.04), diabetic nephropathy (HR: 1.56, 95% CI: 1.08-2.25) and low hemoglobin levels (HR: 0.89, 95% CI: 0.81-0.98) were independent risk factors for abdominal wall complications. CONCLUSIONS:Urgent-start PD is a safe and efficacious option for unplanned ESRD patients. A well-trained PD team, a standardized catheter insertion procedure by experienced nephrologists, and a carefully designed initial PD prescription as well as comprehensive follow-up care, might be essential for the successful urgent-start PD program.

Dataset Information

Early technical complications and long-term survival of urgent peritoneal dialysis according to break-in periods.

Background

Methods

Results

Conclusion

Publications

Early technical complications and long-term survival of urgent peritoneal dialysis according to break-in periods.

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