Abstract
Majority of patients with chronic kidney disease initiated dialysis without a permanent dialysis access. The practice of urgent-start peritoneal dialysis (PD) can potentially avoid the utilization of central venous catheter and its complications. It was a single-centre retrospective cohort study, including all incident adult PD patients from Singapore General Hospital from January to December 2017. Patients were followed up till July 2018. Urgent-start PD was defined as the commencement of PD within 2 weeks of catheter insertion. The primary aim was pericatheter leak and secondary aims were infectious complications including day-30 and day-90 exit-site/tunnel infection and peritonitis, peritonitis-free survival, technique survival, death-censored technique survival and patient survival. Mechanical and infectious complications were compared using Fisher’s Exact test, technique and patient survival were compared using Kaplan-Meier analysis, log-rank test and multivariable Cox regression. A total of 163 PD patients were included in the study. Of these, 42 patients initiated urgent-start PD and 121 patients initiated conventional-start PD. Baseline characteristics including age, gender, race, body mass index, comorbidities including diabetes mellitus, ischaemic heart disease, cerebrovascular disease, and modality of PD were comparable between the two groups. Pericatheter leak was similar between urgent-start PD and conventional-start PD groups (3 (7%) versus 2 (2%); p =0.11). Exit-site/tunnel infection at day-30 (5 (4%) versus 0 ; p =0.22) and day-90 (8 (7%) versus 0 ; p=0.09) were not significantly different between urgent-start PD and conventional-start PD groups. Similarly, peritonitis at day-30 (2 (2%) versus 1 (2%); p = 0.59) and day-90 (6 (5%) versus 3 (7%); p= 0.42) were comparable between urgent-start PD and conventional-start PD groups. Peritonitis-free survival (p=0.12), technique survival (p=0.07), death-censored technique survival (p =0.10) and patient survival (p=0.39) were comparable between the two groups. In multivariable Cox regression, after adjusting for presence of ischemic heart disease, technique survival (Hazard ratio (HR): 2.26, 95% confidence interval (CI) 0.99 – 5.13), patient survival (HR: 2.04, 95% CI: 0.59 – 7.06) and peritonitis-free survival (HR: 1.78, 95% CI: 0.72 – 4.38) were comparable between the two groups. Urgent-start PD had a similar pericatheter leak, infectious complications, technique and patient survival compared to conventional-start PD. Urgent-start PD can be considered as a modality of renal replacement therapy for unplanned end-stage kidney failure patients who require dialysis urgently.
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