Urgent-Start Peritoneal Dialysis Complications: Prevalence and Risk Factors

Abstract

Background: Mechanical complications are of particular concern in urgent-start peritoneal dialysis (PD) because of the shorter break-in period. However, risk factors have been reported inconsistently and data in urgent-start PD populations are limited.

Study design: Observational cohort study.

Setting & participants: All patients treated with urgent-start PD, defined as PD therapy initiated within 1 week after catheter insertion, January 2003 to May 2013.

Predictors: Age, sex, abdominal surgery history, body mass index, hemoglobin level, albumin level, C-reactive protein level, break-in period (period between catheter insertion and PD therapy initiation), dialysate exchange volume, and use of overnight dwell.

Outcomes: The presence of mechanical complications related to abdominal wall or catheter, including hernia, hydrothorax, hydrocele, subcutaneous leak, pericatheter leak, catheter malposition, omental wrap, and obstruction.

Results: 922 patients on urgent-start PD therapy were enrolled (mean age, 59.1±15.0 [SD] years). Prevalences of abdominal wall and catheter complications were 4.8% and 9.5%, respectively. The most common abdominal wall complication was hernia (55%), followed by hydrothorax (25%). On adjustment, male sex (HR, 5.41; 95% CI, 2.15-13.59; P<0.001) and history of abdominal surgery (HR, 2.34; 95% CI, 1.04-5.26; P=0.04) were independently associated with higher risk for developing abdominal wall complications.

Limitations: As a cohort study, comparisons could not be established between urgent-start PD and conventional PD.

Conclusions: Urgent-start PD is a safe and practicable approach. Male sex and history of abdominal surgery could contribute to the development of abdominal wall complications.

Keywords: Peritoneal dialysis (PD); abdominal wall complications; break-in period; catheter complications; catheter obstruction; emergent dialysis; end-stage renal disease (ESRD); hernia; hydrothorax; risk factor; technique failure; technique survival; urgent-start PD.