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Comparative Study
. 2021 Mar;53(3):583-590.
doi: 10.1007/s11255-020-02630-8. Epub 2020 Sep 7.

Comparison of outcomes of urgent-start and conventional-start peritoneal dialysis: a single-centre experience

Chee Chin Phang  1 , Marjorie Wai Yin Foo  1 , David W Johnson  2   3   4   5 , Sin Yan Wu  1 , Ying Hao  6 , Mathini Jayaballa  1 , Riece Koniman  1 , Choong Meng Chan  1 , Elizabeth Ley Oei  1 , Tze Tec Chong  7 , Htay Htay  8
Affiliations
Comparative Study

Comparison of outcomes of urgent-start and conventional-start peritoneal dialysis: a single-centre experience

Chee Chin Phang et al. Int Urol Nephrol. 2021 Mar.

Abstract

Background: There has been a growing interest in urgent-start peritoneal dialysis (PD) in patients with end-stage kidney disease to avoid central venous catheter use and its complications. This study aimed to compare clinical outcomes between urgent-start PD (defined as PD commencement within 2 weeks of PD catheter insertion) and conventional-start PD.

Methods: This was a single-centre retrospective cohort study of all incident PD patients at Singapore General Hospital between January 2017 and February 2018. The primary outcome was dialysate leak. Secondary outcomes included catheter malfunction, catheter readjustment, exit-site infection, peritonitis, technique and patient survival.

Results: A total of 187 incident PD patients were included. Of these, 66 (35%) initiated urgent-start PD. Dialysate leak was significantly higher in urgent-start PD compared with conventional-start PD groups (7.6% versus 0.8%; p = 0.02) whilst catheter malfunction (4.5% vs. 3.3%; p = 0.70) and catheter readjustment (1.5% vs. 2.5%; p = 1.00) were comparable between the two groups. Exit-site infection was comparable (IRR: 0.66 95% CI 0.25-1.74) whilst peritonitis was significantly higher in urgent-start PD compared with conventional-start PD (incidence risk ratio (IRR) 3.10, 95% confidence interval (CI) 1.29-7.44). Time to first episode of peritonitis, particularly Gram-positive peritonitis was significantly shorter with urgent-start PD. Technique survival (hazards ratio (HR) 1.95, 95% CI 0.89-4.31) and patient survival (HR 1.46, 95% CI 0.44-4.87) were comparable between the two groups.

Conclusion: Urgent-start PD was associated with higher risks of dialysate leak and peritonitis but comparable technique and patient survival compared to conventional-start PD.

Keywords: Infectious complications; Mechanical complications; Peritoneal dialysis; Technique survival; Urgent-start.

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