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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 ; : 213-220, 2022.
Article in English | WPRIM | ID: wpr-927474
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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Full text: Available Index: WPRIM (Western Pacific) Main subject: Time Factors / Retrospective Studies / Renal Dialysis / Peritoneal Dialysis / Kidney Failure, Chronic Type of study: Observational study Limits: Female / Humans / Male Language: English Journal: Annals of the Academy of Medicine, Singapore Year: 2022 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Main subject: Time Factors / Retrospective Studies / Renal Dialysis / Peritoneal Dialysis / Kidney Failure, Chronic Type of study: Observational study Limits: Female / Humans / Male Language: English Journal: Annals of the Academy of Medicine, Singapore Year: 2022 Type: Article