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Qi Y, Zhang W, Wang J. A comparison of urgent-start of hemodialysis vs urgent initiation of peritoneal dialysis: a meta-analysis study. Int Urol Nephrol 2024; 56:2031-2043. [PMID: 38191865 DOI: 10.1007/s11255-023-03904-7] [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: 09/08/2023] [Accepted: 12/01/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE To investigate the effects of urgent-start HD(USHD) and urgent-start PD(USPD) on dialysis patients and provide references for relevant clinical practice. METHODS A literature search was conducted in Chinese and English databases (PubMed, Web of Science, Cochrane Library, CNKI, Wanfang, VIP) and the cutoff date for which was July 30, 2023. Studies comparing USHD and USPD were included and I2 statistics and Q tests were used to determine heterogeneity among them. Risk ratios (RR) with 95% confidence intervals (CI) were computed for count data. RESULTS Nine studies met the inclusion criteria. The all-cause mortality rate was 0.173 (0.070, 0.277) for USPD versus 0.214 (0.142, 0.286) for USHD, indicating that USPD had a protective effect against all-cause mortality compared to USHD (RR = 0.76, 95% CI 0.63-0.91). Patients receiving USPD had lower risks of infection-related mortality (RR = 0.19; 95% CI 0.05-0.76), bacteremia (RR = 0.38; 95% CI 0.18-0.80), and composite complications (RR = 0.54; 95% CI 0.41-0.71). However, no significant differences were found between USHD and USPD for cardiovascular mortality (RR = 0.68; 95% CI 0.28-1.68) or cancer mortality (RR = 0.44; 95% CI 0.15-1.29). CONCLUSION Compared to USHD, USPD has better protective effects against all-cause mortality, infection-related mortality, bacteremia, and composite complications. However, more high-quality research is still needed to further investigate the impacts of the two dialysis modalities on patients.
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Affiliation(s)
- Yuanyuan Qi
- Department of Nephrology, Lanzhou University Second Hospital, No. 82 Cuiyingmen ChengGuan District, Lanzhou, 730000, Gansu, China
| | - Wenkai Zhang
- Department of Nephrology, Lanzhou University Second Hospital, No. 82 Cuiyingmen ChengGuan District, Lanzhou, 730000, Gansu, China
| | - Juanli Wang
- Department of Nephrology, Lanzhou University Second Hospital, No. 82 Cuiyingmen ChengGuan District, Lanzhou, 730000, Gansu, China.
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Xu Y, Jiang W. Comparison of Unplanned/Urgent-Start Versus Conventional-Start Peritoneal Dialysis: A Systematic Review and Meta-Analysis. Semin Dial 2024; 37:200-210. [PMID: 38477178 DOI: 10.1111/sdi.13198] [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: 10/19/2023] [Revised: 12/21/2023] [Accepted: 01/30/2024] [Indexed: 03/14/2024]
Abstract
The timing of peritoneal dialysis (PD) initiation, whether conventional-start (planned) or urgent-start (unplanned), may impact the outcomes of PD and the rate of associated complications in individuals with chronic kidney disease (CKD). The goal of this study was to evaluate the effects of unplanned/urgent-start PD versus conventional-start PD in this cohort of patients. Electronic search of MEDLINE (via PubMed), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus databases was done from inception until July 2023 for studies reporting outcomes of unplanned/urgent-start and conventional-start PD in CKD patients. Outcomes of interest included mechanical complications, post-procedure infections, mortality, and transfer to hemodialysis. Heterogeneity, publication bias, and the influence of individual studies on the pooled odds ratio (OR) with 95% confidence interval (CI) were evaluated. Twenty-seven studies were finally included in the review. The overall risk of post-procedure infectious was comparable for both PD initiation methods (OR: 1.05; 95% CI: 0.83-1.34). Similarly, the risks for peritonitis and exit site infections did not differ significantly. However, urgent-start PD correlated with a significantly higher risk of overall mechanical complications (OR: 1.70; 95% CI: 1.23-2.34). Specifically, the risk for leaks was notably higher (OR: 2.47; 95% CI: 1.67-3.65) in the urgent-start group compared to the conventional-start PD group. Urgent-start PD correlated with significantly increased mortality rates (OR: 1.83; 95% CI: 1.39-2.41). There was no difference in the likelihood of technique survival and transfer to hemodialysis. Both urgent-start and conventional-start PD correlated with similar risks of overall infectious complications. Urgent-start PD resulted in significantly increased risks of mechanical complications and mortality. Our findings emphasize the need for meticulous planning and consideration when opting for PD initiation.
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Affiliation(s)
- Yunfen Xu
- Department of Nephrology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
| | - Weizhong Jiang
- Department of Nephrology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
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Virtanen J, Heiro M, Koivuviita N, Löyttyniemi E, Järvisalo MJ, Tertti R, Metsärinne K, Hellman T. Survival, cumulative hospital days and infectious complications in urgent-start PD compared with urgent-start HD. Perit Dial Int 2024:8968608241244939. [PMID: 38661183 DOI: 10.1177/08968608241244939] [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: 04/26/2024] Open
Abstract
BACKGROUND Urgent-start peritoneal dialysis (PD) carries a similar efficacy and safety profile compared to urgent-start haemodialysis (HD) but is only sparsely applied due to resource issues and concerns of complication risks. Furthermore, few data exist on adverse outcomes associated with central venous catheter (CVC) insertions in urgent-start HD patients. Thus, we sought to compare patient and dialysis-related outcomes in patients undergoing urgent-start PD or HD. METHODS All patients initiating urgent-start PD in a tertiary research hospital in 2005-2018 were included in this retrospective, single-centre, comparative study and matched with urgent-start HD patients of similar age and chronic kidney disease aetiology. All urgent-start PDs were initiated within 72 h after catheter insertion, and urgent-start HDs were performed via a CVC. All analyses were performed at 3 months and at 1 year of follow-up, respectively. RESULTS Thirty-three patients who commenced urgent-start PD and 58 matched urgent-start HD control patients were included. Altogether, 26 patients (29%; PD: 36%, HD 24%) died within the 1-year follow-up, and patient survival was similar at 3 months (hazard ratio (HR): 1.15, 95% confidence interval (CI): 0.35-3.81, p = 0.82) and at 1 year of follow-up (HR: 0.64, 95% CI: 0.30-1.39, p = 0.26) between the study groups. There were no differences in the total kidney replacement therapy (KRT)-related infection rate (p = 0.66) or cumulative first-year hospital care days (p = 0.43) between the treatment groups. Altogether, 139 CVCs were inserted during the 1-year follow-up. The number of CVCs per patient was associated with the emergence of blood culture-positive bacteraemia and increased cumulative first-year hospital care days. CONCLUSIONS Patient survival, cumulative first-year hospital care days and total KRT-related infection rate at 3 months and 1-year follow-up are similar between urgent-start PD and urgent-start HD patients. Furthermore, CVC insertion rate is associated with incident blood culture-positive bacteraemia and increased cumulative first-year hospital care days.
