Urgent-Start PD Preferred Modality for Appropriate Candidates

Urgent-Start PD Preferred Modality for Appropriate Candidates

Dallas—Results from a recent single-center prospective cohort study suggest that urgent-start peritoneal dialysis (PD) should be the preferred modality of dialysis offered to appropriate PD candidates who present unplanned requiring urgent dialysis. The study was conducted by Neda Hashemi, MD, and colleagues and reported during a poster session at the NKF Spring Clinical Meetings. The poster was titled Urgent-Start Peritoneal Dialysis versus Other Modalities of Dialysis: Long-Term Outcomes.

Previous reports have validated the short-term feasibility of urgent-start PD, a modality whereby unplanned end-stage renal disease (ESRD) patients are started on PD utilizing low-volume, recumbent PD soon after catheter placement. Results in short-term studies have found similar outcomes for urgent-start PD to other dialysis modalities; however, there are few data on long-term outcomes.

The study compared hospitalizations, infections, and technique survival in 161 patients with ESRD for up to 36 months. The patients were admitted to the outpatient dialysis unit between March 15, 2010, and March 15, 2013.

Patients were categorized as: (1) urgent-start hemodialysis (HD), defined as HD initiation with a central venous catheter); (2) urgent-start PD (PD initiation ≤14 days following placement of PD catheter); (3) planned HD (HD initiation with arteriovenous fistula or graft); or (4) planned PD (PD initiation >14 days following placement of PD catheter and following completion of PD training).

Participants were ≥18 years of age with a minimum of 90 days of follow-up. All participants were followed until study end (3/15/2014), death, transplantation, or transfer out of the dialysis unit. Mean duration of follow-up was 810 days.

As compared to urgent-start PD patients, urgent-start HD patients have a 4.0 fold higher rate of bacteremia (adjusted); 66% more access procedures (adjusted); lower technique survival at 6, 12, and 24 months; and lower patient survival at 12 and 24 months.

There were no significant differences between traditional PD patients and urgent-start PD patients in rates of peritonitis, exit-site infections, hospitalizations, or technique survival.

“In this intention-to-treat analysis with up to 36 months of follow-up, patients starting dialysis urgently as part of a structured urgent-start PD program had lower rates of bacteremia and fewer access procedures as compared to patients urgently started on HD, while having similar rates of infections, hospitalizations, and technique failure as compared to traditional PD patients,” the researchers said.

Source: Hashemi N, Ghofrani H, Ghaffari A. Urgent-start peritoneal dialysis versus other modalities of dialysis: long-term outcomes. Poster presented at the National Kidney Foundation Spring Clinical Meetings, March 2015, Dallas, Texas.