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. 2022 Jun 11;7(8):1866-1877.
doi: 10.1016/j.ekir.2022.05.032. eCollection 2022 Aug.

Randomized Study of Urgent-Start Peritoneal Dialysis Versus Urgent-Start Temporary Hemodialysis in Patients Transitioning to Kidney Failure

Watanyu Parapiboon  1 , Juthamash Sangsuk  1 , Tanawin Nopsopon  2 , Wannapat Pitsawong  3 , Sajja Tatiyanupanwong  4 , Talerngsak Kanjanabuch  5   6   7   8 , David W Johnson  9   10   11
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Randomized Study of Urgent-Start Peritoneal Dialysis Versus Urgent-Start Temporary Hemodialysis in Patients Transitioning to Kidney Failure

Watanyu Parapiboon et al. Kidney Int Rep. .

Abstract

Introduction: We sought to evaluate the efficacy and complications of urgent-start peritoneal dialysis (PD) compared with urgent-start temporary hemodialysis (HD) followed by subsequent elective transfer to PD.

Methods: In this multicenter open-label prospective randomized controlled trial, adults with kidney failure who required immediate dialysis but did not have access to definitive dialysis were randomized to receive either urgent-start PD or urgent-start temporary HD over 2 weeks to 4 weeks followed by a transition to a chronic PD program according to the country policy. The primary outcome was the composite end point of operation-related, catheter-related, and dialysis-related complications at 6 weeks. Secondary outcomes were 6-week mortality, 6-week technique survival, and 1-week composite complications.

Results: A total of 207 participants requiring urgent-start dialysis were enrolled from 3 tertiary hospitals between November 2018 and February 2020 as follows: 104 were assigned to receive urgent-start PD, and 103 were assigned to urgent-start temporary HD. Compared with urgent-start temporary HD, urgent-start PD had a lower composite complication rate at 6 weeks (19% vs. 37%, risk ratio [RR] 0.52, 95% CI 0.33-0.83), which was primarily accounted for by a reduction in dialysis-related complications (4% vs. 24%, RR 0.16, 95% CI 0.06-0.44). No significant differences were observed between the 2 groups with respect to patient and technique survival rates at 1 week and 6 weeks.

Conclusion: An urgent-start PD strategy during the transition of kidney failure to chronic dialysis is safe and has fewer complications commensurate with their reduced exposure to procedural risk than urgent-start temporary HD up to 6 weeks after dialysis commencement.

Keywords: CKD transition; complications; randomized controlled trial; unplanned dialysis; urgent-start HD; urgent-start PD.

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Figures

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Graphical abstract
Figure 1
Figure 1
Patient flow diagram. HD, hemodialysis; PD, peritoneal dialysis.
Figure 2
Figure 2
Risk ratio of complication outcomes. Number is presented as counts for patients with relevant complications. HD, hemodialysis; PD, peritoneal dialysis.
Figure 3
Figure 3
Kaplan–Meier curves comparing patient survival. HD, hemodialysis; PD, peritoneal dialysis.
Figure 4
Figure 4
Kaplan–Meier curves comparing technique survival. HD, hemodialysis; PD, peritoneal dialysis.
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References

    1. Saran R., Robinson B., Abbott K.C., et al. US renal data system 2019 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis. 2020;75(suppl 1):A6–A7. doi: 10.1053/j.ajkd.2019.09.002. - DOI - PubMed
    1. Hole B., Caskey F., Evans K., et al. UK Renal Registry 19th Annual Report: Chapter 12 multisite dialysis access audit in England, Northern Ireland and Wales in 2015 and 2014 PD one year follow-up: national and centre-specific analyses. Nephron. 2017;137(suppl 1):269–296. doi: 10.1159/000481374. - DOI - PubMed
    1. Mendelssohn D.C., Malmberg C., Hamandi B. An integrated review of “unplanned” dialysis initiation: reframing the terminology to “suboptimal” initiation. BMC Nephrol. 2009;10:22. doi: 10.1186/1471-2369-10-22. - DOI - PMC - PubMed
    1. ANZDATA . Hemodialysis. Australia and New Zealand Dialysis and Transplant Registry; 2015. Chapter 4. The 38th Annual ANZDATA Report.https://www.anzdata.org.au/report/anzdata-38th-annual-report-2015/
    1. Perl J., Wald R., McFarlane P., et al. Hemodialysis vascular access modifies the association between dialysis modality and survival. J Am Soc Nephrol. 2011;22:1113–1121. doi: 10.1681/ASN.2010111155. - DOI - PMC - PubMed

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