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Affiliation(s)
- Jonna Virtanen
- Kidney Center, Department of Internal Medicine, Turku University Hospital and University of Turku, Finland
| | - Maija Heiro
- Department of Internal Medicine, Vaasa Central Hospital and University of Turku, Vaasa, Finland
| | - Niina Koivuviita
- Kidney Center, Department of Internal Medicine, Turku University Hospital and University of Turku, Finland
| | - Eliisa Löyttyniemi
- Department of Biostatistics, University of Turku and Turku University Hospital, Finland
| | - Mikko J Järvisalo
- Kidney Center, Department of Internal Medicine, Turku University Hospital and University of Turku, Finland
- Department of Internal Medicine, Satakunta Central Hospital, Pori, Finland
| | - Risto Tertti
- Department of Internal Medicine, Vaasa Central Hospital and University of Turku, Vaasa, Finland
| | - Kaj Metsärinne
- Kidney Center, Department of Internal Medicine, Turku University Hospital and University of Turku, Finland
| | - Tapio Hellman
- Kidney Center, Department of Internal Medicine, Turku University Hospital and University of Turku, Finland
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Sahutoglu T. Balancing superiority and applicability: considerations for urgent-start peritoneal dialysis. Int Urol Nephrol 2024:10.1007/s11255-024-03977-y. [PMID: 38401005 DOI: 10.1007/s11255-024-03977-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/03/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Tuncay Sahutoglu
- Nephrology, Mehmet Akif Inan Training and Research Hospital, Esentepe Mah. Ertuğrul Cad. / Sanliurfa, Sanliurfa, Turkey.
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He J, Wu B, Zhang Y, Dai L, Ji J, Liu Y, He Q. Prognosis of urgent initiation of peritoneal dialysis: a systematic review and meta-analysis. Ren Fail 2024; 46:2312533. [PMID: 38391179 DOI: 10.1080/0886022x.2024.2312533] [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: 08/01/2023] [Accepted: 01/27/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES Currently, there is no consensus on the optimal timing for the initiation of peritoneal dialysis (PD) after catheter placement. DESIGN Systematic review and meta-analysis. EXACT DATE OF DATA COLLECTION From inception till July 31, 2023. MAIN OUTCOME MEASURES To assess the outcomes and safety of unplanned PD initiation (<14/7 days after catheter insertion) in cohort studies. RESULTS Fifteen studies involving 3054 participants were included. (1) The risk of unplanned initiation of leakage and Obstruction was no difference in both the break-in period (BI) <14 and BI < 7 groups. (2) Catheter displacement was more likely to occur in the emergency initiation group with BI < 7. (3) No significant differences were observed between the two groups regarding infectious complications. (4) There was no difference in transition to HD between patients with BI < 7 and BI < 14 d. CONCLUSION Infectious complications of unplanned initiation of peritoneal dialysis did not differ from planned initiation. Emergency initiation in the BI < 7 group had higher catheter displacement, but heterogeneity was higher. There were no differences in leakage or obstruction in either group. Catheter survival was the same for emergency initiation of peritoneal dialysis compared with planned initiation of peritoneal dialysis and did not increase the risk of conversion to hemodialysis. REGISTRATION This meta-analysis was registered on PROSPERO (https://www.crd.york.ac.uk/PROSPERO/, number: CRD42023431369).
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Affiliation(s)
- Ji He
- Jinzhou Medical University, Jinzhou, Liaoning, China
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - BaoQiao Wu
- Second Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yue Zhang
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Limiao Dai
- Second Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, Zhejiang, China
| | - Juan Ji
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
| | - Yueming Liu
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Qiang He
- Jinzhou Medical University, Jinzhou, Liaoning, China
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
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Corr M, Hunter C, Conroy D, McGrogan D, Fogarty D, O'Neill S. A Service Reconfiguration Bundle for Expanding Access to Peritoneal Dialysis Including for Older Frailer Patients. Healthcare (Basel) 2023; 11:healthcare11111654. [PMID: 37297794 DOI: 10.3390/healthcare11111654] [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: 03/23/2023] [Revised: 05/20/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION Rates of peritoneal dialysis (PD) have been traditionally low in Northern Ireland. With rising numbers of patients reaching end-stage kidney disease, PD is a more cost-effective treatment than haemodialysis and aligns with international goals to increase home-based dialysis options. The aim of our study was to highlight how a service reconfiguration bundle expanded access to PD in Northern Ireland. METHODS The service reconfiguration bundle consisted of the appointment of a surgical lead, a dedicated interventional radiologist for fluoroscopically guided PD catheter insertion, and a nephrology-led ultrasound-guided PD catheter insertion service in an area of particular need. All patients in Northern Ireland who had a PD catheter inserted in the year following service reconfigurations were included and prospectively followed up for one-year. Patient demographics, PD catheter insertion technique, setting of procedure, and outcome data were summarised. RESULTS The number of patients receiving PD catheter insertion doubled to 66 in the year following service reconfigurations. The range of approaches to PD catheter insertion (laparoscopic n = 41, percutaneous n = 24 and open n = 1) allowed a wide range of patients to benefit from PD. Six patients had emergency PD catheter insertion, with four receiving urgent or early start PD. Nearly half (48%, 29/60) of the PD catheters inserted electively were in smaller elective hubs rather than the regional unit. A total of 97% of patients successfully started PD. Patients who experienced percutaneous PD catheter insertion were older [median age 76 (range 37-88) vs. 56 (range 18-84), p < 0.0001] and had less previous abdominal surgery than patients who experienced laparoscopic PD catheter insertion (25%, 6/24 vs. 54%, 22/41, p = 0.05). DISCUSSION Through a service reconfiguration bundle, we were able to double our annual incident PD population. This study highlights how flexible models of service delivery introduced as a bundle can quickly deliver expanded access to PD and home therapy.
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Affiliation(s)
- Michael Corr
- Centre of Public Health, Queen's University Belfast, Belfast BT7 1NN, UK
- Regional Nephrology & Transplant Unit, Belfast Health and Social Care Trust, Belfast BT9 7ER, UK
| | - Carolyn Hunter
- Nephrology Department, Northern Health and Social Care Trust, Antrim BT41 2RL, UK
| | - Daniel Conroy
- Interventional Radiology Department, Belfast Health and Social Care Trust, Belfast BT12 6BA, UK
| | - Damian McGrogan
- Regional Nephrology & Transplant Unit, Belfast Health and Social Care Trust, Belfast BT9 7ER, UK
| | - Damian Fogarty
- Centre of Public Health, Queen's University Belfast, Belfast BT7 1NN, UK
- Regional Nephrology & Transplant Unit, Belfast Health and Social Care Trust, Belfast BT9 7ER, UK
| | - Stephen O'Neill
- Centre of Public Health, Queen's University Belfast, Belfast BT7 1NN, UK
- Regional Nephrology & Transplant Unit, Belfast Health and Social Care Trust, Belfast BT9 7ER, UK
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Li SY, Chen CY, Tsai MT, Lin NC, Liu CS, Lin CC. Hybrid Method for Peritoneal Dialysis Catheter Insertion: A New Technique for Improved Outcomes and Reduced Costs. Am J Nephrol 2023; 54:349-358. [PMID: 37253336 DOI: 10.1159/000531162] [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: 04/19/2023] [Accepted: 05/13/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Peritoneal dialysis (PD) is a well-established treatment choice for end-stage kidney disease (ESKD). While there are several methods for PD catheter insertion, they each have limitations. In this study, we present a new hybrid method for PD catheter insertion and compare it to the conventional laparoscopic method. METHODS This retrospective study included 171 patients who were undergoing their first PD catheter insertion, and a total of 20% of the enrolled patients had a past medical history of abdominal surgery. Out of these, 101 patients underwent the laparoscopic method and 70 underwent a new invented hybrid method. The study aimed to compare the surgical outcomes, incidence of early and late complications, hospital stay, and medical expenses between the two groups. RESULTS There were no notable differences in basic demographic features and comorbid conditions between the two groups. The results of our data revealed that the hybrid group had a significantly shorter break-in period and did not require temporary hemodialysis. Additionally, length of hospital stay and medical costs were significantly lower in the hybrid group (all p < 0.05). The incidence of early complications was lower in the hybrid group, while the incidence of late complications was comparable between the two groups. CONCLUSION Our study demonstrates that the hybrid method of PD catheter insertion provides a safe and efficient alternative to the traditional laparoscopic method, enabling urgent-start PD and reducing hospital stays and medical expenses. Our findings support the use of the hybrid method as a new standard of care for ESKD patients undergoing PD catheter insertion.
