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. 2025 Mar;44(2):338-348.
doi: 10.23876/j.krcp.23.103. Epub 2024 Feb 19.

Immediate-start peritoneal dialysis without break-in-period: an 18-year retrospective cohort study on patient survival

Jee Young Lee  1 , Hyun-Jin Cho  1 , Yoo-Sun Joo  2 , Hye-Jin Na  1 , Jung-Hwan Park  1 , Young-Il Jo  1
Affiliations

Immediate-start peritoneal dialysis without break-in-period: an 18-year retrospective cohort study on patient survival

Jee Young Lee et al. Kidney Res Clin Pract. 2025 Mar.

Abstract

Background: Immediate-start peritoneal dialysis (ISPD) is an effective renal replacement therapy that can prevent central venous catheterization due to its immediate initiation of peritoneal dialysis (PD) after catheter insertion without a break-in period. This study aimed to investigate the effect of ISPD on long-term patient survival.

Methods: In this retrospective single-center cohort study, 178 consecutive patients who started PD from August 2005 to March 2023 were enrolled, from whom 144 patients with ISPD were analyzed. PD was initiated without a break-in period within 24 hours of catheter insertion using percutaneous needle-guidewire technique. The primary outcome was patient survival, estimated using the Kaplan-Meier method. A Cox proportional hazard regression model was used to identify factors independently associated with patient survival.

Results: The median follow-up period was 4.00 years (interquartile range, 1.23-5.75 years). The mean age of patients was 61.6 ± 13.6 years; 58 patients (40.3%) were male and 93 patients (64.6%) were diabetic. Overall patient survival rates at 1, 3, 5, and 10 years were 98.5%, 93.5%, 92.1%, and 65.6%, respectively. The technique survival rates at 1, 3, 5, and 10 years were 88.1%, 74.9%, 63.2%, and 40.2%, respectively. The peritonitis-free survival rates at 1, 3, 5, and 10 years were 92.3%, 76.0%, 59.4%, and 28.0%, respectively. In the multivariate analysis, diabetes was the only factor associated with patient survival and technique survival.

Conclusion: Our study demonstrated that patient survival and technique survival rates were relatively high in ISPD patients who were catheterized using percutaneous needle-guidewire technique.

Keywords: Peritoneal dialysis; Renal replacement therapy; Risk factors; Survival; Treatment outcome.

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Conflict of interest statement

Conflicts of interest

All authors have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.. Flow diagram for enrollment and follow-up for ISPD patients.
HD, hemodialysis; ISPD, immediate-start peritoneal dialysis; IQR, interquartile range; KUMC, Konkuk University Medical Center; PD, peritoneal dialysis.
Figure 2.
Figure 2.. The Kaplan-Meier survival curve.
(A) Patient survival, (B) patient survival by diabetes mellitus (DM) and non-DM, (C) technique survival, and (D) peritonitis-free survival.
None
See this image and copyright information in PMC

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