Peritoneal Dialysis Catheter for Urgent Start Dialysis vs Elective Start

Orlando—Previous studies have validated the successful use of percutaneous peritoneal dialysis catheters used in urgent-start dialysis. However, there are few data available on long-term outcomes of percutaneous peritoneal dialysis used for immediate dialysis.

Ammar Almehmi, MD, and colleagues conducted a retrospective study designed to compare the outcomes of percutaneous peritoneal dialysis catheters that were used for urgent start versus elective start dialysis. Results of the study were reported during a poster session at the NKF 2017 Spring Clinical Meetings in a poster titled Survival of Percutaneous Peritoneal Dialysis Catheters Used for Urgent vs Elective Start Dialysis: One Year Follow-Up.

The study included all patients who had de novo peritoneal dialysis catheters placed percutaneously between January 2005 and December 2015. There were 18 patients who had a percutaneous peritoneal dialysis catheter placed for urgent start dialysis and 32 who had a percutaneous peritoneal dialysis catheter placed for elective start dialysis. The primary end point in the comparison of outcomes between the two groups was complication-free catheter survival at 365 days. Secondary end points included complication-free catheter survival at 90 days, overall catheter survival at 365 days, and median days-to-catheter removal.

Of the 50 patients in the study, 42% were female (n=21), median age was 56.4 years, and median body mass index was 27.98. The two groups were similar in baseline demographic characteristics.

In the elective-start group, the complication-free catheter survival at 90 and 365 days were 66% and 35%, compared with 61% (P=.75) and 39% (P=.33), respectively, in the urgent-start group. Catheter leak was significantly higher in the urgent-start group compared with the elective-start group (22% vs 3.1%, respectively; P=.05). Likewise, catheter malfunction was higher in the urgent-start group versus the elective-start group, a difference that did not reach statistical significance (28% vs 9%, respectively; P=.11).

The difference in overall catheter survival at 365 days between the urgent-start group and the elective-start group was statistically significant: 33% vs 64%, respectively; P=.04). Median days-to-catheter removal was 532 in the urgent-start group and 169 in the elective-start group (P=.07).

In conclusion, the researchers said, “The use of percutaneous peritoneal dialysis catheters for immediate use is a feasible alternative to hemodialysis. However, a higher rate of catheter leak and shorter one-year overall survival was observed when peritoneal dialysis catheters were used for urgent start dialysis. Larger prospective studies are needed.”

Source: Almehm A, Al balas A, Krishna VN, Abdel-Aa; AK. Survival of percutaneous peritoneal dialysis catheters used for urgent vs elective start dialysis: One-year follow-up. Abstract of a poster presented at the National Kidney Foundation 2017 Spring Clinical Meetings, April 21,m 2017, Orlando, Florida.