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. 2022 Jul 14:13:936573.
doi: 10.3389/fendo.2022.936573. eCollection 2022.

Break-in Period ≤24 Hours as an Option for Urgent-start Peritoneal Dialysis in Patients With Diabetes

Xiaoqing Hu  1 , Liming Yang  2 , Zhanshan Sun  3 , Xiaoxuan Zhang  4 , Xueyan Zhu  5 , Wenhua Zhou  1 , Xi Wen  1 , Shichen Liu  1 , Wenpeng Cui  1
Affiliations

Break-in Period ≤24 Hours as an Option for Urgent-start Peritoneal Dialysis in Patients With Diabetes

Xiaoqing Hu et al. Front Endocrinol (Lausanne). .

Abstract

Background: The optimal break-in period (BI) of urgent-start peritoneal dialysis (USPD) initiation for patients with end-stage renal disease (ESRD) and diabetes is unclear. We aimed to explore the safety and applicability of a BI ≤24 h in patients with ESRD and diabetes.

Methods: We used a retrospective cohort design wherein we recruited patients with ESRD and diabetes who underwent USPD at five institutions in China between January 2013 and August 2020. The enrolled patients were grouped according to BI. The primary outcomes were mechanical and infectious complication occurrences, whereas the secondary outcome was technique survival.

Results: We enrolled 310 patients with diabetes, of whom 155 and 155 patients were in the BI ≤24 h and BI >24 h groups, respectively. The two groups showed a comparable incidence of infectious and mechanical complications within 6 months after catheter insertion (p>0.05). Logistic regression analysis revealed that a BI ≤24 h was not an independent risk factor for mechanical or infectious complications. Kaplan-Meier estimates showed no statistically significant between-group differences in technique survival rates (p>0.05). Cox multivariate regression analysis revealed that a BI ≤24 h was not an independent risk factor for technique failure.

Conclusion: USPD initiation with a BI ≤24 h may be safe and feasible for patients with ESRD and diabetes.

Keywords: break-in period; complications; diabetics; end-stage renal disease; urgent start peritoneal dialysis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart. PD, peritoneal dialysis; USPD: urgent start PD; HD, hemodialysis.
Figure 2
Figure 2
The effects of break-in period on mechanical complications, catheter migration and infectious complications in different follow-up time (Logistic Multivariate Analysis). (A) Mechanical complications. Model was adjusted for peritoneal dialysis center, age, temporary hemodialysis usage, abdominal surgery history, white blood cells, hemoglobin, creatinine, blood urea nitrogen, blood potassium, blood phosphorus. (B) Catheter migration. Model was adjusted for peritoneal dialysis center, temporary hemodialysis usage, hypertension, abdominal surgery history, white blood cells, blood urea nitrogen and blood phosphorus. (C) Infectious complications. Model was adjusted for peritoneal dialysis center, temporary hemodialysis usage, sex, cause of end stage renal disease, hypertension, abdominal surgery history, white blood cells, hemoglobin, blood albumin, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, blood urea nitrogen, blood uric acid, creatinine, blood calcium, blood phosphorus and blood glucose. OR, odds ratio; CI, confidence interval.
Figure 3
Figure 3
Kaplan–Meier plot of technique survival analysis in different break-in period group and predictors of technique failure (Cox Multivariate Analysis). (A) Technique survival curves. (B) Predictors of technique failure. Model was adjusted for peritoneal dialysis center, age, hypertension, white blood cells, blood urea nitrogen and blood potassium. HR, hazard ratio; CI, confidence interval.
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