Peritoneal dialysis can be an option for unplanned chronic dialysis: initial results from a developing country

Abstract

Aim: Starting dialysis in an unplanned manner is frequent situation in dialysis center even for patients with regular nephrology follow-up. Peritoneal dialysis (PD) appears as an option for unplanned initiation of chronic dialysis, offering the advantage of not using central venous catheters and preserving of residual renal function. Since July 2014, we have offered PD as urgent start for chronic kidney disease (CKD) patients.

Methods: It was a prospective study that aimed to evaluate the mortality rate in hospitalized patients who started unplanned urgent PD in the first 90 days. It was used high-volume PD right after (<48 h) PD catheter placement, and it was kept until metabolic and fluid controls were achieved. After hospital discharge, patients were treated with intermittent PD on alternate days at the dialysis unit until family training.

Results: Thirty-five patients were included from July 2014 to January 2015. Age was 57.7 ± 19.2 years, diabetes was the main etiology of CKD (40.6 %), and uremia was the main dialysis indication (54.3 %). Metabolic and fluid controls were achieved after five sessions of high-volume PD, and patients remained in intermittent PD for 23.2 ± 7.2 days receiving 11.5 ± .3.1 intermittent PD sessions. Peritonitis and mechanical complications occurred in 14.2 and 25.7 %, respectively. Mortality rate was 20 %, and technique survival was 85.7 %. The chronic PD program presented a growth of 41.1 %.

Conclusion: The concept of unplanned start on chronic PD may be feasible, safe, complementary alternative to hemodialysis and a tool to increase the PD penetration rate among incident patients starting dialysis therapy.

Keywords: Hemodialysis; Peritoneal dialysis; Unplanned dialysis.