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Affiliation(s)
- Szu-Yuan Li
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,
| | - Cheng-Yen Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Tsun Tsai
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Niang-Cheng Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chin-Su Liu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Taipei Veterans General Hospital International Medical Service Center, Taipei, Taiwan
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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8
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Yaxley J, Scott T. Urgent-start peritoneal dialysis. Nefrologia 2023; 43:293-301. [PMID: 36517362 DOI: 10.1016/j.nefroe.2022.05.010] [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: 01/13/2022] [Accepted: 05/12/2022] [Indexed: 06/17/2023] Open
Abstract
Peritoneal dialysis is an important form of kidney replacement therapy. Most patients presenting with an unplanned, urgent need for dialysis are prescribed haemodialysis, leading to peritoneal dialysis underutilisation. Urgent-start peritoneal dialysis refers to treatment that is commenced within 2 weeks of catheter placement. Urgent-start peritoneal dialysis represents an efficacious, cost-effective alternative to the conventional approach of commencing dialysis. There is a paucity of evidence to guide management, however experience with the technique is increasing. This article overviews the rationale and practical application of urgent-start peritoneal dialysis.
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Affiliation(s)
- Julian Yaxley
- Department of Nephrology, Cairns Hospital, Cairns, Queensland, Australia; Department of Nephrology, Gold Coast University Hospital, Southport, Queensland, Australia; Department of Intensive Care Medicine, Gold Coast University Hospital, Southport, Queensland, Australia.
| | - Tahira Scott
- Department of Nephrology, Cairns Hospital, Cairns, Queensland, Australia; Department of Nephrology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Balkoca M, Turkmen E, Dilek M, Arik N, Sayarlioglu H. Evaluation of complications in urgent start peritoneal dialysis: Single-center experience. Ther Apher Dial 2023; 27:314-319. [PMID: 36127867 DOI: 10.1111/1744-9987.13916] [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: 07/20/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients who were urgent start peritoneal dialysis (USPD) were evaluated in terms of complications. METHODS The data from 102 patients (43 males and 59 females, mean age 58.18 ± 15.3 years) who were on peritoneal dialysis with a placed catheter between January 2014 and June 2019 in our Nephrology clinic was evaluated. The patients were divided into three groups according to the starting time of peritoneal dialysis. The development of complications between the groups (peritonitis, leakage, hernia), hemodialysis return time and overall survival times were compared. RESULTS There was no difference between the groups in terms of survival and complications. Diabetes, advanced age, albumin values were found to be risk factors for mortality, while no differences were found between the groups in terms of complications and mortality. CONCLUSION USPD can be recommended for both because it provides a permanent dialysis option and because it leads to fewer complications than urgent start HD.
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Affiliation(s)
- Murat Balkoca
- Department of Internal Medicine, Ondokuz Mayıs Üniversitesi, Samsun, Turkey
| | - Ercan Turkmen
- Department of Nephrology, Ondokuz Mayıs Üniversitesi, Samsun, Turkey
| | - Melda Dilek
- Department of Nephrology, Ondokuz Mayıs Üniversitesi, Samsun, Turkey
| | - Nurol Arik
- Department of Nephrology, Ondokuz Mayıs Üniversitesi, Samsun, Turkey
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Calice-Silva V, Nerbass FB. Diálise peritoneal de início urgente no Brasil: excelentes resultados, pouca aplicação. J Bras Nefrol 2023. [DOI: 10.1590/2175-8239-jbn-2023-e002pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
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11
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Calice-Silva V, Nerbass FB. Unplanned-start peritoneal dialysis in Brazil: great results, little application. J Bras Nefrol 2023; 45:3-4. [PMID: 36917680 PMCID: PMC10139717 DOI: 10.1590/2175-8239-jbn-2023-e002en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/17/2023] [Indexed: 03/16/2023] Open
Affiliation(s)
- Viviane Calice-Silva
- Fundação Pró-Rim, Joinville, SC, Brazil.,Universidade da Região de Joinville, Joinville, SC, Brazil
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12
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Luciano RL. Peritoneal Dialysis Should Be Considered the First Option for Patients Requiring Urgent Start Dialysis: CON. KIDNEY360 2023; 4:138-140. [PMID: 36821605 PMCID: PMC10103267 DOI: 10.34067/kid.0007822021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/12/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Randy L. Luciano
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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13
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Hangai KT, Pecoits-Filho R, Blake PG, da Silva DP, Barretti P, de Moraes TP. Impact of unplanned peritoneal dialysis start on patients' outcomes-A multicenter cohort study. Front Med (Lausanne) 2022; 9:717385. [PMID: 36507496 PMCID: PMC9727097 DOI: 10.3389/fmed.2022.717385] [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: 05/30/2021] [Accepted: 10/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background Patients with end-stage kidney disease (ESKD) who start unplanned dialysis therapy are more likely to be treated with hemodialysis (HD) using a central venous catheter, which has been associated with a greater risk of infections and other complications, as well as with a higher long-term risk of death. Urgent-start PD is an alternative that has been suggested as an option for starting dialysis in these cases, with potentially better patient outcomes. However, the definition of urgent-start PD is not homogeneous, and no study, to our knowledge, has compared clinical outcomes among urgent start, early start, and conventional start of PD. In this study, we aimed to compare these types of initiation of dialysis therapy in terms of a composite outcome of patient survival and technique failure. Methods This is a retrospective, multicenter, cohort study, involving data from 122 PD clinics in Brazil. We used the following: Urgent-start groups refer to patients who initiated PD within 72 h after the PD catheter insertion; early-start groups are those starting PD from 72 h to 2 weeks after the catheter insertion; and conventional-start groups are those who used the PD catheter after 2 weeks from its insertion. We analyzed the composite endpoint of all causes of patient's mortality and technique failure (within the initial 90 days of PD therapy) using the following three different statistical models: multivariate Cox, Fine and Gay competing risk, and a multilevel model. Results We included 509 patients with valid data across 68 PD clinics. There were 38 primary outcomes, comprising 25 deaths and 13 technique failures, with a total follow-up time of 1,393.3 months. Urgent-start PD had no association with the composite endpoint in all three models. Conclusion Unplanned PD seems to be a safe and feasible option for treatment for patients with non-dialysis ESKD in urgent need of dialysis.
