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Tsihlis G, Pirabhahar K, Sciberras F, Nicdao M, Aw L, Agoo A, Lee V, Li J, Kairaitis L, Sud K, Swinnen J, Chau K. Pericatheter Leak Associated With Earlier Peritoneal Dialysis Initiation Does Not Influence Long-Term Outcomes. Kidney Int Rep 2024; 9:2727-2738. [PMID: 39291194 PMCID: PMC11403086 DOI: 10.1016/j.ekir.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/12/2024] [Accepted: 07/02/2024] [Indexed: 09/19/2024] Open
Abstract
Introduction Internationally, peritoneal dialysis (PD) is increasingly being commenced within 2 weeks of catheter insertion. Studies are warranted to evaluate outcomes of this strategy. Methods This study examines outcomes of early-start PD (ESPD) and conventional-start PD (CSPD), commencing at ≤14 days and >14 days after catheter insertion, respectively. All adults with kidney failure within a large metropolitan PD unit initiating PD through a new catheter, inserted using laparoscopic or modified Seldinger technique, between August 2019 and August 2022, were included in this retrospective observational study. Demographic data and episodes of infectious and mechanical complications were collected using electronic medical records. Analysis was conducted using analysis of variance and Chi-square testing. A P-value < 0.05 was significant with Bonferroni correction performed where relevant. Kaplan-Meier and competing risks analyses were performed for time to PD-related peritonitis and transfer to hemodialysis. Results A total of 297 patients (70% male, mean age 58.7 years) were included, with 130 (43.8%) patients undertaking ESPD. Most patients had laparoscopically inserted catheters (65.3%) and 65 patients (22.0%) received prior hemodialysis. When compared to CSPD, ESPD was associated with a higher number of pericatheter leaks (6.9% vs. 0.6%, P = 0.003), with otherwise similar complication episodes and no significant difference with respect to time to PD-related peritonitis or transfer to hemodialysis. Catheter insertion technique or prior hemodialysis treatment did not significantly influence outcomes. Conclusion ESPD is associated with increased pericatheter leaks when compared to CSPD, with an otherwise similar complication profile.
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Affiliation(s)
- George Tsihlis
- Western Renal Services (Western Sydney and Nepean Blue Mountains Local Health Districts), Sydney, New South Wales, Australia
- The Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Kieren Pirabhahar
- Blacktown and Mount Druitt Clinical School, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Frederika Sciberras
- Western Renal Services (Western Sydney and Nepean Blue Mountains Local Health Districts), Sydney, New South Wales, Australia
| | - MaryAnn Nicdao
- Western Renal Services (Western Sydney and Nepean Blue Mountains Local Health Districts), Sydney, New South Wales, Australia
| | - Laraine Aw
- Western Renal Services (Western Sydney and Nepean Blue Mountains Local Health Districts), Sydney, New South Wales, Australia
| | - Alvie Agoo
- Western Renal Services (Western Sydney and Nepean Blue Mountains Local Health Districts), Sydney, New South Wales, Australia
| | - Vincent Lee
- Western Renal Services (Western Sydney and Nepean Blue Mountains Local Health Districts), Sydney, New South Wales, Australia
- The Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jennifer Li
- Western Renal Services (Western Sydney and Nepean Blue Mountains Local Health Districts), Sydney, New South Wales, Australia
- The Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Lukas Kairaitis
- Western Renal Services (Western Sydney and Nepean Blue Mountains Local Health Districts), Sydney, New South Wales, Australia
- Blacktown and Mount Druitt Clinical School, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Kamal Sud
- Western Renal Services (Western Sydney and Nepean Blue Mountains Local Health Districts), Sydney, New South Wales, Australia
- Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Renal Medicine, Nepean Kidney Research Centre, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Jan Swinnen
- Médecins Sans Frontières, Geneva, Switzerland
- Department of Vascular Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Katrina Chau
- Western Renal Services (Western Sydney and Nepean Blue Mountains Local Health Districts), Sydney, New South Wales, Australia
- Blacktown and Mount Druitt Clinical School, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
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Santarelli S, Ramazzotti V, Agostinelli RM, Degano G. Interventional nephrology in peritoneal dialysis: Best practice report of the Peritoneal Dialysis Project Group of the Italian Society of Nephrology. J Vasc Access 2024:11297298241258800. [PMID: 39127877 DOI: 10.1177/11297298241258800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2024] Open
Abstract
The procedure of peritoneal dialysis (PD) catheter placement is of utmost importance for a good outcome of peritoneal dialysis. Currently, catheters are mainly placed by surgeons and interventional nephrologists. Still, there is a lack of trained personnel in many dialysis units, which can impair the efficiency of PD units and reduce the patients' possibility to enter a PD programme. The Italian Society of Nephrology has endorsed a practical core curriculum for interventional nephrology in PD available on the Society website, which is here reported for the wider nephrology community. The topics addressed are the hernias of the abdominal wall, catheter placement with standard surgical open technique, basic video-laparoscopy, advanced video-laparoscopy, video-laparoscopic cholecystectomy and catheter placement, cuff-shaving and video-laparoscopy in catheter malfunction.
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Affiliation(s)
- Stefano Santarelli
- Nephrology and Dialysis Unit, 'Carlo Urbani' Hospital, Jesi, Ancona, Italy
| | | | | | - Giorgio Degano
- General Surgery Unit, 'Carlo Urbani' Hospital, Jesi, Ancona, Italy
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Wongpraphairot S, Choopun K, Sriphatphiriyakun T, Titawatanakul A, Chongsuvivatwong V, Phongphithakchai A. Comparison of immediate-start peritoneal dialysis without break-in period and conventional-start peritoneal dialysis: a two-center retrospective audit. Int Urol Nephrol 2024; 56:2403-2409. [PMID: 38441870 DOI: 10.1007/s11255-024-03967-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/29/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE Immediate-start peritoneal dialysis (PD) has emerged as a strategy for patients in need of urgent dialysis. However, the ideal timing for initiating this procedure remains uncertain. In this study, we aimed to compare complications and outcomes between immediate-start PD and conventional-start PD. METHODS We performed a two-center retrospective cohort study between 1 January 2015 and 31 May 2020. Patients who underwent PD were divided into immediate-start PD (without break-in period) and conventional-start PD group (break-in period within at least 14 days). The primary outcomes were the incidence of the mechanical complications and infectious complication. The secondary outcomes were technique failure and patient survival. RESULTS A total of 209 patients (106 in the immediate-start PD group and 103 in the conventional-start PD group) were included. Immediate-start PD had significantly lower catheter malfunction or migration rate compare with conventional-start PD (2.8% vs. 15.5%, p = 0.003) but comparable rates of dialysate leaks, pleuroperitoneal leaks, and hemoperitoneum. Infectious complications (exit-site infection and peritonitis) were similar between groups. Technique survival was comparable (7.5% vs. 4.8%, p = 0.22), while immediate-start PD exhibited lower mortality rates (0.9% vs. 13.6%, p = 0.001). CONCLUSION Immediate-start PD appears to be a viable option for patients in need of urgent dialysis, with reduced catheter complications and comparable infectious complications and technique survival when compared to conventional-start PD.
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Affiliation(s)
- Suwikran Wongpraphairot
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 15 Kanchanavanit Road, Hat Yai, 90110, Songkhla, Thailand
| | | | | | | | | | - Atthaphong Phongphithakchai
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 15 Kanchanavanit Road, Hat Yai, 90110, Songkhla, Thailand.
