Abstract
BackgroundGuidelines recommend a break-in period of 2 weeks before starting peritoneal dialysis (PD), but PD within 14 days is also an acceptable and safe alternative to hemodialysis (HD) in patients with an urgent need. However, the effect of the break-in period within 48 hours or later had not been evaluated for early technical complications, long-term maintenance, and survival in patients starting urgent PD.MethodsOf 360 patients with a surgically inserted PD catheter, we evaluated 190 patients who needed urgent PD and 29 patients who received conventional PD at a single center between January 2007 and December 2014 in this retrospective observational study. Enrolled patients were divided according to break-in period of <48 hours (P1) or 2–13 days (P2) before starting urgent PD. The primary endpoint was incidence of early technical complications and secondary endpoints included long-term PD maintenance, and patient survival.ResultsPD was started in 103 patients (54.2%) within 48 hours and in 87 patients (45.8%) within 2 to 13 days. The incidence of early technical complication was significantly higher in P1 group (28.2%) than in P2 group (10.3%) (P = 0.002). The need for a repositioning procedure was significantly greater in P1 group (14.6%) than in P2 group (3.4%) (P = 0.009). However, we observed no significant differences between the two groups with respect to the prevalence of catheter dysfunction requiring change to HD within 6 months or incidence of peritonitis or exit-site infection. There was no significant difference in PD maintenance and patient survival according to the break-in period between P1 and P2 as well as against the control group.ConclusionUrgent PD was associated with a low incidence of early technical complications if start was avoided within 48 hours after catheter insertion, and long-term PD maintenance was independent of the break-in period.
Highlights
It remains unclear whether peritoneal dialysis (PD) or hemodialysis (HD) is a better modality. [1, 2] HD has been preferred for its efficacy, rapid correction of metabolic and uremic abnormalities, and convenient vascular access
The incidence of early technical complication was significantly higher in P1 group (28.2%) than in P2 group (10.3%) (P = 0.002)
There was no significant difference in PD maintenance and patient survival according to the break-in period between P1 and P2 as well as against the control group
Summary
It remains unclear whether peritoneal dialysis (PD) or hemodialysis (HD) is a better modality. [1, 2] HD has been preferred for its efficacy, rapid correction of metabolic and uremic abnormalities, and convenient vascular access. There are few reports on break-in periods shorter than 7 days, and there is a lack of data on associated long-term PD survival or transition to HD.[4,5,6,7,8,9]. Guidelines recommend a break-in period of 2 weeks before starting peritoneal dialysis (PD), but PD within 14 days is an acceptable and safe alternative to hemodialysis (HD) in patients with an urgent need. The effect of the break-in period within 48 hours or later had not been evaluated for early technical complications, long-term maintenance, and survival in patients starting urgent PD
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