Comparison of outcomes of urgent-start and conventional-start peritoneal dialysis: a single-centre experience
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NEPHROLOGY - ORIGINAL PAPER
Comparison of outcomes of urgent‑start and conventional‑start peritoneal dialysis: a single‑centre experience Chee Chin Phang1 · Marjorie Wai Yin Foo1 · David W. Johnson2,3,4,5 · Sin Yan Wu1 · Ying Hao6 · Mathini Jayaballa1 · Riece Koniman1 · Choong Meng Chan1 · Elizabeth Ley Oei1 · Tze Tec Chong7 · Htay Htay1 Received: 22 April 2020 / Accepted: 31 August 2020 © Springer Nature B.V. 2020
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 urgentstart 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. Keywords Infectious complications · Mechanical complications · Peritoneal dialysis · Technique survival · Urgent-start
Background
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11255-020-02630-8) contains supplementary material, which is available to authorized users. * Htay Htay [email protected] 1
Optimal pre-dialysis care in patients with chronic kidney disease (CKD) should ideally improve the likelihood that they will initiate dialysis with permanent dialysis access, consisting of either an arteriovenous fistula or a peritoneal dialysis (PD) catheter. However, despite the well-recognised risks of heightened morbidity (infection, hospitalisation) and 4
Translational Research Institute, Brisbane, Australia
5
Metro South and Ipswich Nephrology and Transplant Services (MINTS), Logan Cit
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