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Duan P, Zhang H, Zhang Y. The effect of urgent-start peritoneal dialysis and urgent-start hemodialysis on clinical outcomes in patients with chronic kidney disease: an updated systematic review and meta-analysis. Int Urol Nephrol 2024; 56:2301-2312. [PMID: 38441869 DOI: 10.1007/s11255-024-03999-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/19/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE Recently, urgent-start peritoneal dialysis (PD) has been suggested in place of urgent-start hemodialysis (HD) in cases of chronic kidney disease (CKD). However, the comparative effectiveness of these methods is still unclear. This study compared the outcomes of urgent-start PD and urgent-start HD in CKD patients. METHODS Electronic searches were conducted in PubMed, EMbase, Google Scholar databases, and Cochrane Library, up to 30th July 2023 for studies reporting data on all-cause mortality. Secondary outcomes included dialysis-related infectious and mechanical complications. Risk ratios (RRs) with 95% confidence interval (CI) were calculated. RESULTS Nine eligible studies involving 941 PD and 779 HD patients were analyzed. Pooled analysis demonstrated elevated risk of all-cause mortality (RR: 1.06, 95% CI: 1.02 to 1.09), dialysis-related infectious complications (RR: 1.05, 95% CI: 1.02 to 1.07), and mechanical complications (RR: 1.08, 95% CI: 1.04 to 1.13) in patients undergoing urgent-start HD than in patients on urgent-start PD. CONCLUSION Our findings indicate that CKD patients that received urgent-start HD are at increased risk of all-cause mortality and infectious, and mechanical complications that are associated with the dialysis than patients that received urgent-start PD. These findings have to be considered when making treatment decisions for patients with acute kidney injury. Better understanding of the mechanism of these differences may help to create guidelines for more informed clinical practices.
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Affiliation(s)
- Peixin Duan
- Department of Nephrology, Changxing People's Hospital, Changxing County, Huzhou, Zhejiang, China
| | - Hailuo Zhang
- Department of Nephrology, Changxing People's Hospital, Changxing County, Huzhou, Zhejiang, China
| | - Yun Zhang
- Department of Nephrology, Changxing People's Hospital, Changxing County, Huzhou, Zhejiang, China.
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Mohammadi A, Akhondi H, Joshi DR, Mirabbasi SA. Rare Pathogens in Peritoneal Dialysis-Associated Peritonitis: A Comprehensive Case Study and Guideline Review. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e943953. [PMID: 38831580 PMCID: PMC11163831 DOI: 10.12659/ajcr.943953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/16/2024] [Accepted: 04/04/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Peritoneal dialysis (PD) serves as a critical renal replacement therapy for individuals with end-stage renal disease (ESRD), leveraging the peritoneum for fluid and substance exchange. Despite its effectiveness, PD is marred by complications such as peritonitis, which significantly impacts patient outcomes. The novelty of our report lies in the presentation of a rare case of PD-associated peritonitis caused by 2 unusual pathogens, emphasizing the importance of rigorous infection control measures. CASE REPORT We report on an 80-year-old African-American female patient with ESRD undergoing PD, who was admitted twice within 8 months for non-recurring episodes of peritonitis. These episodes were attributed to the rare pathogens Achromobacter denitrificans/xylosoxidans and Carbapenem-resistant Acinetobacter baumannii. Despite presenting with similar symptoms during each episode, such as abdominal pain and turbid dialysis effluent, the presence of these uncommon bacteria highlights the intricate challenges in managing infections associated with PD. The treatment strategy encompassed targeted antibiotic therapy, determined through susceptibility testing. Notably, the decision to remove the PD catheter followed extensive patient education, ensuring the patient comprehended the rationale behind this approach. This crucial step, along with the subsequent shift to hemodialysis, was pivotal in resolving the infection, illustrating the importance of patient involvement in the management of complex PD-related infections. CONCLUSIONS This case underscores the complexities of managing PD-associated peritonitis, particularly with uncommon and resistant bacteria. It emphasizes the importance of rigorous infection control measures, the need to consider atypical pathogens, and the critical role of patient involvement in treatment decisions. Our insights advocate for a more informed approach to handling such infections, aiming to reduce morbidity and improve patient outcomes. The examination of the literature on recurrent peritonitis and treatment strategies provides key perspectives for navigating these challenging cases effectively.
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Affiliation(s)
- Abbas Mohammadi
- Department of Internal Medicine, Spring Valley Hospital, Valley Health System, Las Vegas, NV, USA
| | - Hossein Akhondi
- Department of Internal Medicine, Spring Valley Hospital, Valley Health System, Las Vegas, NV, USA
| | - Dhiresh R. Joshi
- Department of Infectious Diseases, Spring Valley Hospital, Valley Health System, Las Vegas, NV, USA
| | - Seyed Abbas Mirabbasi
- Department of Internal Medicine, Spring Valley Hospital, Valley Health System, Las Vegas, NV, USA
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Ma T, Li X, Hao J, Song D, Wang H, Liu T, Zhang Y, Abi N, Xu X, Dong J. The prognostic values of estimating intraperitoneal pressure in the occurrence of abdominal wall complications in peritoneal dialysis patients. J Nephrol 2024; 37:1351-1360. [PMID: 38512377 DOI: 10.1007/s40620-024-01913-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 01/24/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Increased intraperitoneal pressure is associated with abdominal wall complications and technical failure of peritoneal dialysis (PD). Several equations have been developed to estimate intraperitoneal pressure. We aimed to assess the prognostic yield of the intraperitoneal pressure as estimated by current equations on the occurrence of abdominal wall complications in peritoneal dialysis patients. METHODS This is a retrospective analysis of data from a prospective cohort which recruited 1207 incident PD patients. Estimated intraperitoneal pressure was calculated using four available equations (according to Sigogne, Castellanos, Scanziani and de Jesus Ventura). Abdominal wall complications were recorded during follow-up. Univariate analysis and multivariate analysis with competing risk regression were used to assess the predictive power of the estimates of intraperitoneal pressure in the occurrence of abdominal wall complications. RESULTS During a median follow-up of 30 months, 66 (5.5%) patients (1.6/100 patient-years) developed abdominal wall complications. The median time to the occurrence of abdominal wall complications was 5.7 months. Only the estimated intraperitoneal pressure by the de Jesus Ventura equation significantly predicted abdominal wall complications by using univariate analyses. Associations between estimated intraperitoneal pressure by the de Jesus Ventura equation and the occurrence of abdominal wall complications disappeared after adjusting for significant clinical factors. CONCLUSIONS We verified the prognostic value of estimation of intraperitoneal pressure by four available equations in predicting abdominal wall complications in our single-center PD cohort. Due to a low diagnostic yield, a novel equation for estimating the intraperitoneal pressure is urgently needed.