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Affiliation(s)
- Kellen Thayanne Hangai
- Programa de Pós- Graduação em Ciências da Saúde-Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Roberto Pecoits-Filho
- Programa de Pós- Graduação em Ciências da Saúde-Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Peter G. Blake
- Division of Nephrology, University of Western Ontario, London, ON, Canada
| | - Daniela Peruzzo da Silva
- Programa de Pós- Graduação em Ciências da Saúde-Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Pasqual Barretti
- Division of Nephrology, Department of Internal Medicine, Universidade Estadual Paulista (UNESP), Botucatu, Brazil,*Correspondence: Pasqual Barretti
| | - Thyago Proença de Moraes
- Programa de Pós- Graduação em Ciências da Saúde-Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
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Abstract
The practice and clinical outcomes of peritoneal dialysis (PD) have demonstrated significant improvement over the past 20 years. The aim of this review is to increase awareness and update healthcare professionals on current PD practice, especially with respect to patient and technique survival, patient modality selection, pathways onto PD, understanding patient experience of care and use prior to kidney transplantation. These improvements have been impacted, at least in part, by greater emphasis on shared decision-making in dialysis modality selection, the use of advanced laparoscopic techniques for PD catheter implantation, developments in PD connecting systems, glucose-sparing strategies, and modernising technology in managing automated PD patients remotely. Evidence-based clinical guidelines such as those prepared by national and international societies such as the International Society of PD have contributed to improved PD practice underpinned by a recognition of the place of continuous quality improvement processes.
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Affiliation(s)
- Ayman Karkar
- Medical Affairs - Renal Care, Scientific Office, Baxter A.G., Dubai, United Arab Emirates
| | - Martin Wilkie
- Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield, UK
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15
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Calice-Silva V, Nerbass FB. Incremental peritoneal dialysis after unplanned start initiation. FRONTIERS IN NEPHROLOGY 2022; 2:932562. [PMID: 37675037 PMCID: PMC10479764 DOI: 10.3389/fneph.2022.932562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/28/2022] [Indexed: 09/08/2023]
Abstract
Incremental peritoneal dialysis (PD) is characterized as less than a "standard dose" PD prescription. Compared to standard treatment, it has many potential advantages, including better preservation of residual renal function, a lower risk of peritonitis, and a decreased care delivery burden while reducing the environmental impact and economic cost. Unplanned PD can be defined when treatment starts up to 14 days after catheter insertion and is recognized as a safe and feasible clinical approach. In this perspective paper, we briefly discuss both strategies and share our experience and clinical routine in managing incremental PD after unplanned initiation.
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Affiliation(s)
- Viviane Calice-Silva
- Nephrology Division, Pro-rim Foundation, Joinville, Brazil
- Medicine School, Universidade da Região de Joinville (Univille), Joinville, Brazil
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Müller JVC, Ponce D. Infectious and mechanical complications in planned-start vs. urgent-start peritoneal dialysis: a cohort study. J Bras Nefrol 2022; 45:27-35. [PMID: 35788617 PMCID: PMC10139726 DOI: 10.1590/2175-8239-jbn-2021-0287en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/05/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Few studies have compared the infectious and mechanical complications seen in planned-start and urgent-start peritoneal dialysis (PD) patients. OBJECTIVES To compare the incidence and etiology of mechanical and infectious complications in patients offered planned- and urgent-start PD and assess potential differences in patient survival and time on PD. METHODS This retrospective cohort study included patients with chronic kidney disease on planned- and urgent-start PD seen from 2014 to 2020 and compared them for mechanical and infectious complications, clinical outcome, death rates, and need to switch to hemodialysis. RESULTS Ninety-nine patients on planned-start PD and 206 on urgent-start PD were included. Incidence of exit-site infection (18.9 vs. 17.17%, p=0.71) and peritonitis (24.27 vs. 27.27%, p=0.57) were similar between patients, while pathogens causing peritonitis were different, although non-fermenting Gram-negative bacilli were more commonly seen in the planned-start PD group. Leakage as a mechanical complication and hospitalization were more common among patients needing urgent-start PD (10.68 vs. 2.02%, p=0.0085 and 35.44 vs. 17.17%, p=0.0011, respectively). Patient survival was similar between groups. Cox regression found an association between death and age (HR=1.051, 95% CI 1.026-1.07, p=0.0001) and albumin (HR=0.66, 95% CI 0.501-0.893, p=0.0064), and between peritonitis and a diagnosis of diabetes (HR=2.016, 95% CI 1.25-3.25, p=0.004). CONCLUSION Patient survival and time on PD were similar between the planned- and urgent-start PD groups, while leakage was more frequently seen in the urgent-start PD group. Death was associated with lower albumin levels and older age, while peritonitis was associated with diabetes.
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Affiliation(s)
- João Victor Costa Müller
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de Medicina, Botucatu, SP, Brasil
| | - Daniela Ponce
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de Medicina, Botucatu, SP, Brasil
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Müller JVC, Ponce D. Complicações infecciosas e mecânicas relacionadas à diálise peritoneal de início planejado vs. não planejado: um estudo de coorte. J Bras Nefrol 2022. [DOI: 10.1590/2175-8239-jbn-2021-0287pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Antecedentes: Poucos estudos compararam as complicações infecciosas e mecânicas relacionadas à diálise peritoneal (DP) de início planejado e não planejado. Objetivos: Comparar a incidência e etiologia das complicações mecânicas e infecciosas associadas à DP tanto de início planejado quanto não planejado e avaliar comparativamente a sobrevida da técnica e dos pacientes. Métodos: Estudo de coorte retrospectivo que avaliou pacientes com doença renal crônica em DP não planejada e planejada de 2014 a 2020 quanto às complicações mecânicas e infecciosas e desfechos clínicos óbito ou mudança para hemodiálise. Resultados: Foram avaliados 99 pacientes em DP planejada e 206 em DP não planejada. Foram semelhantes quanto à incidência de Infecção do Orifício de Saída (18,9x17,17%, p=0,71), peritonite (24,27x27,27%, p=0,57) e diferentes quanto aos agentes etiológicos das peritonites, sendo os bacilos Gram-negativos não fermentadores mais frequentes no grupo planejado. Diferiram quanto à complicação mecânica extravasamento e internação, ambas mais frequentes no grupo não planejado (10,68 x 2,02%, p=0,0085 e 35,44 x 17,17%, p=0,0011, respectivamente). Semelhantes quanto à sobrevida dos pacientes e da técnica. À regressão de Cox, associou ao óbito a idade (HR=1,051, IC 95% 1,026-1,07, p=0,0001) e a albumina (HR=0,66, IC 95% 0,501-0,893, p=0,0064), e à peritonite a presença de diabetes (HR=2,016, IC 95% 1,25-3,25, p=0,004). Conclusão: A sobrevida da técnica e dos pacientes foi semelhante nos grupos DP planejada e não planejada, enquanto o extravasamento foi mais frequente no grupo de início não planejado. Associaram-se ao óbito menores valores de albumina e maior idade, e à peritonite, o diabetes.
