Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jul 2;20(1):238.
doi: 10.1186/s12882-019-1408-9.

Urgent-start peritoneal dialysis for patients with end stage renal disease: a 10-year retrospective study

Hongjian Ye  1   2 , Xiao Yang  1   2 , Chunyan Yi  1   2 , Qunying Guo  1   2 , Yafang Li  1   2 , Qiongqiong Yang  1   2 , Wei Chen  1   2 , Haiping Mao  1   2 , Jianbo Li  1   2 , Yagui Qiu  1   2 , Xunhua Zheng  1   2 , Dihua Zhang  1   2 , Jianxiong Lin  1   2 , Zhijian Li  1   2 , Zongpei Jiang  1   2 , Fengxian Huang  1   2 , Xueqing Yu  3   4
Affiliations

Urgent-start peritoneal dialysis for patients with end stage renal disease: a 10-year retrospective study

Hongjian Ye et al. BMC Nephrol. .

Abstract

Background: Urgent-start peritoneal dialysis (PD) can help patients with end-stage renal diseases (ESRD) that are referred late to dialysis. However, catheter patency and related complications of urgent-start PD have not been thoroughly clarified. We investigated the clinical outcomes of urgent-start PD in a Chinese cohort.

Methods: We enrolled ESRD patients who received urgent-start PD (starting PD within 14 days after catheter insertion) in our center from January 1, 2006 to December 31, 2014, and followed them up for 10 years. The primary outcome was catheter failure. Secondary outcomes included short-term and long-term complications related to urgent-start PD.

Results: Totally 2059 patients (58.9% male, mean age 47.6 ± 15.9 years) were enrolled. Few perioperative complications were observed, including significant hemorrhage (n = 3, 0.1%) and bowel perforation (n = 0). Early peritonitis occurred in 24 (1.2%) patients (0.28 episodes per patient-year). Within the first month after catheter insertion, functional catheter malfunction occurred in 85 (4.1%) patients, and abdominal wall complications (including hernia, hydrothorax, hydrocele, and leakage) in 36 (1.7%) patients. During a median 36.5 (17.7-61.4) months of follow-up, 75 (3.6%) patients experienced catheter failure, and 291 (14.1%) had death-censoring technique failure. At the end of 1-month, 1 -year, 3-year, and 5-year, catheter patency rate was 97.6, 96.4, 96.2, 96.2%; and technique survival rate was 99.5, 97.0, 90.3, 82.7%, respectively. After adjusting for confounders, every 5-year increase in age was associated with 19% decrease of risk for catheter failure (hazard ratio [HR]: 0.81, 95% confidence interval [CI]: 0.73-0.89). Male sex (HR: 1.43, 95% CI: 1.00-2.04), diabetic nephropathy (HR: 1.56, 95% CI: 1.08-2.25) and low hemoglobin levels (HR: 0.89, 95% CI: 0.81-0.98) were independent risk factors for abdominal wall complications.

Conclusions: Urgent-start PD is a safe and efficacious option for unplanned ESRD patients. A well-trained PD team, a standardized catheter insertion procedure by experienced nephrologists, and a carefully designed initial PD prescription as well as comprehensive follow-up care, might be essential for the successful urgent-start PD program.

Keywords: Catheter patency; Complications; End stage renal disease; Peritoneal dialysis; Technique survival; Urgent-start peritoneal dialysis.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The flow chart of the urgent-start PD program
Fig. 2
Fig. 2
A schematic diagram of catheterization. A double purse-string sutures technique was used for the catheter fixation and prevention of leakage
Fig. 3
Fig. 3
The flow chart of the management of functional catheter problems
Fig. 4
Fig. 4
The distributions of the onset time and causes of the functional catheter problems and catheter failure
Fig. 5
Fig. 5
Catheter survival and death-censoring technique survival estimated by Kaplan-Meier analysis
See this image and copyright information in PMC

Comment in

References

    1. United States Renal Data System . 2017 USRDS Annual Data Report: Epidemiology of kidney disease in the United States. Bethesda: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2017.
    1. Yu X. How to set up PD centres: the Chinese perspective. 2017. http://www.thelancet.com/campaigns/kidney/updates. Accessed May 2017.
    1. Zhang L, Wang F, Wang L, Wang W, Liu B, Liu J, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet. 2012;379(9818):815–822. doi: 10.1016/S0140-6736(12)60033-6. - DOI - PubMed
    1. Xu R, Han QF, Zhu TY, Ren YP, Chen JH, Zhao HP, et al. Impact of individual and environmental socioeconomic status on peritoneal dialysis outcomes: a retrospective multicenter cohort study. PLoS One. 2012;7(11):e50766. doi: 10.1371/journal.pone.0050766. - DOI - PMC - PubMed
    1. Xu D, Liu T, Dong J. Urgent-start peritoneal Dialysis complications: prevalence and risk factors. Am J Kidney Dis. 2017;70(1):102–110. doi: 10.1053/j.ajkd.2016.12.021. - DOI - PubMed

Publication types