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Affiliation(s)
- Tiantian Ma
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Renal Division, Department of Medicine, Ministry of Health, Ministry of Education, Institute of Nephrology, Peking University First Hospital, Peking University, Beijing, 100034, China
| | - Xinqiu Li
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Renal Division, Department of Medicine, Ministry of Health, Ministry of Education, Institute of Nephrology, Peking University First Hospital, Peking University, Beijing, 100034, China
| | - Jiayu Hao
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Renal Division, Department of Medicine, Ministry of Health, Ministry of Education, Institute of Nephrology, Peking University First Hospital, Peking University, Beijing, 100034, China
| | - Di Song
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Renal Division, Department of Medicine, Ministry of Health, Ministry of Education, Institute of Nephrology, Peking University First Hospital, Peking University, Beijing, 100034, China
| | - Hongyan Wang
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Renal Division, Department of Medicine, Ministry of Health, Ministry of Education, Institute of Nephrology, Peking University First Hospital, Peking University, Beijing, 100034, China
| | - Tianjiao Liu
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Renal Division, Department of Medicine, Ministry of Health, Ministry of Education, Institute of Nephrology, Peking University First Hospital, Peking University, Beijing, 100034, China
| | - Yaling Zhang
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Renal Division, Department of Medicine, Ministry of Health, Ministry of Education, Institute of Nephrology, Peking University First Hospital, Peking University, Beijing, 100034, China
| | - Nanzha Abi
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Renal Division, Department of Medicine, Ministry of Health, Ministry of Education, Institute of Nephrology, Peking University First Hospital, Peking University, Beijing, 100034, China
| | - Xiao Xu
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Renal Division, Department of Medicine, Ministry of Health, Ministry of Education, Institute of Nephrology, Peking University First Hospital, Peking University, Beijing, 100034, China
| | - Jie Dong
- Key Laboratory of Renal Disease, Key Laboratory of Renal Disease, Renal Division, Department of Medicine, Ministry of Health, Ministry of Education, Institute of Nephrology, Peking University First Hospital, Peking University, Beijing, 100034, China.
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Rope R, Ryan E, Weinhandl ED, Abra GE. Home-Based Dialysis: A Primer for the Internist. Annu Rev Med 2024; 75:205-217. [PMID: 38039393 DOI: 10.1146/annurev-med-050922-051415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
Home-based dialysis modalities offer both clinical and practical advantages to patients. The use of the home-based modalities, peritoneal dialysis and home hemodialysis, has been increasing over the past decade after a long period of decline. Given the increasing frequency of use of these types of dialysis, it is important for clinicians to be familiar with how these types of dialysis are performed and key clinical aspects of care related to their use in patients with end-stage kidney disease.
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Affiliation(s)
- Robert Rope
- Division of Nephrology and Hypertension, Oregon Health & Science University, Portland, Oregon, USA;
| | - Eric Ryan
- Division of Nephrology and Hypertension, Oregon Health & Science University, Portland, Oregon, USA;
| | - Eric D Weinhandl
- DaVita Clinical Research, Minneapolis, Minnesota, USA
- Department of Pharmaceutical Care and Health Systems, University of Minnesota, Minneapolis, Minnesota, USA
| | - Graham E Abra
- Division of Nephrology, Department of Medicine, Stanford University, Stanford, California, USA;
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Li X, Ma T, Hao J, Song D, Wang H, Liu T, Zhang Y, Abi N, Xu X, Zhang M, Sun W, Li X, Dong J. Novel equations for estimating intraperitoneal pressure among peritoneal dialysis patients. Clin Kidney J 2023; 16:1447-1456. [PMID: 37664572 PMCID: PMC10469109 DOI: 10.1093/ckj/sfad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Indexed: 09/05/2023] Open
Abstract
Background Increased intraperitoneal pressure (IPP) is associated with abdominal wall complications and technical failure in peritoneal dialysis (PD). Since the standard measurement of IPP is limited due to its cumbersome procedures, we aimed to develop and validate equations for estimating IPP. Methods We performed a cross-sectional study with a total of 200 prevalent PD patients who were divided into development and validation datasets after random sampling matched by body mass index. The IPPs were measured using the Durand method, with whole-body and abdominal anthropometry indices collected. Equations with 2.0-L and 1.5-L fill volumes were generated by stepwise linear regression modelling. The bias, accuracy and precision of the estimated IPP (eIPP) with 2-L and 1.5-L fill volumes were compared with actual IPPs by the Durand method. The eIPP for the 2-L fill volume was also compared with other existing equations. Results Two new equations incorporating waist circumference and height from the decubitus plane to mid-axillary line were generated. The eIPPs exhibited small biases in relation to the Durand method , with median differences of -0.24 cmH2O and -0.10 cmH2O for 2 L and 1.5 L, respectively. The precisions evaluated by the standard deviation of the absolute value of the differences were 2.59 cmH2O and 2.50 cmH2O, respectively. The accuracies evaluated by the value of the percentage of estimates that differed by >20% for the eIPP were 26% for 2.0 L and 27% for 1.5 L. Better bias, precision and accuracy were observed for the eIPP equation compared with other existing equations for the 2.0-L fill volume. Conclusions We provided two new equations developed from abdominal anthropometry indices to accurately estimate the IPP in the PD population.
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Affiliation(s)
- Xinqiu Li
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Tiantian Ma
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Jiayu Hao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Di Song
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Hongyan Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Tianjiao Liu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Yaling Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Nanzha Abi
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Xiao Xu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Manze Zhang
- School of Basic Medical Sciences Peking University, China
| | - Weiqi Sun
- School of Basic Medical Sciences Peking University, China
| | - Xin Li
- School of Basic Medical Sciences Peking University, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
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Wei Z, Jin Y, Cheng J, Han X, Liu J, Liu S. Chinese experience on comparison of clinical efficacy and safety of hemodialysis and peritoneal dialysis in the treatment of diabetic kidney failure: a systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1116103. [PMID: 37636569 PMCID: PMC10449255 DOI: 10.3389/fmed.2023.1116103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Objective This meta-analysis aims to compare the efficacy and safety of peritoneal dialysis (PD) and hemodialysis (HD) in the treatment of diabetic kidney failure. Methods Five databases were selected to retrieve research on PD and HD for diabetic kidney failure until 6 August 2022. A fixed-effects or random-effects model was utilized to calculate the standardized mean difference (SMD) or odds ratio (OR) based on the heterogeneity among studies. Results Sixteen studies were included. The results showed that patients with diabetic kidney failure treated with PD had lower levels of albumin, total protein, and systolic blood pressure (SBP) and higher levels of urine volume, creatinine, and blood urea nitrogen (BUN) and lower risk of cardiovascular and bleeding events, with significant statistical difference when compared with patients treated with HD (albumin: SMD = -1.22, 95%CI: -1.53, -0.91; total protein: SMD = -0.96, 95%CI: -1.16, -0.77; SBP: SMD = -0.35, 95%CI: -0.64, -0.06; urine volume: SMD = 0.68, 95%CI: 0.40, 0.96; creatinine: SMD = 0.49, 95%CI: 0.27, 0.72; BUN: SMD = 0.55, 95%CI: 0.25, 0.85; cardiovascular events: OR = 0.42, 95%CI: 0.28, 0.62; bleeding: OR = 0.41, 95%CI 0.27, 0.62). Conclusion This meta-analysis summarized the advantages and disadvantages of PD and HD for treating diabetic kidney failure patients. Compared with HD, PD is more effective in preserving residual kidney function, reducing hemodynamic effect, and lowering the risk of bleeding and cardiovascular events in diabetic kidney failure patients, but it also predisposes to protein-energy malnutrition and increases the risk of infection.
