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Front. Physiol. | doi: 10.3389/fphys.2018.01830

Urgent-start peritoneal dialysis as a bridge to definitive chronic renal replacement therapy: short- and long-term outcomes

Ewa Wojtaszek1*,  Jolanta Malyszko1, Katarzyna Grygiel1, Agnieszka Grzejszczak1 and Joanna Matuszkiewicz-Rowinska1
  • 1Medical University of Warsaw, Poland

Background. The peritoneal dialysis (PD) urgent-start pathway, without typical two-week break-in period, was meant for late-referral patients able and prone to join PD-first program, with its main advantages such as: keeping the vascular system intact, preserving their residual renal function and retaining life-style flexibility. We compared the short- and long-term outcomes of consecutive 35 patients after urgent- and 94 patients after the planned start of PD as the first choice.
Methods. The study included all incident end-stage renal disease patients starting PD program between Jan 2005 and Dec 2015, classified into two groups: those with urgent (unplanned) and those with elective (planned) start. Urgent PD was initiated as an overnight automatic procedure (APD) with dwell volume gradually increased, and after 2-3 weeks, target PD method was established.
The mean time between catheter implantation and PD start was 3.5 ± 2.3 in urgent and 16.2 ± 1.7 days in planned-start groups (p< 0.00001). 51% of the patients in the urgent-start group required PD during first 48 hour after catheter insertion. Mean follow-up of 17.6 ± 11.09 months (median 19.0) was in the urgent-start group and 28.6 ± 26.6 months (median 19.5) in the planned-start group. The early mechanical complications were observed more often in the urgent-start group (29% vs 4%, p=0.00005). The only significant predictors of early mechanical complications were serum albumin (p = 0.02) and time between the catheter insertion and PD start. The first year patient survival and technique survival censored for death and kidney transplantation were not significantly different between groups. In Cox proportional analysis the independent risk factors for patient survival as well as for method and patient survival appeared Charlson Comorbidity Index CCI (HR 1.4; p=0.01 and 1.24; p=0.02) and time from catheter implantation to PD start with HR 5.11; p=0.03 and 4.29; p=0.04 for <2 days, while time > 14 days lost its predictive value (p = 0.07).
Conclusions. Peritoneal dialysis may be a feasible and safe alternative to HD in patients who need to start dialysis urgently without established dialysis access, with an acceptable complications rates, as well as patient and technique survival.

Keywords: Peritoneal dialiysis, short-term outcomes, Mechanical complication, Technique survival, Patient survival, Long-term outcomes, Infectious complications

Received: 24 Sep 2018; Accepted: 06 Dec 2018.

Edited by:

Janusz Witowski, Poznan University of Medical Sciences, Poland

Reviewed by:

Robert Ekart, University Clinical Centre Maribor
Rümeyza Kazancıoğlu, Bezmiâlem Vakıf Üniversitesi, Turkey
Martin E. Wilkie, Sheffield Teaching Hospital, United Kingdom  

Copyright: © 2018 Wojtaszek, Malyszko, Grygiel, Grzejszczak and Matuszkiewicz-Rowinska. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Ewa Wojtaszek, Medical University of Warsaw, Warsaw, Masovian, Poland,