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Affiliation(s)
| | - Daniela Ponce
- Universidade Estadual Paulista Júlio de Mesquita Filho, Brasil
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18
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Yaxley J, Scott T. Urgent-start peritoneal dialysis. Nefrologia 2022. [DOI: 10.1016/j.nefro.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Ng AKH, Tan SN, Tay ME, Van Der Straaten JC, Cremere G, Chionh CY. Comparison of planned-start, early-start and deferred-start strategies for peritoneal dialysis initiation in end-stage kidney disease. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:213-220. [PMID: 35506404 DOI: 10.47102/annals-acadmedsg.2021495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION In patients with end-stage kidney disease (ESKD) suitable for peritoneal dialysis (PD), PD should ideally be planned and initiated electively (planned-start PD). If patients present late, some centres initiate PD immediately with an urgent-start PD strategy. However, as urgent-start PD is resource intensive, we evaluated another strategy where patients first undergo emergent haemodialysis (HD), followed by early PD catheter insertion, and switch to PD 48-72 hours after PD catheter insertion (early-start PD). Conventionally, late-presenting patients are often started on HD, followed by deferred PD catheter insertion before switching to PD≥14 days after catheter insertion (deferred start PD). METHODS This is a retrospective study of new ESKD patients, comparing the planned-start, early-start and deferred-start PD strategies. Outcomes within 1 year of dialysis initiation were studied. RESULTS Of 148 patients, 57 (38.5%) patients had planned-start, 23 (15.5%) early-start and 68 (45.9%) deferred-start PD. Baseline biochemical parameters were similar except for a lower serum urea with planned-start PD. No significant differences were seen in the primary outcomes of technique and patient survival across all 3 subgroups. Compared to planned-start PD, early-start PD had a shorter time to catheter migration (hazard ratio [HR] 14.13, 95% confidence interval [CI] 1.65-121.04, P=0.016) while deferred-start PD has a shorter time to first peritonitis (HR 2.49, 95% CI 1.03-6.01, P=0.043) and first hospital admission (HR 2.03, 95% CI 1.35-3.07, P=0.001). CONCLUSION Planned-start PD is the best PD initiation strategy. However, if this is not possible, early-start PD is a viable alternative. Catheter migration may be more frequent with early-start PD but does not appear to impact technique survival.
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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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21
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The Failed Kidney. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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22
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Pellizzari C, de Moraes TP. Urgent-start peritoneal dialysis. J Bras Nefrol 2022; 44:464-465. [PMID: 36332006 PMCID: PMC9838660 DOI: 10.1590/2175-8239-jbn-2022-e009en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 08/18/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Caio Pellizzari
- Santa Casa de Misericórdia de Curitiba, Curitiba, PR, Brasil,Pontifícia Universidade Católica do Paraná, Programa de
Pós-Graduação em Ciências da Saúde, Curitiba, PR, Brasil
| | - Thyago Proença de Moraes
- Santa Casa de Misericórdia de Curitiba, Curitiba, PR, Brasil,Pontifícia Universidade Católica do Paraná, Programa de
Pós-Graduação em Ciências da Saúde, Curitiba, PR, Brasil
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Unplanned vs. planned peritoneal dialysis as initial therapy for dialysis patients in chronic kidney replacement therapy. Int Urol Nephrol 2021; 54:1417-1425. [PMID: 34665414 DOI: 10.1007/s11255-021-03029-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 10/08/2021] [Indexed: 12/19/2022]
Abstract
AIM To compare infectious and mechanical complications, technique failure and mortality of a planned PD vs. an unplanned PD program. DESIGN It was a prospective observational study that included chronic kidney disease (CKD) patients who started PD according to medical recommendation: group1-planned and group 2-unplanned PD. METHODS This study evaluated patients who started planned and unplanned PD programs in a teaching hospital from July 2014 to December 2017. RESULTS A total of 58 patients were included in the planned PD group and 113 in the unplanned PD group. There was difference between the two groups in leak and hospital admissions, that were more frequent in the unplanned PD group. Periods free from exite site infection, peritonitis and mechanical complications were longer in the planned group. Cox regression analysis identified age and the lowest albumin value as factors associated with mechanical complications; peritonitis indicated the presence of ESI and mechanical complications; the change to HD was associated with a younger age, mechanical complications, diabetes mellitus (DM) and peritonitis. The factors associated with death were age and lower values of albumin. After 48 months, the growth of the PD program was 252%. CONCLUSION The technique survival and patient mortality in unplanned PD was similar to planned PD, while the period marked by the absence of complications related to PD was longer in the planned PD group. In the Cox regression, unplanned PD was not identified as risk factor for death, transition to HD or complications related to therapy, while age and lower albumin values were predictors of negative outcomes. IMPACT Unplanned PD is not risk factor for death and complications related to PD and can be an option to unplanned HD.
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Ding X, Gao W, Guo Y, Cai Q, Bai Y. Comparison of mortality and complications between urgent-start peritoneal dialysis and urgent-start hemodialysis: A systematic review and meta-analysis. Semin Dial 2021; 35:207-214. [PMID: 34435394 DOI: 10.1111/sdi.13001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/25/2021] [Accepted: 06/20/2021] [Indexed: 11/28/2022]
Abstract
The advantages of urgent-start peritoneal dialysis (PD) vis-à-vis urgent-start hemodialysis (HD) are not clear. We performed a systematic review and meta-analysis of studies comparing the two modalities. Databases of PubMed, Embase, Ovoid, and Google Scholar were searched up to November 1, 2020. The primary outcome was mortality, and secondary outcomes were dialysis-related infectious complications and mechanical complications. Risk ratios (RRs) were calculated for all outcomes. Seven studies were included. The pooled analysis revealed a statistically significant reduced risk of all-cause mortality in patients undergoing urgent-start PD as compared to urgent-start HD (RR: 0.61, 95% confidence interval [CI] [0.40, 0.94], I2 = 56.34%). A meta-analysis of dialysis-related infectious complications indicated no statistically significant difference between the two modalities (RR: 0.66, 95% CI [0.29, 1.50], I2 = 69.62%). Our analysis revealed a statistically significant reduced risk of mechanical complications in patients undergoing urgent-start PD (RR: 0.54, 95% CI [0.40, 0.73], I2 = 0%). To conclude, unadjusted data from observational studies are indicative of lower mortality and lower risk of mechanical complications with urgent-start PD versus urgent-start HD. The risk of infectious complications was not different between the two groups. Further studies with a larger sample size using propensity-matched cohorts are needed to strengthen current evidence.
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Affiliation(s)
- Xinyu Ding
- Department of Nephropathy, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Wenfeng Gao
- Department of Urology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yingbo Guo
- Department of Nephropathy, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qian Cai
- Department of Nephropathy, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yu Bai
- Department of Nephropathy, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
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Athmalingam VKR, Wong KW. Combined fluoroscopic- and sonographic-assisted Tenckhoff catheter insertion for patients with previous intraperitoneal surgery. Semin Dial 2021; 35:245-250. [PMID: 34390274 DOI: 10.1111/sdi.13012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/29/2021] [Accepted: 07/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Tenckhoff catheter (TC) insertion for patients with previous intraperitoneal surgery (IPS) is challenging. METHODS This is a case series of 11 patients with history of previous IPS who underwent TC insertion under combined fluoroscopic and sonographic (CFS) guidance with preperitoneal tunneling at our center. RESULTS This is an interim result of our study. The mean age of the patients was 49.1 (±12.7). Seven were females, and four were males. Only two patients underwent more than one IPS prior to this procedure. The mean body mass index (BMI) of patients was 29.2 kg/m2 (±6.2). All patients underwent the procedure successfully. One patient developed post-procedure exit site bleeding which resolved spontaneously. One patient had urgent-start peritoneal dialysis (PD) (less than 72 h), and two patients had early-start PD (less than 2 weeks). Median catheter survival is 8 months at the time of writing. CONCLUSION CFS-assisted TC insertion with preperitoneal tunneling for patients with previous IPS is a safe and effective technique.