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Affiliation(s)
| | | | | | | | | | - Shengjun Liu
- Department of Nephrology, The Frist Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
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Cholerzyńska H, Zasada W, Michalak H, Miedziaszczyk M, Oko A, Idasiak-Piechocka I. Urgent Implantation of Peritoneal Dialysis Catheter in Chronic Kidney Disease and Acute Kidney Injury-A Review. J Clin Med 2023; 12:5079. [PMID: 37568481 PMCID: PMC10419992 DOI: 10.3390/jcm12155079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/13/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Acute kidney injury (AKI) and sudden exacerbation of chronic kidney disease (CKD) frequently necessitate urgent kidney replacement therapy (UKRT). Peritoneal dialysis (PD) is recognized as a viable modality for managing such patients. Urgent-start peritoneal dialysis (USPD) may be associated with an increased number of complications and is rarely utilized. This review examines recent literature investigating the clinical outcomes of USPD in CKD and AKI. Relevant research was identified through searches of the MEDLINE (PubMed), Scopus, Web of Science, and Google Scholar databases using MeSH terms and relevant keywords. Included studies focused on the emergency use of peritoneal dialysis in CKD or AKI and reported treatment outcomes. While no official recommendations exist for catheter implantation in USPD, the impact of the technique itself on outcomes was found to be less significant compared with the post-implantation factors. USPD represents a safe and effective treatment modality for AKI, although complications such as catheter malfunctions, leakage, and peritonitis were observed. Furthermore, USPD demonstrated efficacy in managing CKD, although it was associated with a higher incidence of complications compared to conventional-start peritoneal dialysis. Despite its cost-effectiveness, PD requires greater technical expertise from medical professionals. Close supervision and pre-planning for catheter insertion are essential for CKD patients. Whenever feasible, an urgent start should be avoided. Nevertheless, in emergency scenarios, USPD does remain a safe and efficient approach.
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Affiliation(s)
| | | | | | - Miłosz Miedziaszczyk
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (H.C.); (W.Z.); (H.M.); (A.O.); (I.I.-P.)
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Khan SF, Rosner MH. Optimizing peritoneal dialysis catheter placement. FRONTIERS IN NEPHROLOGY 2023; 3:1056574. [PMID: 37675363 PMCID: PMC10479565 DOI: 10.3389/fneph.2023.1056574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/22/2023] [Indexed: 09/08/2023]
Abstract
Long-term success of peritoneal dialysis as a kidney replacement therapy requires a well-functioning peritoneal dialysis catheter. With ongoing reductions in infectious complications, there is an increased emphasis on the impact of catheter-related and mechanical complications. There is currently a marked variation in the utilization of various types of catheters (double cuff vs single cuff, coiled tip vs straight tip), methods of catheter insertion (advanced laparoscopic, open surgical dissection, image guided percutaneous, blind percutaneous), timing of catheter insertion, location of catheter placement (pre-sternal v. abdominal) and peri-operative practices. Specialized approaches to catheter placement in clinical practice include use of extended catheters and embedded catheters. Marked variations in patient lifestyle preferences and comorbidities, specifically in high acuity patient populations (polycystic kidney disease, obesity, cirrhosis) necessitate individualized approaches to catheter placement and care. Current consensus guidelines recommend local procedural expertise, consideration of patient characteristics and appropriate resources to support catheter placement and long-term functioning. This review focuses on an overview of approaches to catheter placement with emphasis on a patient-centered approach.
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Affiliation(s)
- Sana F. Khan
- Division of Nephrology, University of Virginia Health System, Charlottesville, VA, United States
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12
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Ghaffari A, Doria Medina Sanchez J. Peritoneal Dialysis Should Be Considered the First Option for Patients Requiring Urgent Start Dialysis: PRO. KIDNEY360 2023; 4:134-137. [PMID: 36821604 PMCID: PMC10103293 DOI: 10.34067/kid.0007782021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/15/2022] [Indexed: 06/18/2023]
Affiliation(s)
- Arshia Ghaffari
- Division of Nephrology and Hypertension, Keck School of Medicine, University of Southern California, Los Angeles, California
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13
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Rosner MH. Peritoneal Dialysis Should Be Considered the First Option for Patients Requiring Urgent Start Dialysis: COMMENTARY. KIDNEY360 2023; 4:141-142. [PMID: 36821606 PMCID: PMC10103274 DOI: 10.34067/kid.0002342022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Mitchell H. Rosner
- Division of Nephrology, University of Virginia Health, Charlottesville, Virginia
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14
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El Bardai G, Chouhani BA, Kabbali N, Najdi A, Arrayhani M, Sqalli Houssaini T. Early and Late Patient Outcomes in Urgent-Start Peritoneal Dialysis: A Prospective Study of Unplanned Initiation of Chronic Dialysis. Cureus 2022; 14:e31254. [PMID: 36382328 PMCID: PMC9642965 DOI: 10.7759/cureus.31254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) has become a well-established complementary alternative to hemodialysis (HD) as the first-line renal replacement modality. Unlike the temporary catheter for hemodialysis that can be used immediately after implementation, the PD catheter usage period remains controversial. The aim of this study was to compare the short- and long-term outcomes in patients under peritoneal dialysis according to the delay of starting the dialysis after catheter placement. METHODS This observational prospective study was conducted over an eight-year and four-month period (from April 2014 to August 2021), including all patients treated with peritoneal dialysis for 18 months (from April 2014 to October 2015). The patients were divided into two groups according to whether the catheter was used during the first 15 days (PD-E) or 15 days after (PD-L) catheter placement. The primary outcomes were early complications (mechanical and infectious) within 90 days. Secondary outcomes included technique survival. RESULTS Among the 36 patients included in the study, 14 started PD early (38.8%), while 22 started it 15 days after catheter placement (61.2%). The mean age between the two groups was not significantly different (41 ± 17 years vs 35 ± 16 years, p: not significant). There were no significant differences in the Charlson comorbidity index or the degree of autonomy. The incidence of infections was not significantly different between the two groups (13.6% in PD-L vs 21.4% in PD-E, p: not significant). The total number of mechanical complications was not significantly higher in the PD-E group compared to the PD-L group (42.8% vs 27.3%, respectively, p: not significant). Kaplan-Meier estimates of technique survival were comparable between the groups (log Rank: 1.908, p: 0.67). CONCLUSIONS Our study showed no increase in the risk of complications associated with early use of the PD catheter and no difference in technique survival. PD can be used as first-line renal replacement therapy in the unplanned initiation of chronic dialysis.
