SUN-077 COMPARISON BETWEEN URGENT START VERSUS PLANNED PERITONEAL DIALYSIS PROGRAM DURING THE FIRST YEAR OF TREATMENT

Abstract

Urgent start peritoneal dialysis (US PD) has been proposed as an option to start renal replacement therapy (RRT) in those end-stage renal disease (ESRD) patients with the need of urgent dialysis. Considering 60-70% of ESRD population in Brazil starts dialysis unplanned and the well-consolidated findings in the literature showing a greater risk for mortality in the group that starts hemodialysis through a central venous catheter, urgent start PD seems to be a safe option to those patients especially in developing countries where the pre-nephrology care is scarce. Previous studies have demonstrated similar outcomes after dialysis initiation in terms of technique survival, mechanical complications and hospitalization when compared with those patients undergoing planned PD (No-US PD). The aim of this study was compare US and No-US incident PD patient’s characteristic and the outcomes in the first year on therapy. Incident ESRD patients starting PD either through urgent start or planned program between Oct/2016 and Sept/2017 were included in the study. Patient’s demographics and comorbidities characteristics were evaluated and the outcomes (technique survival and hospitalization rates) during the first year on dialysis analyzed. For technique survival analyses only negative dropout causes were considered. Chi-square tests and independent samples t-test were performed for comparison between categorical variables and continuous variables respectively between both groups (US x No-US PD). Kaplan-Meier curves were constructed to compare technique survival and hospitalization rates between the study groups. During the study period 60 patients started PD in our service. Out of those 60, 12 have received HD for more than 120 days and were excluded from the analyses. The remaining 48 patients (34 – US/14 N-US) were evaluated (mean age was 51.3±14 and 54.4±17 years old, 55.9% and 64.3% were male, 88.2% and 71.4% were white, respectively). Diabetes and Hypertension had similar prevalence in both groups, 42.9% of No-US PD patients received HD previous to start PD in comparison to 17.4% in the US PD group (p=0.07). US-PD group had 67.6% of patients starting PD after modified Seldinger technique catheter implantation versus 35.7% in the no-US PD group (p=0.057). No differences were found in the dropout and hospitalization rates and in the K-M curves. Considering technique survival, only 6 patients (12.5% of total) had dropped-out of PD due to negative causes and needed to be transfer to HD with no differences between PD initiation program. (K-M curve - Figure 01 – p=0.1). Figure 01 - Kaplan-Meier analysis results for dropout considering both PD initiation - Urgent start and planned start PD. There were no differences between US and No-US incident PD patient’s demographics and comorbidities characteristic. The outcomes evaluated (technique survival and hospitalization rates) in the first year on dialysis were also not different in both groups.