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Affiliation(s)
| | - Koh Wei Wong
- Department of Nephrology, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
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Teitelbaum I, Glickman J, Neu A, Neumann J, Rivara MB, Shen J, Wallace E, Watnick S, Mehrotra R. KDOQI US Commentary on the 2020 ISPD Practice Recommendations for Prescribing High-Quality Goal-Directed Peritoneal Dialysis. Am J Kidney Dis 2020; 77:157-171. [PMID: 33341315 DOI: 10.1053/j.ajkd.2020.09.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 12/29/2022]
Abstract
The recently published 2020 International Society for Peritoneal Dialysis (ISPD) practice recommendations regarding prescription of high-quality goal-directed peritoneal dialysis differ fundamentally from previous guidelines that focused on "adequacy" of dialysis. The new ISPD publication emphasizes the need for a person-centered approach with shared decision making between the individual performing peritoneal dialysis and the clinical care team while taking a broader view of the various issues faced by that individual. Cognizant of the lack of strong evidence for the recommendations made, they are labeled as "practice points" rather than being graded numerically. This commentary presents the views of a work group convened by the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) to assess these recommendations and assist clinical providers in the United States in interpreting and implementing them. This will require changes to the current clinical paradigm, including greater resource allocation to allow for enhanced services that provide a more holistic and person-centered assessment of the quality of dialysis delivered.
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Affiliation(s)
- Isaac Teitelbaum
- Division of Nephrology, Department of Medicine, University of Colorado, Aurora, CO
| | - Joel Glickman
- Division of Nephrology, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Alicia Neu
- Division of Pediatric Nephrology, Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | | | - Matthew B Rivara
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
| | - Jenny Shen
- Division of Nephrology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA
| | - Eric Wallace
- Division of Nephrology, Department of Medicine, University of Alabama, Birmingham, AL
| | - Suzanne Watnick
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA; Northwest Kidney Centers, Seattle, WA
| | - Rajnish Mehrotra
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA.
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Wang Y, Li Y, Wang H, Ma Y, Ma D, Tian D, Liu B, Zhou Z, Yang W, Li X, Cui J, Chen L. Early-start and conventional-start peritoneal dialysis: a Chinese cohort study on outcome. Ren Fail 2020; 42:305-313. [PMID: 32208797 PMCID: PMC7144326 DOI: 10.1080/0886022x.2020.1743310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Early-start peritoneal dialysis (PD) is an effective option for patients need unplanned dialysis. However, there are few studies on the long-term prognosis of early-start PD patients. Methods In this retrospective study, 635 eligible patients from 1 March 1996 to 30 September 2016 were included, and divided into three groups according to the duration of break-in period: 3 days or less, 4–13 days and more than 14 days. Patients started PD within 2 weeks and after 2 weeks were defined as early-start and conventional-start, respectively. The primary outcome was all-cause mortality, and the secondary outcome measures were peritonitis free survival and technical survival. Mechanical and infectious complications in the first 180 days were also analyzed. Results Early-start PD patients were more likely to have higher serum total carbon dioxide and creatinine levels and lower serum albumin, Kt/v, creatinine clearance (Ccr) and residual glomerular filtration rate (rGFR) levels at the start of PD. The median follow-up period was 30 months (interquartile range, 13-53 months). A worse survival was observed in the early-start group than that in the conventional-start group (p < 0.001), even adjustment for the covariates (HR 1.549, 95%CI 1.104–2.173, p = 0.011). In the subgroup analysis, in patients commencing PD after 2006 early-start and conventional-start PD patients had comparable survival. No differences were observed in the rate of infectious and mechanical complications, peritonitis-free survival and technique survival between early-start and conventional-start PD patients. Conclusions Early-start PD could be a safe and effective strategy for patients needing unplanned dialysis initiation with the progress of technology on PD.
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Affiliation(s)
- Ying Wang
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Haiyun Wang
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Ma
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Danna Ma
- Nephrology Division, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Dongli Tian
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Bingyan Liu
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zijuan Zhou
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Yang
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xuemei Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jie Cui
- Nephrology Division, Massachusetts General Hospital, Boston, MA, USA
| | - Limeng Chen
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Chiu M, Jain AK, Blake PG. Truly Urgent "Urgent-Start" Peritoneal Dialysis. Kidney Int Rep 2020; 5:1625-1626. [PMID: 32897273 PMCID: PMC7462928 DOI: 10.1016/j.ekir.2020.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Michael Chiu
- Division of Nephrology, Department of Medicine, Western University, and London Health Sciences Centre, London, Ontario, Canada
| | - Arsh K. Jain
- Division of Nephrology, Department of Medicine, Western University, and London Health Sciences Centre, London, Ontario, Canada
| | - Peter G. Blake
- Division of Nephrology, Department of Medicine, Western University, and London Health Sciences Centre, London, Ontario, Canada
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Phang CC, Foo MWY, Johnson DW, Wu SY, Hao Y, Jayaballa M, Koniman R, Chan CM, Oei EL, Chong TT, Htay H. Comparison of outcomes of urgent-start and conventional-start peritoneal dialysis: a single-centre experience. Int Urol Nephrol 2020; 53:583-590. [PMID: 32895864 DOI: 10.1007/s11255-020-02630-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/31/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND There has been a growing interest in urgent-start peritoneal dialysis (PD) in patients with end-stage kidney disease to avoid central venous catheter use and its complications. This study aimed to compare clinical outcomes between urgent-start PD (defined as PD commencement within 2 weeks of PD catheter insertion) and conventional-start PD. METHODS This was a single-centre retrospective cohort study of all incident PD patients at Singapore General Hospital between January 2017 and February 2018. The primary outcome was dialysate leak. Secondary outcomes included catheter malfunction, catheter readjustment, exit-site infection, peritonitis, technique and patient survival. RESULTS A total of 187 incident PD patients were included. Of these, 66 (35%) initiated urgent-start PD. Dialysate leak was significantly higher in urgent-start PD compared with conventional-start PD groups (7.6% versus 0.8%; p = 0.02) whilst catheter malfunction (4.5% vs. 3.3%; p = 0.70) and catheter readjustment (1.5% vs. 2.5%; p = 1.00) were comparable between the two groups. Exit-site infection was comparable (IRR: 0.66 95% CI 0.25-1.74) whilst peritonitis was significantly higher in urgent-start PD compared with conventional-start PD (incidence risk ratio (IRR) 3.10, 95% confidence interval (CI) 1.29-7.44). Time to first episode of peritonitis, particularly Gram-positive peritonitis was significantly shorter with urgent-start PD. Technique survival (hazards ratio (HR) 1.95, 95% CI 0.89-4.31) and patient survival (HR 1.46, 95% CI 0.44-4.87) were comparable between the two groups. CONCLUSION Urgent-start PD was associated with higher risks of dialysate leak and peritonitis but comparable technique and patient survival compared to conventional-start PD.