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Affiliation(s)
- Ghita El Bardai
- Department of Nephrology, Dialysis, and Transplantation, Hassan II University Hospital, Fez, MAR
- Laboratory of Epidemiology and Health Science Research (ERESS), Faculty of Medicine-Fez, Sidi-Mohammed-Ben-Abdellah University, Fez, MAR
| | - Basmat Amal Chouhani
- Department of Nephrology, Dialysis, and Transplantation, Hassan II University Hospital, Fez, MAR
- Laboratory of Epidemiology and Health Science Research (ERESS), Faculty of Medicine-Fez, Sidi-Mohammed-Ben-Abdellah University, Fez, MAR
| | - Nadia Kabbali
- Department of Nephrology, Dialysis, and Transplantation, Hassan II University Hospital, Fez, MAR
- Laboratory of Epidemiology and Health Science Research (ERESS), Faculty of Medicine-Fez, Sidi-Mohammed-Ben-Abdellah University, Fez, MAR
| | - Adil Najdi
- Epidemiology, Faculty of Medicine and Pharmacy of Tangier, Tangier, MAR
| | - Mohamed Arrayhani
- Nephrology, Dialysis, and Transplantation, Souss Massa University Hospital, Agadir, MAR
| | - Tarik Sqalli Houssaini
- Department of Nephrology, Dialysis, and Transplantation, Hassan II University Hospital, Fez, MAR
- Laboratory of Epidemiology and Health Science Research (ERESS), Faculty of Medicine-Fez, Sidi-Mohammed-Ben-Abdellah University, Fez, MAR
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15
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Abstract
Peritoneal dialysis (PD) is an important home-based treatment for kidney failure and accounts for 11% of all dialysis and 9% of all kidney replacement therapy globally. Although PD is available in 81% of countries, this provision ranges from 96% in high-income countries to 32% in low-income countries. Compared with haemodialysis, PD has numerous potential advantages, including a simpler technique, greater feasibility of use in remote communities, generally lower cost, lesser need for trained staff, fewer management challenges during natural disasters, possibly better survival in the first few years, greater ability to travel, fewer dietary restrictions, better preservation of residual kidney function, greater treatment satisfaction, better quality of life, better outcomes following subsequent kidney transplantation, delayed need for vascular access (especially in small children), reduced need for erythropoiesis-stimulating agents, and lower risk of blood-borne virus infections and of SARS-CoV-2 infection. PD outcomes have been improving over time but with great variability, driven by individual and system-level inequities and by centre effects; this variation is exacerbated by a lack of standardized outcome definitions. Potential strategies for outcome improvement include enhanced standardization, monitoring and reporting of PD outcomes, and the implementation of continuous quality improvement programmes and of PD-specific interventions, such as incremental PD, the use of biocompatible PD solutions and remote PD monitoring. The use of peritoneal dialysis (PD) can be advantageous compared with haemodialysis treatment, although several barriers limit its broad implementation. This review examines the epidemiology of peritoneal dialysis (PD) outcomes, including clinical, patient-reported and surrogate PD outcomes. Peritoneal dialysis (PD) has distinct advantages compared with haemodialysis, including the convenience of home treatment, improved quality of life, technical simplicity, lesser need for trained staff, greater cost-effectiveness in most countries, improved equity of access to dialysis in resource-limited settings, and improved survival, particularly in the first few years of initiating therapy. Important barriers can hamper PD utilization in low-income settings, including the high costs of PD fluids (owing to the inability to manufacture them locally and the exorbitant costs of their import), limited workforce availability and a practice culture that limits optimal PD use, often leading to suboptimal outcomes. PD outcomes are highly variable around the world owing in part to the use of variable outcome definitions, a heterogeneous practice culture, the lack of standardized monitoring and reporting of quality indicators, and kidney failure care gaps (including health care workforce shortages, inadequate health care financing, suboptimal governance and a lack of good health care information systems). Key outcomes include not only clinical outcomes (typically defined as medical outcomes based on clinician assessment or diagnosis) — for example, PD-related infections, technique survival, mechanical complications, hospitalizations and PD-related mortality — but also patient-reported outcomes. These outcomes are directly reported by patients and focus on how they function or feel, typically in relation to quality of life or symptoms; patient-reported outcomes are used less frequently than clinical outcomes in day-to-day routine care.
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16
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Sarnak MJ, Auguste BL, Brown E, Chang AR, Chertow GM, Hannan M, Herzog CA, Nadeau-Fredette AC, Tang WHW, Wang AYM, Weiner DE, Chan CT. Cardiovascular Effects of Home Dialysis Therapies: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e146-e164. [PMID: 35968722 DOI: 10.1161/cir.0000000000001088] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality in patients with end-stage kidney disease. Currently, thrice-weekly in-center hemodialysis for 3 to 5 hours per session is the most common therapy worldwide for patients with treated kidney failure. Outcomes with thrice-weekly in-center hemodialysis are poor. Emerging evidence supports the overarching hypothesis that a more physiological approach to administering dialysis therapy, including in the home through home hemodialysis or peritoneal dialysis, may lead to improvement in several cardiovascular risk factors and cardiovascular outcomes compared with thrice-weekly in-center hemodialysis. The Advancing American Kidney Health Initiative, which has a goal of increasing the use of home dialysis, is aligned with the American Heart Association's 2024 mission to champion a full and healthy life and health equity. We conclude that incorporation of interdisciplinary care models to increase the use of home dialysis therapies in an equitable manner will contribute to the ultimate goal of improving outcomes for patients with kidney failure and cardiovascular disease.
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17
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Dong X, Wu H, Ye H, Yi C, Diao X, Liu R, Mao H, Huang F, Yu X, Yang X. Incidence and Risk Factors Associated with Technique Failure in the First Year of Peritoneal Dialysis: A Single Center Retrospective Cohort Study in Southern China. BMC Nephrol 2022; 23:207. [PMID: 35690721 PMCID: PMC9188716 DOI: 10.1186/s12882-022-02833-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/30/2022] [Indexed: 11/29/2022] Open
Abstract
Background Technique failure is more likely to occur during the first 12 months after peritoneal dialysis (PD) initiation, which is a great challenge encountered in PD patients. The aim of this study was to investigate the incidence and risk factors associated with technique failure within the first year of PD patients in Southern China. Methods Incident PD patients who were followed up for at least one year at The First Affiliated Hospital of Sun Yat-sen University from January 1, 2006 to December 31, 2015 were included. Technique failure was defined as transferring to hemodialysis (HD) for more than 30 days or death within the first year after start of PD. A competitive risk regression analysis was used to explore the incidence and risk factors of the technique failure. Results Overall, 2,290 incident PD patients were included in this study, with a mean age of 48.2 ± 15.7 years, 40.9% female and 25.2% with diabetes. A total of 173 patients (7.5%) had technique failure during the first year of PD. Among them, the patient death account for 62.4% (n = 108) and transferring to HD account for 37.6% (n = 65). The main reasons for death were cardiovascular diseases (n = 32, 29.6%), infection (n = 15, 13.8%) and for conversion to HD were mechanical cause (n = 28, 43.1%), infection cause (n = 22, 33.8%). The risk factors for the technique failure included advanced age (HR 2.78, 95%CI 1.82–4.30), low body mass index (BMI < 18.5 kg/m2: HR 1.77, 95%CI 1.17–2.67), history of congestive heart failure (HR 2.81, 95%CI 1.58–4.98), or time on HD before PD ≤ 3 months (HR 1.49, 95%CI 1.05–2.10), peritonitis (HR 2.02, 95%CI 1.36–3.01);while higher serum albumin (HR 0.93, 95%CI 0.89–0.96) and using employee medical insurance to pay expenses (HR 0.47, 95%CI 0.32–0.69) were associated with reduced risk. Conclusions Advanced age, poor nutritional status, history of HD or congestive heart failure, and peritonitis are related factors that increase the risk of technique failure in the first year of PD, while patients' type of medical insurance may also have an influence on early technique failure. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02833-4.
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Affiliation(s)
- Xiao Dong
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, People's Republic of China
| | - Haishan Wu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, People's Republic of China
| | - Hongjian Ye
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, People's Republic of China
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, People's Republic of China
| | - Xiangwen Diao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, People's Republic of China
| | - Ruihua Liu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, People's Republic of China
| | - Haiping Mao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, People's Republic of China
| | - Fengxian Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, People's Republic of China
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China. .,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, People's Republic of China. .,GuangdongProvincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China. .,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, People's Republic of China.
