Comparison of planned-start, early-start and deferred-start strategies for peritoneal dialysis initiation in end-stage kidney disease.
10.47102/annals-acadmedsg.2021495
- Author:
Alvin Kok Heong NG
1
;
Sye Nee TAN
;
Meng Eng TAY
;
Jane Caroline VAN DER STRAATEN
;
Group CREMERE
;
Chang Yin CHIONH
Author Information
1. Department of Renal Medicine, Changi General Hospital, Singapore.
- Publication Type:Journal Article
- MeSH:
Female;
Humans;
Kidney Failure, Chronic/therapy*;
Male;
Peritoneal Dialysis/methods*;
Renal Dialysis;
Retrospective Studies;
Time Factors
- From:Annals of the Academy of Medicine, Singapore
2022;51(4):213-220
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:In patients with end-stage kidney disease (ESKD) suitable for peritoneal dialysis (PD), PD should ideally be planned and initiated electively (planned-start PD). If patients present late, some centres initiate PD immediately with an urgent-start PD strategy. However, as urgent-start PD is resource intensive, we evaluated another strategy where patients first undergo emergent haemodialysis (HD), followed by early PD catheter insertion, and switch to PD 48-72 hours after PD catheter insertion (early-start PD). Conventionally, late-presenting patients are often started on HD, followed by deferred PD catheter insertion before switching to PD≥14 days after catheter insertion (deferred start PD).
METHODS:This is a retrospective study of new ESKD patients, comparing the planned-start, early-start and deferred-start PD strategies. Outcomes within 1 year of dialysis initiation were studied.
RESULTS:Of 148 patients, 57 (38.5%) patients had planned-start, 23 (15.5%) early-start and 68 (45.9%) deferred-start PD. Baseline biochemical parameters were similar except for a lower serum urea with planned-start PD. No significant differences were seen in the primary outcomes of technique and patient survival across all 3 subgroups. Compared to planned-start PD, early-start PD had a shorter time to catheter migration (hazard ratio [HR] 14.13, 95% confidence interval [CI] 1.65-121.04, P=0.016) while deferred-start PD has a shorter time to first peritonitis (HR 2.49, 95% CI 1.03-6.01, P=0.043) and first hospital admission (HR 2.03, 95% CI 1.35-3.07, P=0.001).
CONCLUSION:Planned-start PD is the best PD initiation strategy. However, if this is not possible, early-start PD is a viable alternative. Catheter migration may be more frequent with early-start PD but does not appear to impact technique survival.