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Affiliation(s)
- Chee Chin Phang
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Marjorie Wai Yin Foo
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - David W Johnson
- Princess Alexandra Hospital, Brisbane, Australia.,Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia.,Metro South and Ipswich Nephrology and Transplant Services (MINTS), Logan City, Australia
| | - Sin Yan Wu
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Ying Hao
- Health Services Research Centre (HSRC), Singapore Health Services (SingHealth), Singapore, Singapore
| | - Mathini Jayaballa
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Riece Koniman
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Choong Meng Chan
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Elizabeth Ley Oei
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Tze Tec Chong
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore.
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30
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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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Tu YR, Tsai TY, Lin MS, Tu KH, Lee CC, Wu VCC, Hsu HH, Chang MY, Tian YC, Chang CH. Association between initial dialytic modalities and the risks of mortality, infection death, and cardiovascular events: A nationwide population-based cohort study. Sci Rep 2020; 10:8066. [PMID: 32415125 PMCID: PMC7229162 DOI: 10.1038/s41598-020-64986-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 04/24/2020] [Indexed: 11/20/2022] Open
Abstract
To date, few studies have been conducted to pairwise compare the prognosis of peritoneal dialysis (PD), unplanned PD, and unplanned hemodialysis (HD). We analyzed longitudinal data from Taiwan’s National Health Insurance Research Database. We included 45,165 patients whose initial dialytic modality was PD or unplanned HD between January 1, 2001 and December 31, 2013. We divided the patients into three groups according to their initial dialytic modalities. The primary outcomes were all-cause mortality and death from infection during 1-year follow up. The risks of all-cause mortality and infection death were higher in the unplanned PD group than in the planned PD group (hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.28–1.60; HR 1.54, 95% CI 1.32–1.80). Likewise, the risks of all-cause mortality and infection death were higher in the unplanned HD group (HR 1.64, 95% CI 1.48–1.82; HR 1.85, 95% CI 1.61–2.13). Furthermore, the risks of all-cause mortality and infection death were also higher in the unplanned HD group than in the unplanned PD group (HR 1.15, 95% CI 1.07–1.23; HR 1.20, 95% CI 1.09–1.32). In conclusion, our study demonstrates that patients whose initial modality was planned PD or unplanned PD may have better clinical outcomes than those whose initial modality was unplanned HD.
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Affiliation(s)
- Yi-Ran Tu
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsung-Yu Tsai
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Shyan Lin
- Devision of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Yulin, Taiwan
| | - Kun-Hua Tu
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Chia Lee
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | | | - Hsiang-Hao Hsu
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Yang Chang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ya-Chung Tian
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Hsiang Chang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Abstract
The cost and health burden of ESRD continues to increase globally. Total Medicare expenditure on dialysis has increased from 229 million USD in 1973 to 35.4 billion USD in 2016. Dialysis access can represent almost a tenth of these costs. Central venous catheters have been recognized as a significant factor driving costs and mortality in this population. Home dialysis, which includes peritoneal dialysis and home hemodialysis, is an effective way of reducing costs related to renal replacement therapy, reducing central venous catheter usage and in many cases improving the clinical and psychosocial aspects of patients' health. Addressing access-related issues for peritoneal dialysis, urgent-start peritoneal dialysis and home hemodialysis can have impact on the success of home dialysis. This article reviews issues related to dialysis access for home therapies.
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Dias DB, Mendes ML, Caramori JT, Falbo Dos Reis P, Ponce D. Urgent-start dialysis: Comparison of complications and outcomes between peritoneal dialysis and haemodialysis. Perit Dial Int 2020; 41:244-252. [PMID: 32223522 DOI: 10.1177/0896860820915021] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Few studies have evaluated the viability and outcomes between peritoneal dialysis (PD) and haemodialysis (HD) in urgent-start renal replacement therapy (RRT). This study aimed to compare infectious and mechanical complications related to urgent-start PD and HD. Secondary outcomes were to identify risk factors for complications and mortality related to urgent-start dialysis. METHODS A quasi-experimental study with incident patients receiving PD and HD in a Brazilian university hospital, between July 2014 and December 2017. Subjects included individuals with final-stage chronic kidney disease who required immediate RRT, that is, HD through central venous catheter or PD in which the catheter was implanted by a nephrologist and utilized for 72 h, without previous training. Patients with PD were subjected, initially, to high-volume PD for metabolic compensation. After hospital discharge, they remained in intermittent PD in the dialysis unit until training was completed. Mechanical and infectious complications were compared, as well as the recovery of renal function and survival. RESULTS In total, 93 patients were included in PD and 91 in HD. PD and HD groups were similar regarding age (58 ± 17 vs. 60 ± 15 years; p = 0.49), frequency of diabetes mellitus (37.6% vs. 50.5%; p = 0.10), other comorbidities (74.1% vs. 71.4%; p = 0.67) and biochemical parameters at the beginning of RRT, that is, creatinine (9.1 ± 4.1 vs. 8.0 ± 2.8; p = 0.09), serum albumin (3.1 ± 0.6 vs. 3.3 ± 0.6; p = 0.06) and haemoglobin (9.5 ± 1.8 vs. 9.8 ± 2.0; p = 0.44). After a minimum follow-up period of 180 days and a maximum follow-up period of 2 years, there was no difference regarding mechanical complications (24.7% vs. 37.4%; p = 0.06) or bacteraemia (15.0% vs. 24.0%; p = 0.11); however, there was a difference regarding infection of the exit site (25.8% vs. 39.5%; p = 0.04) and diuresis maintenance [700 (0-1500) vs. 0 (0-500); p < 0.001], with better results in the PD group. There was better phosphorus control at 180 days in the PD group (62.4% vs. 41.8%; p = 0.008), with a lower requirement for phosphate binder usage (28% vs. 55%; p < 0.001), erythropoietin (18.3% vs. 49.5%; p < 0.001) and anti-hypertensives (11.8% vs. 30.8%; p = 0.003). Time to death was similar between groups. In the multivariate analysis, PD was a predictor of renal function recovery [odds ratio: 3.95 (1.01-15.4)]. CONCLUSION PD is a viable and safe alternative to HD in a scenario of urgent-start RRT with complication rates and outcomes similar to those of HD, highlighting the results regarding renal function recovery.