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18
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Analysis of mechanical complications in urgent-start peritoneal dialysis. J Nephrol 2022; 35:1489-1496. [PMID: 35312961 DOI: 10.1007/s40620-022-01294-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/20/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD) is an excellent, but underutilized dialysis technique. Thus, its implementation may depend also on the chance to offer this modality of treatment to patients referred late to the nephologists. This approach has recently been named "urgent-start peritoneal dialysis" (UPD). The main barrier to this practice is represented by the fear of early mechanical complications. METHODS All prevalent patients needing urgent-start PD at our institution between 1 January, 2009 and 31 December, 2019 were included in the study. During this period, 242 peritoneal catheters were inserted in 222 patients. In all patients, an anti-leakage/dislocation suture was made. PD was started within 24 h from catheter placement. RESULTS The early incidence of leakages, catheter dislocations, omental wrappings, bleedings, peritonitis and exit-site infections was 11/242 (4.5%), 5/242 (2%), 3/242 (1.2%), 2/242 (0.8%), 6/242 (2.5%) and 4/242 (1.6%), respectively. No bowel perforations were observed. Nearly one third of the late complications (13/45; 35.2%) resulted in discontinuation of PD, while one fourth (11/45; 24.4%) required surgical revision. The remaining episodes (21/45; 46.6%) were successfully managed by a conservative approach. The survival of the catheter at 3, 6, 12, 24, 36 and 48 months was 93.6, 91.2, 84.8, 77.4, 65.5 and 59.3%, respectively. The technique survival at 3, 6, 12, 24, 36 and 48 months was 97.2, 94.9, 87.6, 78.9, 66.6 and 60.0%, respectively. The main causes of PD drop-out included infectious complications (36.8%) followed by mechanical complications (17.5%). CONCLUSIONS A tight seal between deep cuff and surrounding tissues (double purse-string technique) in association with a starting low-volume exchange scheme allows to minimize early and late mechanical complication in UPD.
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19
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Karpinski S, Sibbel S, Cohen DE, Colson C, Van Wyck DB, Ghaffari A, Schreiber MJ, Brunelli SM, Tentori F. Urgent-start peritoneal dialysis: Association with outcomes. ARCH ESP UROL 2022; 43:186-189. [PMID: 35272530 DOI: 10.1177/08968608221083781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The majority of end-stage kidney disease (ESKD) patients start dialysis without adequate pre-dialysis planning. Of these patients, the vast majority initiate in-centre haemodialysis using a central venous catheter (ICHD-CVC). A minority utilise urgent-start peritoneal dialysis (USPD), whereby a peritoneal dialysis catheter is placed and used for dialysis without the usual 2-4-week waiting period. In this multicentre, retrospective study of adult patients initiating dialysis during 2018, we compared outcomes among patients utilising these two dialysis initiation routes. Patients who initiated dialysis via ICHD-CVC were matched 1:1 to patients who utilised USPD on the basis of aetiology of ESKD, race, diabetes status and insurance type. Hospitalisation and mortality were evaluated from dialysis initiation through the first of death, transplant, loss to follow-up or study end (30 June 2019). Outcomes were compared using models adjusted for age and sex. A total of 717 USPD patients were matched to ICHD-CVC patients. During follow-up, USPD patients were hospitalised at a rate of 1.21 admissions/patient-year (pt-yr) versus 1.51 admissions/pt-yr for ICHD-CVC. This corresponded to a 24% lower rate of hospitalisation among USPD patients (adjusted incidence rate ratio 0.76, 95% confidence interval [CI] 0.65-0.88). Mortality rates were 0.08 and 0.11 deaths/pt-yr among USPD patients and ICHD-CVC patients, respectively (adjusted hazard ratio 0.84, 95% CI 0.62, 1.15). These findings suggest that more widespread adoption of USPD may be beneficial among patients with limited pre-dialysis planning.
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Affiliation(s)
- Steph Karpinski
- DaVita Clinical Research, Minneapolis, MN, USA
- DaVita Institute for Patient Safety, Denver, CO, USA
| | - Scott Sibbel
- DaVita Clinical Research, Minneapolis, MN, USA
- DaVita Institute for Patient Safety, Denver, CO, USA
| | - Dena E Cohen
- DaVita Clinical Research, Minneapolis, MN, USA
- DaVita Institute for Patient Safety, Denver, CO, USA
| | - Carey Colson
- DaVita Clinical Research, Minneapolis, MN, USA
- DaVita Institute for Patient Safety, Denver, CO, USA
| | | | - Arshia Ghaffari
- Kidney Center, University of Southern California, Los Angeles, CA, USA
| | - Martin J Schreiber
- DaVita Institute for Patient Safety, Denver, CO, USA
- DaVita Inc., Denver, CO, USA
| | - Steven M Brunelli
- DaVita Clinical Research, Minneapolis, MN, USA
- DaVita Institute for Patient Safety, Denver, CO, USA
| | - Francesca Tentori
- DaVita Clinical Research, Minneapolis, MN, USA
- DaVita Institute for Patient Safety, Denver, CO, USA
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20
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Pilatti M, Theodorovitz VC, Hille D, Sevignani G, Ferreira HC, Vieira MA, Calice-Silva V, de França PHC. Urgent vs. planned peritoneal dialysis initiation: complications and outcomes in the first year of therapy. J Bras Nefrol 2022; 44:482-489. [PMID: 35385569 PMCID: PMC9838670 DOI: 10.1590/2175-8239-jbn-2021-0182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/04/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Urgent-start peritoneal dialysis (US-PD) has been proposed as a safe modality of renal replacement therapy (RRT) for end-stage renal disease (ESRD) patients with an indication for emergency dialysis initiation. We aimed to compare the characteristics, 30-day complications, and clinical outcomes of US-PD and planned peritoneal dialysis (Plan-PD) patients over the first year of therapy. METHODS This was a single-center retrospective study that included incident adult patients followed for up to one year. US-PD was considered when incident patients started therapy within 7 days after Tenckhoff catheter implantation. Plan-PD group consisted of patients who started therapy after the breaking period (15 days). Mechanical and infectious complications were compared 30 days from PD initiation. Hospitalization and technique failure during the first 12 months on PD were assessed by Kaplan-Meier curves and the determinants were calculated by Cox regression models. RESULTS All patients starting PD between October/2016 and November/2019 who fulfilled the inclusion criteria were analyzed. We evaluated 137 patients (70 in the US-PD x 67 Plan-PD). The main complications in the first 30 days were catheter tip migration (7.5% Plan-PD x 4.3% US-PD - p= 0.49) and leakage (4.5% Plan-PD x 5.7% US-PD - p=0.74). Most catheters were placed using the Seldinger technique. The main cause of dropout was death in US-PD patients (15.7%) and transfer to HD in Plan-PD patients (13.4%). The occurrence of complications in the first 30 days was the only risk factor for dropout (OR = 2.9; 95% CI 1.1-7.5, p = 0.03). Hospitalization rates and technique survival were similar in both groups. CONCLUSION The lack of significant differences in patients' outcomes between groups reinforces that PD is a safe and applicable dialysis method in patients who need immediate dialysis.
