Abstract
BackgroundThe clinical consequences of starting chronic peritoneal dialysis (PD) after emergent dialysis via a temporary hemodialysis (HD) catheter has rarely been evaluated within a full spectrum of treated end-stage renal disease (ESRD). We investigated the longer-term outcomes of patients undergoing emergent-start PD in comparison with that of other practices of PD or HD in a prospective cohort of new-onset ESRD.MethodsThis was a 2-year prospective observational study. We enrolled 507 incident ESRD patients, among them 111 chose PD (43 planned-start, 68 emergent-start) and 396 chose HD (116 planned-start, 280 emergent-start) as the long-term dialysis modality. The logistic regression model was used to identify variables associated with emergent-start dialysis. The Kaplan–Meier survival analysis was used to determine patient survival and technique failure. The propensity score-adjusted Cox regression model was used to identify factors associated with patient outcomes.ResultsDuring the 2-year follow-up, we observed 5 (4.5%) deaths, 15 (13.5%) death-censored technique failures (transfer to HD) and 3 (2.7%) renal transplantations occurring in the PD population. Lack of predialysis education, lower predialysis estimated glomerular filtration rate and serum albumin were predictors of being assigned to emergent dialysis initiation. The emergent starters of PD displayed similar risks of patient survival, technique failure and overall hospitalization, compared with the planned-start counterparts. By contrast, the concurrent planned-start and emergent-start HD patients with an arteriovenous fistula or graft were protected from early overall death and access infection-related mortality, compared with the emergent HD starters using a central venous catheter.ConclusionsIn late-referred chronic kidney disease patients who have initiated emergent dialysis via a temporary HD catheter, post-initiation PD can be a safe and effective long-term treatment option. Nevertheless, due to the potential complications and cost concerns, such practice of PD initiation would better be replaced with a planned-start mode by employing more effective predialysis therapeutic education and timely catheter placement.
Highlights
The clinical consequences of starting chronic peritoneal dialysis (PD) after emergent dialysis via a temporary hemodialysis (HD) catheter has rarely been evaluated within a full spectrum of treated end-stage renal disease (ESRD)
Despite wide-spread promotion of planned-start dialysis therapy for patients with advanced chronic kidney disease (CKD), there remain patients who are referred ultra-late to the nephrologists, [4, 10] and acute dialysis has to be initiated via a temporary hemodialysis (HD) catheter due to life-threatening uremic emergency [11, 12]
The most common primary cause for ESRD differed between PD (41.4% chronic glomerulonephritis) and HD (48.0% diabetic nephropathy) populations
Summary
The clinical consequences of starting chronic peritoneal dialysis (PD) after emergent dialysis via a temporary hemodialysis (HD) catheter has rarely been evaluated within a full spectrum of treated end-stage renal disease (ESRD). Patients may be forced to start PD treatment urgently due to intolerable uremic symptoms, even though the catheter has just been placed for less than 2 weeks [4] Such practice of PD initiation, i.e., urgent-start PD, has recently gained resurgent momentum as an option of dialysis treatment especially for the late-referred CKD patients [5,6,7]. Despite wide-spread promotion of planned-start dialysis therapy for patients with advanced chronic kidney disease (CKD), there remain patients who are referred ultra-late to the nephrologists, [4, 10] and acute dialysis has to be initiated via a temporary hemodialysis (HD) catheter due to life-threatening uremic emergency [11, 12]. To shed light on this issue, we undertook this observational study to make clear the longer-term outcomes of patients who underwent emergent-start PD in comparison with that of other practices of PD or HD in a prospective cohort of incident ESRD patients over a period of 2 years
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