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Affiliation(s)
| | | | | | | | - Daniela Ponce
- Botucatu School of Medicine, 67785UNESP, Sao Paulo, Brazil
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34
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Zang X, Du X, Li L, Mei C. Complications and outcomes of urgent-start peritoneal dialysis in elderly patients with end-stage renal disease in China: a retrospective cohort study. BMJ Open 2020; 10:e032849. [PMID: 32205371 PMCID: PMC7103849 DOI: 10.1136/bmjopen-2019-032849] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES To investigate the complications and survival of elderly patients with end-stage renal disease (ESRD) who received urgent-start peritoneal dialysis (USPD) or urgent-start haemodialysis (USHD), and to explore the value of peritoneal dialysis (PD) as the emergent dialysis method for elderly patients with ESRD. DESIGN Retrospective cohort study. SETTING Two tertiary care hospitals in Shanghai, China. PARTICIPANTS Chinese patients (n=542) >65 years of age with estimated glomerular filtration rate ≤15 mL/min/m2 who received urgent-start dialysis between 1 January 2005 and 31 December 2015, and with at least 3 months of treatment. Patients who converted to other dialysis methods, regardless of the initial dialysis method, were excluded, as well as those with comorbidities that could significantly affect their dialysis outcomes. PRIMARY AND SECONDARY OUTCOME MEASURES Dialysis-related complications and survival were compared. Patients were followed until death, stopped PD, transfer to other dialysis centres, loss to follow-up or 31 December 2016. RESULTS There were 309 patients in the USPD group and 233 in the USHD group. The rate of dialysis-related complications within 30 days after catheter implantation was significantly lower in the USPD group compared with the USHD group (4.5% vs 10.7%, p=0.031). The 6-month and 1, 2 and 3-year survival rates were 95.3%, 91.4%, 86.6% and 64.8% in the USPD group, and 92.2%, 85.7%, 70.2% and 57.8% in the USHD group, respectively (p=0.023). The multivariable Cox regression analysis showed that USHD (HR=2.220, 95% CI 1.298 to 3.790; p=0.004), age (HR=1.025, 95% CI 1.013 to 1.043, p<0.001) and hypokalaemia (HR=0.678, 95% CI 0.487 to 0.970; p=0.032) were independently associated with death. CONCLUSIONS USPD was associated with slightly better survival compared with USHD. USPD was associated with fewer complications and better survival than USHD in elderly patients with ESRD.
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Affiliation(s)
- Xiujuan Zang
- Division of Nephrology, Kidney Institute, Changzheng Hospital, Second Military Medical University, Shanghai, China
- Division of Nephrology, Shanghai Songjiang District Central Hospital, Shanghai, China
| | - Xiu Du
- Division of Nephrology, Shanghai Songjiang District Central Hospital, Shanghai, China
| | - Lin Li
- Division of Nephrology, Kidney Institute, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Changlin Mei
- Division of Nephrology, Kidney Institute, Changzheng Hospital, Second Military Medical University, Shanghai, China
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35
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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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36
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Abstract
Incremental peritoneal dialysis (PD) has been variably defined. It involves taking advantage of the residual renal function that is usually present at initiation of dialysis to initially prescribe less onerous lower doses of PD while still achieving individualized clearance goals. We propose that incremental PD be defined as a strategy, rather than a particular regime, in which: (1) less than standard “full-dose” PD is initially prescribed in recognition of the value of residual renal function; (2) peritoneal clearance is initially less than the individualized clearance goal but the combination of peritoneal plus renal clearance achieves or exceeds that goal clearance; and (3) there is a clear intention to increase dose of PD as renal clearance declines and/or symptoms appear.Incremental PD by its nature lessens the workload of dialysis for those doing PD, reduces cost and exposure of the peritoneal membrane to glucose, and may lessen mechanical symptoms. Evidence that incremental PD improves clinical outcomes compared to the use of full-dose PD is lacking but one randomized controlled trial, multiple observational studies, and a systematic review all suggest that outcomes are at least as good. Given that incremental PD costs less and is inherently less onerous, it is reasonable, pending larger randomized trials, to adopt this strategy.
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Affiliation(s)
- Peter G Blake
- Division of Nephrology, Western University, London, ON, Canada
| | - Jie Dong
- Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Simon J Davies
- Faculty of Medicine and Health Sciences, Keele University, Stoke-on-Trent, UK
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37
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Jiang HY, Huang DJ, Bai YH, Li JS, Pi HY, Chen J, Li LH, Li J. Prognostic factors in patients undergoing early-start peritoneal dialysis within 24 h after catheter insertion. ACTA ACUST UNITED AC 2019; 52:e8055. [PMID: 30916219 PMCID: PMC6437961 DOI: 10.1590/1414-431x20188055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 12/12/2018] [Indexed: 12/14/2022]
Abstract
This study aimed to investigate the clinical characteristics, prognosis, and factors for survival of patients who underwent early-start peritoneal dialysis (PD) within 24 h after catheter insertion three years after PD. This study was conducted from January 1, 2013 to December 31, 2017. All adult patients who were diagnosed with end-stage renal disease (ESRD) and underwent PD for the first time within 24 h after catheter insertion in our hospital were included. All patients with PD were followed-up until they withdrew from PD, switching to hemodialysis, were transferred to other medical centers, underwent renal transplantation, died or were lost to follow-up, or continued to undergo dialysis until the end of the study period. The follow-up observation lasted three years. The number of eligible patients was 110, and switching to hemodialysis and death were the main reasons for patients to withdraw from PD. The 1-, 2-, and 3-year technical survival rates of patients were 89.1, 79.1, and 79.1% respectively, while the 1-, 2- and 3-year survival rates were 90, 81.8, and 81.8%, respectively. The Charlson comorbidity index, age, hemoglobin, serum albumin, diabetic nephropathy, chronic glomerulonephritis, and hypertensive renal damage were independent risk factors that affected the prognosis of PD patients. Under the condition of ensuring the quality of the PD catheter insertion, early-start PD within 24 h after catheter insertion is a safe treatment approach for ESRD patients.
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Affiliation(s)
- Hong Ying Jiang
- Department of Nephrology, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan Province, China
| | - Dan Ju Huang
- Department of Nephrology, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan Province, China
| | - Yi Hua Bai
- Department of Nephrology, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan Province, China
| | - Ji Sai Li
- Department of Nephrology, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan Province, China
| | - Hong Yan Pi
- Department of Nephrology, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan Province, China
| | - Jing Chen
- Department of Nephrology, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan Province, China
| | - Luo Hua Li
- Department of Nephrology, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan Province, China
| | - Jing Li
- Department of Nephrology, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan Province, China
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38
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Briggs V, Davies S, Wilkie M. International Variations in Peritoneal Dialysis Utilization and Implications for Practice. Am J Kidney Dis 2019; 74:101-110. [PMID: 30799030 DOI: 10.1053/j.ajkd.2018.12.033] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 12/11/2018] [Indexed: 12/21/2022]
Abstract
In many countries, the use of peritoneal dialysis (PD) remains low despite arguments that support its greater use, including dialysis treatment away from hospital settings, avoidance of central venous catheters, and potential health economic advantages. Training patients to manage aspects of their own care has the potential to enhance health literacy and increase patient involvement, independence, quality of life, and cost-effectiveness of care. Complex reasons underlie the variable use of PD across the world, acting at the level of the patient, the health care team that is responsible for them, and the health care system that they find themselves in. Important among these is the availability of competitively priced dialysis fluid. A number of key interventions can affect the uptake of PD. These include high-quality patient education around dialysis modality choice, timely and successful catheter placement, satisfactory patient training, and continued support that is tailored for specific needs, for example, when people present late requiring dialysis. Several health system changes have been shown to increase PD use, such as targeted funding, PD First initiatives, or physician-inserted PD catheters. This review explores the factors that explain the considerable international variation in the use of PD and presents interventions that can potentially affect them.
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Affiliation(s)
| | | | - Martin Wilkie
- Sheffield Kidney Institute, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, United Kingdom.
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