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Affiliation(s)
- Murilo Pilatti
- Universidade da Região de Joinville, Programa de Pós-Graduação em
Saúde e Meio Ambiente, Joinville, SC, Brasil.,Fundação Pró-Rim, Joinville, SC, Brasil
| | | | - Daniela Hille
- Universidade da Região de Joinville, Programa de Pós-Graduação em
Saúde e Meio Ambiente, Joinville, SC, Brasil
| | | | - Helen Caroline Ferreira
- Universidade da Região de Joinville, Programa de Pós-Graduação em
Saúde e Meio Ambiente, Joinville, SC, Brasil.,Fundação Pró-Rim, Joinville, SC, Brasil
| | | | - Viviane Calice-Silva
- Universidade da Região de Joinville, Programa de Pós-Graduação em
Saúde e Meio Ambiente, Joinville, SC, Brasil.,Fundação Pró-Rim, Joinville, SC, Brasil
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21
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Meng L, Yang L, Zhu X, Sun Z, Zhang X, Li X, Cheng S, Guo S, Zhuang X, Zou H, Luo P, Cui W. Risk factors for early death in urgent-start peritoneal dialysis patients: A multicenter retrospective cohort study. Ther Apher Dial 2021; 26:999-1006. [PMID: 34921510 DOI: 10.1111/1744-9987.13781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Assess risk factors for early death in patients who underwent urgent-start peritoneal dialysis (USPD). METHODS Patients who initiated USPD in five peritoneal dialysis centers from 2013 to 2019 were screened in this multicenter retrospective cohort study. Risk factors for all-cause mortality within 3 months were explored. RESULTS A total of 1265 USPD patients with 43 early deaths were included. Cox regression analyses showed that age older than 60 years (hazard ratio [HR], 3.054; 95% CI [1.597, 5.842]; p = 0.001), albumin less than 30 g/L (HR, 2.234; 95%CI [1.207, 4.136]; p = 0.011), blood glucose greater than 7 mmol/L (HR, 2.766; 95%CI [1.477, 5.180]; p = 0.001), higher estimated glomerular filtration rate (eGFR; HR, 1.121; 95%CI [1.071, 1.172]; p = 0.000), and poor stages of heart failure (class IV compared with class 0-I; HR, 5.165; 95%CI [2.544, 10.486]; p = 0.000) were independent predicting factors for early death. CONCLUSIONS Risk factors for early death were older age, hypoproteinemia, hyperglycemia, higher eGFR, and severe heart failure.
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Affiliation(s)
- Lingfei Meng
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Liming Yang
- Department of Nephrology, The First Hospital of Jilin University-the Eastern Division, China
| | - Xueyan Zhu
- Department of Nephrology, Jilin Central Hospital, Jilin, China
| | - Zhanshan Sun
- Department of Nephrology, Xing'an League People's Hospital, China
| | - Xiaoxuan Zhang
- Department of Nephrology, Jilin FAW General Hospital, China
| | - Xinyang Li
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Siyu Cheng
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Shizheng Guo
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Xiaohua Zhuang
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Hongbin Zou
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Ping Luo
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Wenpeng Cui
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
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22
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Phongphithakchai A, Dandecha P, Raksasuk S, Srithongkul T. Urgent-start peritoneal dialysis for end-stage renal disease patients: literature review and worldwide evidence-based practice. RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00384-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
AbstractThe prevalence of end-stage renal disease (ESRD) is on the rise worldwide. Meanwhile, the number of older people requiring dialysis therapy is increasing as a result of this population. We found that starting dialysis in an unplanned manner is a common occurrence, even for patients with nephrology follow-up. Most centers choose hemodialysis with a high rate of central venous catheter use at the time of initiation of dialysis. Current data has found that central venous catheter use is independently associated with increased mortality and high bacteremia rates. Peritoneal dialysis is one option to avoid bacteremia. The International Society for Peritoneal Dialysis guidelines suggests a break-in period of at least two weeks prior to an elective start of peritoneal dialysis, without mentioning urgent-start peritoneal dialysis. For unplanned ESRD patients, it is unrealistic to wait for two weeks before initiating peritoneal dialysis therapy. Urgent-start peritoneal dialysis has been suggested to be a practical approach of prompt initiation of peritoneal dialysis after catheter insertion, which may avoid an increased risk of central venous catheter-related complications, including bacteremia, central venous stenosis, and thrombosis associated with the temporary use of hemodialysis. Peritoneal dialysis is the alternative option, and many studies have presented an interest in urgent-start peritoneal dialysis. Some reports have compared urgent-start hemodialysis to peritoneal dialysis and found that urgent-start peritoneal dialysis is a safe and effective alternative to hemodialysis for an unplanned dialysis patient. This review aims to compare each literature report regarding techniques, prescriptions, outcomes, complications, and costs of urgent-start peritoneal dialysis.
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Zhao L, Yang J, Bai M, Dong F, Sun S, Xu G. Risk Factors and Management of Catheter Malfunction During Urgent-Start Peritoneal Dialysis. Front Med (Lausanne) 2021; 8:741312. [PMID: 34790676 PMCID: PMC8591039 DOI: 10.3389/fmed.2021.741312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/11/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Catheter malfunction is a common complication of peritoneal dialysis (PD). This study aimed to retrospectively analyze the risk factors and management of catheter malfunction in urgent-start PD. Methods: Patients who underwent urgent-start PD were divided into catheter-malfunction and control groups. Baseline demographic and laboratory data of the two groups were compared, and the risk factors for catheter malfunction were analyzed. Primary outcome measure was catheter survival, and the secondary outcomes were surgical complications and malfunction treatment. Results: Total of 700 patients was analyzed, among whom 143 (20.4%) experienced catheter malfunctions, specifically catheter migration (96, 67.1%), omental wrapping (36, 25.2%), and migration plus omental wrapping (11, 7.7%). Catheter survival time in the malfunction group (202.5 ± 479.4 days) was significantly shorter than that in the control group (1295.3 ± 637.0 days) (P < 0.001). Multivariate analysis revealed higher body mass index [hazard ratio (HR), 1.061; 95% confidence intervals (CI), 1.010–1.115; P = 0.018], lower surgeon count (HR, 1.083; 95% CI, 1.032–1.136; P = 0.001), and higher serum potassium (HR, 1.231; 95% CI, 1.041–1.494; P = 0.036) as independent risk factors for catheter malfunction, while older age (HR, 0.976, 95% CI, 0.962–0.991; P = 0.002) and colonic dialysis (HR, 0.384; 95% CI, 0.254–0.581; P < 0.001) as protective factors. Further subgroup analysis revealed a shorter catheter survival time in patients with younger age ( ≤ 40 years), higher serum potassium levels (≥5 mmol/L), while a longer catheter survival time in patients with colonic dialysis. PD tube and subcutaneous tunnel preservation was successful in 41 out of 44 patients with omental wrapping. All patients had good post-incision prognoses. Conclusions: Urgent-start PD is safe and effective for unplanned PD patients. Adequate pre-operative colonic dialysis and serum potassium level control are conducive in preventing catheter malfunction. Conservative treatment is effective in managing catheter migration alone, while preservation of the PD tube and the subcutaneous tunnel is effective for omental wrapping.
