P1152USE OF URGENT START PERITONEAL DIALYSIS IN END STAGE RENAL DISEASE PATIENTS: A RETROSPECTIVE ANALYSIS IN A NORTH-INDIAN POPULATION

Abstract

Abstract Background and Aims End-stage renal diseases (ESRD) that are referred late to dialysis usually need hemodialysis via central vein catheter (CVC). Urgent start peritoneal dialysis (PD) can be used in these patients to avoid need of CVC. Catheter patency and other complications related to urgent-start PD have not been thoroughly clarified. We evaluated the clinical outcomes of urgent-start PD in a North-Indian cohort. Method In this retrospective study, we enrolled ESRD patients who were started on urgent-start PD (starting PD within 14 days after catheter insertion) in our center from January 1, 2008 to December 31, 2017, and followed them up to 10 years. Catheter failure was primary outcome of study while as secondary outcomes included short-term and long-term complications related to urgent-start PD. Results In this study882 patients (60.3% male, mean age 47.28 ± 14.1years) were enrolled. There were few peri-operative complications with significant hemorrhage seen in 2 patients. Early peritonitis occurred in 8 (0.9%) patients. Within the first month of catheter insertion, abdominal wall complications (hernia, hydrothorax, hydrocele, and leakage) occurred in 24 (2.7%) patients while as functional catheter malfunction developed in 36 (4.1%) patients. On follow-up of the patients (median 35.7 months), 32 (3.6%) patients experienced catheter failure, and 141 (15.9%) had death-censoring technique failure. Catheter patency rate at the end of 1-month, 1 -year, 3-year, and 5-year, was 98.2, 94.9, 93.1,92.4%; and technique survival rate was 99.2, 96.9, 90.2, 82.8%, respectively. Every 5-year increase in age was associated with 17% decrease of risk for catheter failure (hazard ratio [HR]: 0.83, 95%confidence interval [CI]: 0.73–0.89). Risk factors for abdominal wall complications included male sex (HR: 1.45, 95% CI: 1.03–2.1), low hemoglobin levels (HR: 0.88, 95% CI: 0.79–0.98) and diabetic nephropathy (HR: 1.65, 95% CI:1.13–2.35). Conclusion Urgent-start PD is a safe option for ESRD who need urgent dialysis to avoid CVC insertion for HD. For a successful urgent start PD programs, a well-trained PD team, catheter insertion procedure by experienced personnel, and a well-designed PD prescription and a good follow-up care is needed.