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Observational Study
. 2017 Dec 11;18(1):359.
doi: 10.1186/s12882-017-0764-6.

Comparison of outcomes between emergent-start and planned-start peritoneal dialysis in incident ESRD patients: a prospective observational study

Wen-Yi Li  1   2 , Yi-Cheng Wang  3 , Shang-Jyh Hwang  4   5 , Shih-Hua Lin  6 , Kwan-Dun Wu  2 , Yung-Ming Chen  7
Affiliations
Observational Study

Comparison of outcomes between emergent-start and planned-start peritoneal dialysis in incident ESRD patients: a prospective observational study

Wen-Yi Li et al. BMC Nephrol. .

Abstract

Background: The clinical consequences of starting chronic peritoneal dialysis (PD) after emergent dialysis via a temporary hemodialysis (HD) catheter has rarely been evaluated within a full spectrum of treated end-stage renal disease (ESRD). We investigated the longer-term outcomes of patients undergoing emergent-start PD in comparison with that of other practices of PD or HD in a prospective cohort of new-onset ESRD.

Methods: This was a 2-year prospective observational study. We enrolled 507 incident ESRD patients, among them 111 chose PD (43 planned-start, 68 emergent-start) and 396 chose HD (116 planned-start, 280 emergent-start) as the long-term dialysis modality. The logistic regression model was used to identify variables associated with emergent-start dialysis. The Kaplan-Meier survival analysis was used to determine patient survival and technique failure. The propensity score-adjusted Cox regression model was used to identify factors associated with patient outcomes.

Results: During the 2-year follow-up, we observed 5 (4.5%) deaths, 15 (13.5%) death-censored technique failures (transfer to HD) and 3 (2.7%) renal transplantations occurring in the PD population. Lack of predialysis education, lower predialysis estimated glomerular filtration rate and serum albumin were predictors of being assigned to emergent dialysis initiation. The emergent starters of PD displayed similar risks of patient survival, technique failure and overall hospitalization, compared with the planned-start counterparts. By contrast, the concurrent planned-start and emergent-start HD patients with an arteriovenous fistula or graft were protected from early overall death and access infection-related mortality, compared with the emergent HD starters using a central venous catheter.

Conclusions: In late-referred chronic kidney disease patients who have initiated emergent dialysis via a temporary HD catheter, post-initiation PD can be a safe and effective long-term treatment option. Nevertheless, due to the potential complications and cost concerns, such practice of PD initiation would better be replaced with a planned-start mode by employing more effective predialysis therapeutic education and timely catheter placement.

Keywords: Emergent-start; Mortality; Peritoneal dialysis.

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Conflict of interest statement

Ethics approval and consent to participate

The study protocol was approved by the Research Ethics Committee of National Taiwan University Hospital (No. 200810042R), and the Institutional Review Boards of Tri-Service General Hospital (No. 070–05-114) and Kaohsiung Medical University Chung-Ho Memorial Hospital (No. 980077). Written informed consent was obtained from all participants before the start of the study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram of all participants and their outcomes in the first two years after initiation of long-term dialysis therapy. HD, hemodialysis; PD, peritoneal dialysis; AVF, arteriovenous fistula; AVG, arteriovenous graft; CVC, central venous catheter
Fig. 2
Fig. 2
a Survival between patients undergoing emergent-start PD and planned-start PD (Log-Rank test, χ2 = 0.005, p = 0.941); b Technique survival between patients undergoing emergent-start PD and planned-start PD (Log-Rank test, χ2 = 0.406, p = 0.524). PD, peritoneal dialysis
See this image and copyright information in PMC

References

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