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Affiliation(s)
- Lijuan Zhao
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University of People's Liberation Army, Xi'an, China
| | - Jun Yang
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University of People's Liberation Army, Xi'an, China
| | - Ming Bai
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University of People's Liberation Army, Xi'an, China
| | - Fanfan Dong
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University of People's Liberation Army, Xi'an, China
| | - Shiren Sun
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University of People's Liberation Army, Xi'an, China
| | - Guoshuang Xu
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University of People's Liberation Army, Xi'an, China
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Li J, Yu J, Huang N, Ye H, Wang D, Peng Y, Guo X, Yi C, Yang X, Yu X. Prevalence, risk factors and impact on outcomes of 30-day unexpected rehospitalization in incident peritoneal dialysis patients. BMC Nephrol 2021; 22:4. [PMID: 33407231 PMCID: PMC7786918 DOI: 10.1186/s12882-020-02201-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 12/03/2020] [Indexed: 01/25/2023] Open
Abstract
Background Rehospitalization is a major problem for end stage renal disease (ESRD) populations. However, researches on 30-day unexpected rehospitalzation of incident peritoneal dialysis (PD) patients were limited. This study aimed to investigate the prevalence, risk factors and impact on outcomes of 30-day unexpected rehospitalization in incident PD patients. Methods This was a retrospective cohort study. Patients who accepted PD catheter implantation in our centre from Jan 1, 2006 to Dec 31, 2013 and regular follow-up were included. The demographic characteristics, laboratory parameters, and rehospitalization data were collected and analyzed. The primary outcome was all-cause mortality, and the secondary outcomes included cardiovascular disease (CVD) mortality and technical failure. Results Totally 1632 patients (46.9 ± 15.3 years old, 60.1% male, 25.6% with diabetes) were included. Among them, 149 (9.1%) had a 30-day unexpected rehospitalization after discharge. PD-related peritonitis (n = 48, 32.2%), catheter malfunction (n = 30, 20.1%) and severe fluid overload (n = 19, 12.8%) were the top three causes for the rehospitalization. Multivariate logistic regression analysis showed that length of index hospital stays [Odds ratio (OR) =1.02, 95% confidence interval (CI) 1.00–1.03, P = 0.036) and hyponatremia (OR = 1.85, 95% CI 1.06–3.24, P = 0.031) were independently associated with the rehospitalization. Multivariate Cox regression analysis indicated that 30-day rehospitalization was an independent risk factor for all-cause mortality [Hazard ratio (HR) =1.52, 95% CI 1.07–2.16, P = 0.019) and CVD mortality (HR = 1.73, 95% CI 1.03–2.90, P = 0.038). Conclusions The prevalence of 30-day unexpected rehospitalization for incident PD patients in our centre was 9.1%. The top three causes for the rehospitalization were PD-related peritonitis, catheter malfunction and severe fluid overload. Thirty-day unexpected rehospitalization increased the risk of all-cause mortality and CVD mortality for PD patients.
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Affiliation(s)
- Jianbo Li
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, 510080, Guangdong, China
| | - Jing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, 510080, Guangdong, China
| | - Naya Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, 510080, Guangdong, China
| | - Hongjian Ye
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, 510080, Guangdong, China
| | - Dan Wang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, 510080, Guangdong, China
| | - Yuan Peng
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, 510080, Guangdong, China
| | - Xiaobo Guo
- Department of Statistical Science, School of Mathematics, Sun Yat-sen University, Guangzhou, 510275, Guangdong, China
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, 510080, Guangdong, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, 510080, Guangdong, China
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China. .,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, 510080, Guangdong, China. .,Guangdong Provincial People's Hospital, Guangzhou, 510080, Guangdong, China. .,School of Medicine, South China University of Technology, Guangzhou, 510080, Guangdong, China.
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25
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Rajora N, Shastri S, Pirwani G, Saxena R. How To Build a Successful Urgent-Start Peritoneal Dialysis Program. KIDNEY360 2020; 1:1165-1177. [PMID: 35368794 PMCID: PMC8815497 DOI: 10.34067/kid.0002392020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/07/2020] [Indexed: 12/15/2022]
Abstract
In-center hemodialysis (HD) remains the predominant dialysis therapy in patients with ESKD. Many patients with ESKD present in late stage, requiring urgent dialysis initiation, and the majority start HD with central venous catheters (CVCs), which are associated with poor outcomes and high cost of care. Peritoneal dialysis (PD) catheters can be safely placed in such patients with late-presenting ESKD, obviating the need for CVCs. PD can begin almost immediately in the recumbent position, using low fill volumes. Such PD initiations, commencing within 2 weeks of the catheter placement, are termed urgent-start PD (USPD). Most patients with an intact peritoneal cavity and stable home situation are eligible for USPD. Although there is a small risk of PD catheter-related mechanical complications, most can be managed conservatively. Moreover, overall outcomes of USPD are comparable to those with planned PD initiations, in contrast to the high rate of catheter-related infections and bacteremia associated with urgent-start HD. The ongoing coronavirus disease 2019 pandemic has further exposed the vulnerability of patients with ESKD getting in-center HD. PD can mitigate the risk of infection by reducing environmental exposure to the virus. Thus, USPD is a safe and cost-effective option for unplanned dialysis initiation in patients with late-presenting ESKD. To develop a successful USPD program, a strong infrastructure with clear pathways is essential. Coordination of care between nephrologists, surgeons or interventionalists, and hospital and PD center staff is imperative so that patient education, home visits, PD catheter placements, and urgent PD initiations are accomplished expeditiously. Implementation of urgent-start PD will help to increase PD use, reduce cost, and improve patient outcomes, and will be a step forward in fostering the goal set by the Advancing American Kidney Health initiative.
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Affiliation(s)
- Nilum Rajora
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Shani Shastri
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Gulzar Pirwani
- University of Texas Southwestern/DaVita Peritoneal Dialysis Center, Irving, Texas
| | - Ramesh Saxena
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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Calice-Silva V, Tonial BC, Ferreira HC, Nerbass FB. Urgent vs. early-start peritoneal dialysis: patients' profile and outcomes. J Bras Nefrol 2020; 43:110-114. [PMID: 32602882 PMCID: PMC8061954 DOI: 10.1590/2175-8239-jbn-2020-0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/22/2020] [Indexed: 11/22/2022] Open
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.
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Affiliation(s)
- Viviane Calice-Silva
- Fundação Pró-Rim, Joinville, SC, Brasil.,Universidade da Região de Joinville - Univille, Escola de Medicina, Joinville, SC, Brasil
| | - Bruna C Tonial
- Universidade da Região de Joinville - Univille, Escola de Medicina, Joinville, SC, Brasil
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27
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Greenberg KI, Jaar BG. Urgent start peritoneal dialysis: are we there yet? BMC Nephrol 2020; 21:39. [PMID: 32005195 PMCID: PMC6995122 DOI: 10.1186/s12882-020-1706-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/28/2020] [Indexed: 11/10/2022] Open
Abstract
The use of peritoneal dialysis (PD) has increased substantially in the United States (US) in the past decade. This was likely spurred in large part by the implementation of the expanded prospective payment system for the Medicare End Stage Renal Disease (ESRD) program in 2011. Over the same period, there has also been growing interest in urgent start PD, which is commonly defined as initiation of PD within 14 days of catheter insertion. Ye and colleagues recently reported their experience with urgent start PD in 2059 Chinese ESRD patients over a 9-year period. Rates of complications, including peri-catheter leaks and peritonitis, were very low despite initiation of PD immediately after open catheter placement via open laparotomy in nearly all patients. Long term technique survival was good, with only 75 patients developing catheter failure. This study provides further evidence to suggest that urgent start PD is feasible and effective, although the generalizability of these results to Western populations is unclear. Recent proposed changes to the payment models in the Medicare ESRD program, designed to incentivize use of kidney transplantation and home dialysis, are likely to further propel growth of PD and urgent start PD in the US. Further studies are needed to optimize use of urgent PD and patient outcomes.
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Affiliation(s)
- Keiko I Greenberg
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bernard G Jaar
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA. .,Nephrology Center of Maryland, 5601 Loch Raven Boulevard, Suite 3 North, Baltimore, MD, 21239, USA.
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